1. Short title
This Act may be cited as the “Administrative Relief and Accurate Medicare Payments Act of 2013”.
Administrative Relief and Accurate Medicare Payments Act of 2013
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.
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
Timely submission as condition for provider payment—
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
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.”
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”.
Application to reasonable charge administrative provision—
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”.
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”.
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
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”.
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.