A bill to provide for the imposition of administrative fees for Medicare overpayment collection, and to require automated prepayment screening of Medicare claims, and for other purposes

4 Pages·1997·0.18 MB·English

by  United States. Congress. Senate

PROPERTYOF
my
20 R£CB
105thcongress 267
1stSession S.
providefortheimpositionofadministrativefeesformedicareoverpayment
collection, andto require automatedprepayment screeningofmedicare
claims,andforotherpurposes.
IN THE SENATE OF THE UNITED STATES
February5,1997
.McCainintroducedthefollowingbill;whichwasreadtwiceandreferred
totheCommitteeonFinance
A
BILL
Toprovidefortheimpositionofadministrativefeesformedi-
care overpa\Tnent collection, and to require automated
prepayment screening ofmedicare claims, and for other
purposes.
1 BeitenactedhytheSenateandHouseofRepresenta-
2 tivesoftJw UnitedStatesofAmericainCongressassembled,
3 SECTION1.SHORTTITLE.
4 ThisActmaybecitedasthe"ReductionInMedicare
5 OverpaymentCostsActof1997". ' . . '
1 SEC.2.ADMINISTRATIVEFEES FORMEDICARE OVERPAY-
2 MENTCOLLECTION.
3 (a) Administrative Fees for Pro^tders of
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4 ServicesUnderPartA. Section1815(d)oftheSocial
5 SecurityAct (42 U.S.C. 1395g(d)) is amendedbyinsert-
6 ing"(1)"after"(d)"andbyaddingattheendthefollow-
7 ingnewparagraph:
8 "(2)(A) Except as provided in subparagraph (B), if
9 the payment ofthe excess described in paragraph (1) is
10 notmade(oreffectedbyoffset)witliin30daysofthedate
11 ofthe determination, an administrative fee of 1 percent
12 oftheoutstandingbalanceoftheexcess (afterapplication
13 ofparagraph (1)), or such lower amount as anAdminis-
14 trativeLawJudge maydetermine upon an appeal ofthe
15 initialdeterminationoftheexcess,shallbeimposedonthe
16 pro\ider,fordepositintotheTrustFundunderthis})art.
17 "(B) The administrative fee shall be imposed under
18 subparagraph (A) onapro\iderofservicespaidona
19 spectivebasis onlyifsuch pro\ider's cost reportwith re-
20 spect to the payment determined to be in excess ofthe
21 paymentdueunderthispartindicatesthatthepro^^der's
22 projectedcostsexceededits actual costsby30 percentor
23 more.".
24 (b) ADMI^^STRATI^^ Fees for Promders of
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25 SER\acESOROtherPersonsUnt)erPartB. Section
26 1833(j) ofthe Social Securitj^ Act (42 U.S.C. 1395i(j))
•S267IS
—
3
1 is amended byinserting *'(!)" after "(j)" andhyadding
2 attheendthefollowingnewparagraph:
3 "(2) Ifthe excess described inparagraph (1) is not
4 made (or effected by offset) within 30 days ofthe date
5 ofthe determination, an administrative fee of 1 percent
6 oftheoutstandingbalanceoftheexcess (afterapplication
7 ofparagraph (1)), or such lower amount as anAdminis-
8 trative Law-Judge maydetermine upon an appeal ofthe
9 initialdeterminationoftheexcess,shallbeimposedonthe
10 pro\dder, orotherpersonreceivingtheexcess, fordeposit
11 intotheTrustFundunderthispart.".
—
12 (c) Effectr^ Date. The amendments made by
13 tliis section shall apply to final determinations made on
14 orafterthedateofenactmentofthisAct.
15 SEC. 3.AUTOMATED PREPAYMENT SCREENING REQUIRE-
16 MENT.
—
17 (a) Determinatiox byAdministrator. BySep-
18 tember1ofeachyear(beginningwith1997),theAdminis-
19 tratoroftheHealthCareFinancingAdministration,after
20 consultationwith the Comptroller General ofthe United
21 States,shalldetermine
22 (1) the medical diagnoses bypro\'iders ofserv-
23 ices under title X\^II of the Social Security' Act
24 whichfrequentlyresultinoverpajonentstosuchpro-
25 \ddersundersuchtitle; and
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ensLiBRniiv
4 ' 3 ams Lfl3L7 4
1 (2) thepercentage ofclaims involvingthe diag-
2 noses described in paragraph (1), that fiscal
3. intermediaries and carriers under such title shall
4 screen before payment is made in order to avoid
5 suchoverpajTnents.
6 (b) Requirement for Fiscal Intermediaries
—
7 AND Carriers. The Secretary of Health and Human
8 Services shall not enter into a contract with a fiscal
9 intermediars"orcarrierundertitleX\'nioftheSocialSe-
10 curityAct (42 U.S.C. 1395 et seq.) unlessthe Secretary
11 finds that such intermediars' or carrier will screen the
12 claims for payment, in accordance with subsection (a),
13 undersuchtitle.
14 (c) Notice to Fiscal iNTERMEDLyiiES and Car-
—
15 RIERS. The Secretary shall cause to have pubhshed in
16 the Federal Register, in the last 15 days of October of
17 each year, the results ofthe determination made under
18 subsection(a). , • ; ;
O
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