H.R. 1250: Medicare Audit Improvement Act of 2013

Mar 19, 2013
Referred to Committee
0% chance of being enacted
See Instead:

S. 1012 (same title)
Referred to Committee — May 22, 2013

Track this bill
Sam Graves
Representative for Missouri's 6th congressional district
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Last Updated
Mar 19, 2013
36 pages
Related Bills
H.R. 6575 (112th) was a previous version of this bill.

Referred to Committee
Last Action: Oct 16, 2012

S. 1012 (identical)

Referred to Committee
Last Action: May 22, 2013


This bill was assigned to a congressional committee on March 19, 2013, which will consider it before possibly sending it on to the House or Senate as a whole.

Introduced Mar 19, 2013
Referred to Committee Mar 19, 2013
Reported by Committee ...
Passed House ...
Passed Senate ...
Signed by the President ...

1% chance of getting past committee.
0% chance of being enacted.

Only 11% of bills made it past committee and only about 3% were enacted in 2011–2013. [show factors | methodology]

Full Title

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.


No summaries available.

204 cosponsors (111R, 93D) (show)

House Energy and Commerce


House Ways and Means

The committee chair determines whether a bill will move past the committee stage.

Primary Source

THOMAS.gov (The Library of Congress)

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H.R. stands for House of Representatives bill.

A bill must be passed by both the House and Senate in identical form and then be signed by the president to become law.

The bill’s title was written by its sponsor.

GovTrack’s Bill Summary

We don’t have a summary available yet.

Library of Congress Summary

The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress.

Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.
Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.
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.
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.
Subjects to administrative and judicial review the Secretary's compliance with guidelines for reopening and revising benefit determinations.

House Republican Conference Summary

The summary below was written by the House Republican Conference, which is the caucus of Republicans in the House of Representatives.

No summary available.

House Democratic Caucus Summary

The House Democratic Caucus does not provide summaries of bills.

So, yes, we display the House Republican Conference’s summaries when available even if we do not have a Democratic summary available. That’s because we feel it is better to give you as much information as possible, even if we cannot provide every viewpoint.

We’ll be looking for a source of summaries from the other side in the meanwhile.

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