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H.R. 2329 (113th): Administrative Relief and Accurate Medicare Payments Act of 2013


The text of the bill below is as of Jun 12, 2013 (Introduced). The bill was not enacted into law.


I

113th CONGRESS

1st Session

H. R. 2329

IN THE HOUSE OF REPRESENTATIVES

June 12, 2013

(for himself, Mr. Sam Johnson of Texas, Mr. Nunes, Mr. Tiberi, Mr. Roskam, Mr. Price of Georgia, Mr. Schock, Mrs. Black, Mr. Reed, Mr. Young of Indiana, Mr. Kelly of Pennsylvania, Mr. Benishek, and Ms. Jenkins) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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

A BILL

To amend title XVIII of the Social Security Act to provide for a maximum period of 2 years for submissions of Medicare part B claims originally submitted by hospitals as Medicare part A claims and of 60 days for certain such submissions for one-day stays; and for other purposes.

1.

Short title

This Act may be cited as the Administrative Relief and Accurate Medicare Payments Act of 2013.

2.

Maximum period of 2 years for submissions of Medicare part B claims originally submitted by hospitals as Medicare part A claims and of 60 days for certain such submissions for one-day stays

(a)

Timely submission as condition for provider payment

(1)

In general

Section 1835 of the Social Security Act (42 U.S.C. 1395n) is amended—

(A)

in subsection (a)(1), by inserting before the semicolon the following: or, in the case of a claim described in paragraph (1) or (2) of subsection (f), no later than the close of the period described in such respective paragraph; and

(B)

by adding at the end the following new subsection:

(f)

For purposes of subsection (a)(1) and section 1842(b)(3)(B)

(1)

in the case of a claim not described in paragraph (2) for hospital services submitted under this part for which there was a previous claim as inpatient hospital services under part A that was denied as not reasonable and necessary pursuant to section 1862(a)(1), the period described in this paragraph is the period ending 2 calendar years after the date of service; and

(2)

in the case of a claim for hospital services submitted under this part for which there was a previous claim as inpatient hospital services under part A for a length of stay that does not include more than one midnight that was denied as not reasonable and necessary by a qualified independent contractor through a reconsideration conducted under section 1869(c), the period described in this paragraph is the period ending 60 days after the date of receipt of the notice required under section 1869(c)(3)(C)(i) of the decision for such denial with respect to such reconsideration.

.

(2)

Conforming amendment to exceptions authority

Section 1835(a) of such Act (42 U.S.C. 1395n(a)) is amended in the last sentence by inserting and the periods described in paragraphs (1) and (2) of subsection (f) after 1 calendar year period specified in such paragraph.

(b)

Application to reasonable charge administrative provision

(1)

In general

Section 1842(b)(3)(B) of the Social Security Act (42 U.S.C. 1395u(b)(3)(B)) is amended by inserting or, in the case of a claim described in paragraph (1) or (2) of section 1835(f), no later than the close of the period described in such respective paragraph after date of service.

(2)

Conforming amendment to exceptions authority

Section 1842(b)(3) of such Act (42 U.S.C. 1395u(b)(3)) is amended in the last sentence by inserting and the periods described in paragraphs (1) and (2) of section 1835(f) after 1 calendar year period specified in such paragraph.

(c)

Effective date

The amendments made by this section shall apply to services furnished on or after October 1, 2013.

3.

Maximum look-back period of 3 years for Medicare recovery audit contractors’ audit and recovery activities

(a)

In general

Section 1893(h)(4)(B) of the Social Security Act (42 U.S.C. 1395ddd(h)(4)(B)) is amended by striking 4 fiscal years and inserting 3 fiscal years.

(b)

Effective date

The amendment made by subsection (a) shall apply with respect to payments made for items and services furnished on or after October 1, 2013.