HR 6575 · 112th Congress 2011–2013, ended

Medicare Audit Improvement Act of 2012

Introduced Oct 16, 2012 Originated House Sponsor Sam Graves R-MO

Latest action · Oct 26, 2012 Referred to the Subcommittee on Health.

Progress

Where this bill reached, and when. A stage with no date was not reached; one that failed a vote and later carried shows the date it carried.

IntroducedOct 16, 2012
Passed HouseNot reached
Passed SenateNot reached
To the PresidentNot reached
Became lawNot reached

Summary

Medicare Audit Improvement Act of 2012 - Directs the Secretary of Health and Human Services (HHS) to establish a process under which the number of additional documentation requests made by a Medicare contractor pursuant to a complex prepayment or postpayment audit with respect to a hospital's Medicare part A (Hospital Insurance) claims in a year may not exceed, across all such contractors with respect to the hospital's claims, the lesser of: (1) 2% of all such claims for such year, or (2) 500 additional documentation requests during any 45-day period.

Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.

Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.

Directs the Secretary to publish on the Internet website of the Centers for Medicare & Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.

Prohibits the Secretary, in conducting the Medicare Part A and Part B Rebilling Demonstration, from prohibiting any appeal by a hospital of any finding by a recovery audit contractor that an inpatient admission was not reasonably and medically necessary.

Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.

Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.

Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.

Cosponsors 26

Members who signed on, in the order they did. Signatures ran from Oct 16, 2012 to Dec 13, 2012; 3 are original cosponsors, there from the day it was introduced.

Seat	Cosponsor		Signed on
D-CA	Adam B. Schiff	Original	Oct 16, 2012
R-MO	Billy Long	Original	Oct 16, 2012
R-MO	W. Todd Akin	Original	Oct 16, 2012
D-MN	Betty McCollum		Oct 23, 2012
R-NY	Richard L. Hanna		Oct 23, 2012
D-OK	Dan Boren		Nov 6, 2012
R-MO	Jo Ann Emerson		Nov 6, 2012
D-NY	Louise McIntosh Slaughter		Nov 6, 2012
R-KS	Mike Pompeo		Nov 6, 2012
D-NY	William L. Owens		Nov 6, 2012
R-VA	Bob Goodlatte		Nov 13, 2012
R-MS	Alan Nunnelee		Nov 14, 2012
R-MO	Blaine Luetkemeyer		Nov 14, 2012
R-CA	Howard P. "Buck" McKeon		Nov 15, 2012
R-MO	Vicky Hartzler		Nov 16, 2012
D-MN	Collin C. Peterson		Nov 29, 2012
D-GA	Sanford D. Bishop, Jr.		Nov 29, 2012
D-IA	Bruce L. Braley		Nov 30, 2012
R-TN	Marsha Blackburn		Nov 30, 2012
R-AL	Robert B. Aderholt		Nov 30, 2012
R-KS	Tim Huelskamp		Nov 30, 2012
R-IA	Tom Latham		Dec 4, 2012
D-IA	David Loebsack		Dec 11, 2012
D-IA	Leonard L. Boswell		Dec 11, 2012
R-IA	Steve King		Dec 11, 2012
R-NY	Peter T. King		Dec 13, 2012

Committees 2

Where it was sent and what each committee and subcommittee did with it, in order.

Chamber	Committee	What it did
House	Ways and Means Committee	Referred Oct 16, 2012
House	Energy and Commerce Committee	Referred Oct 16, 2012
	Health Subcommittee	Referred Oct 26, 2012

Actions 3

Everything that happened, newest first.

Oct 26, 2012Referred to the Subcommittee on Health.
Oct 16, 2012Introduced in House
Oct 16, 2012Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

In the Congressional Record 1

Days the Record’s own index lists this bill, newest first, with the pages and the members it names. Pages starting H are the House, S the Senate, E Extensions of Remarks.

Where	In the Record	Members	Date
House	Lists H6310H.R. 6575–6576	—	Oct 16, 2012

Research

What has been written about this bill: committee reports, cost estimates, the sponsor’s authority statement, printed hearings and the Congressional Research Service’s work.

Constitutional authority

Congress has the power to enact this legislation pursuant to the following: Article 1, Section 8, Clause 1 (General Welfare) and Clause 3 (Commerce) `Congress shall have the power to . . . provide for the . . . general welfare' `Congress shall have the power . . . to regulate Commerce' The Medicare Audit Improvement Act makes several changes to the way hospital audits are conducted which involves at least three parties: a hospital, a private Medicare contractor who conducts audits and the Center for Medicare and Medicaid Services. During the auditing process, transactions take place between these parties which is what constitutes this bill as regulating commerce. Further, Medicare is considered to be constitutional as part of providing for the general welfare and therefore any changes to Medicare would fall under this provision as well.

The sponsor’s statement, as printed in the page H6310.

Titles 2

Every title it has carried, official and short, at each stage.

Official Title as Introduced: To amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors, and for other purposes.
Short Titles as Introduced: Medicare Audit Improvement Act of 2012

Subjects

Assigned by the Library of Congress. Policy area: Health.

Text 1

Each version as it was printed, newest first.

Oct 16, 2012Introduced in House

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Everything here is as published by Congress: the summary is the Congressional Research Service's, the action wording is the clerks', and the subjects are the Library of Congress's. How far it got is read from the actions themselves, taking the most recent one of each kind, so a bill that failed a vote and later passed is shown as having passed. Records come from this bill on Congress.gov and govinfo.gov; cost estimates are the Congressional Budget Office's, and the hearings are the printed hearings GovInfo publishes, which can appear months after the hearing.