Congress Responds to Physicians’ Medicare Complaints

Physicians who participate in Medicare will have more protections if they are audited and fewer regulations to deal with under a new regulatory reform bill expected to move to a House vote at press time.

Two nearly identical bills that passed their respective committees in October will be merged for the House vote. The House Committee on Energy and Commerce approved HR 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (RACER) on October 30, and the House Ways and Means Committee approved HR 2768, the Medicare Regulatory and Contracting Reform Act on October 11.

Both bills would

• limit the publication of Medicare regulations to once a month,

• require a new comment period for provisions in final rules that were not included in the proposed rules,

• prohibit the retroactive application of regulatory policy changes,

• require Medicare carriers to provide physicians prompt written responses to their questions that can be used by physicians to defend themselves in future audits,

• prohibit Medicare from using the extrapolation method to determine how much a physician owes the government unless the physician has demonstrated a sustained or high rate of billing errors,

• require carriers to notify physicians at least 45 days in advance that they will be audited after receiving payment,

• allow physicians found to have been overpaid by Medicare to repay the difference over three years,

• prohibit Medicare from collecting overpayments from physicians until they have had time to appeal to an administrative law judge, and

• improve education efforts to help physicians reduce errors and improve compliance with coding and other requirements.

APA and the AMA are urging House members to ensure these provisions remain in the legislation they approve. In addition, they are advocating for the inclusion of a few key provisions found only in RACER.

In addition to requiring that Medicare carriers notify physicians 45 days in advance of conducting a postpayment audit, RACER also requires contractors to provide audited physicians with a detailed explanation of their findings, according to HR 3046. This gives audited physicians an opportunity to develop a corrective plan of action, according to the legislation.

The APA Division of Government Relations (DGR) has posted a summary of HR 3046 on the APA Web site at www.psych.org/pub_pol_adv/dgrupdate11201.cfm. The DGR summary of HR 2768 is available at www.psych.org/pub_pol_adv/medicareregreform10901.cfm. ▪