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·1997·0.19 MB·English

by  United States. Congress. House

propertyOF
NOV 17 REC'D
HCHaLlbhARY
105thcongress H.R.1769
1stSession-
ToprovidefortheimpositionofadministrativefeesforMedicareoverpayment
collection, and torequire automatedprepayment screeningofMedicare
claims,andforotherpurposes.
IN THE HOUSE OF REPRESENTATIVES
June3,1997
Mr.Starkintroducedthefollowingbill;wliiehwasreferredtotheCommittee
onWays andMeans, andin additiontothe Committee onCommerce,
foraperiodtobesubsequentlydeterminedbytheSpeaker,ineachcase
forconsiderationofsuchprovisionsasfallwithinthejurisdictionofthe
committeeconcerned
A
BILL
ToprovidefortheimpositionofadministrativefeesforMedi-
care overpayment collection, and to require automated
prepayment screening ofMedicare claims, and for other
purposes.
1 BeitenactedhytheSenateandHouseofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassembled,
3 SECTION1.SHORTTITLE.
4 ThisActmaybecitedasthe"ReductionInMedicare
5 OverpaymentCostsActof1997".
1 SEC.2.ADMINISTRATrVE FEESFORMEDICARE 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)within30daysofthedate
11 ofthe determination, an administrative fee of 1 percent
12 oftheoutstandingbalanceoftheexcess (afterapplication
13 ofparagraph (1)), or such lower amount as anAdminis-
14 trative LawJudgemaydetermine upon an appeal ofthe
15 initialdeterminationoftheexcess,shallbeimposedonthe
16 provider, fordepositintotheTrustFundunderthispart.
17 "(B) The administrative fee shallbe imposedunder
18 subparagraph(A)onaproviderofservicespaidonapro-
19 spectivebasis onlyifsuchprovider's cost reportwith re-
20 spect to the pajmient determined to be in excess ofthe
21 pajanentdueunderthispartindicatesthattheprovider's
22 projectedcostsexceededits actualcostsby30percentor
23 more.".
24 (b) Administrative Fees for Providers of
—
25 ServicesorOtherPersonsUnderPartB. Section
26 1833(j) ofthe Social SecurityAct (42 U.S.C. 1395?(j))
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3
1 is amendedbyinserting"(1)" after "(j)" andbyadding
2 attheendthefoUowingnewparagraph:
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(afterapphcation
7 ofparagraph (1)), or suchloweramountas anAdminis-
8 trative LawJudge maydetermineupon an appeal ofthe
9 initialdeterminationoftheexcess,shallbeimposedonthe
10 provider, orotherpersonreceivingtheexcess, fordeposit
11 intotheTrustFundunderthispart.".
—
12 (c) Effective Date. The amendments made by
13 this section shall apply to final determinations made on
14 orafterthedateofenactmentofthisAct.
15 SEC. 3.AUTOMATED PREPAYMENT SCREENINGREQUIRE-
16 MENT.
—
17 (a) Determination byAdministrator. By Sep-
18 tember1ofeachyear(beginningwith1997),theAdminis-
19 tratoroftheHealthCareFinancingAdministration,after
20 consultationwith the Comptroller General ofthe United
21 States,shalldetermine
22 (1) the medical diagnosesbyproviders ofserv-
23 ices under title XVIII of the Social Security Act
24 whichfrequentlyresultinoverpaymentstosuchpro-
25 vidersundersuchtitle;and
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ensLIBRARY
3 flDTs oLa^3^ ?
1 (2) thepercentageofclaims 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 suchoverpa\Tnents.
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 intermediaryorcarrierundertitleXVIIIoftheSocialSe-
10 curityAct (42 U.S.C. 1395 et seq.) unlessthe Secretary
11 finds that such intermediary or carrier will screen the
12 claims for pajonent, in accordance with subsection (a),
13 undersuchtitle. ^
14 (c) Notice to Fiscal Intermediaries and Car-
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15 RIERS. The Secretary shall cause to have published 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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