,i #aad? ,,congress #a/ ,session ,h4 ,r4 #befh ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #bb1 #bjae ,mr4 ,hold+ 7= himself & ,mr4 ,nunes7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committee on ,en]gy & ,comm]ce1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to improve ! process ( audits by recov]y audit contractors & ! recov]y ( ov]paym5ts "u ! ,m$ic>e program4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,fair ,m$ical ,audits ,act ( #bjae4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,transp>5cy ( audit process & audit report4 ,sec4 #c4 ,qualifications ( auditors4 ,sec4 #d4 ,rec\pm5ts4 ,sec4 #e4 ,extrapolation4 ,sec4 #f4 ,paym5t = ! provision ( support+ docum5tation4 ,sec4 #g4 ,notice ( ov]-utilization ( codes4 ,sec4 #h4 ,*ange 9 look back p]iod4 ,sec4 #i4 ,g5]al effective date4 #b4 ,transp>5cy ( audit process & audit report ,section #ahic7;h77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77#a77 is am5d$-- 7#a7 by r$esignat+ subp>agraphs 7,b7 & 7,c7 z subp>agraphs 7,c7 & 7,d71 respectively2 & 7#b7 by ins]t+ aft] subp>agraph 7,a7 ! foll[+ new subp>agraph3 7,b7 contractors %all be requir$ to provide heal?c>e provid]s )-- 7i7 ! names & contact in=mation = ! auditors2 7ii7 ! legal au?ority "u :i* ! audit is conduct$2 7iii7 a cle> designation ( ! records to be review$ "u ! audit2 7iv7 ! dates by :i* records %all be submitt$2 7v7 ! address to :i* ! records %all be s5t2 7vi7 id5tification ( any errors discov]$ 9 ! audit1 includ+ specification ( all m$ical & reimbursem5t policies us$ 9 ! audit f9d+s2 7vii7 id5tification ( any und]paym5ts discov]$ 9 ! audit2 & 7viii7 a description ( h[ any reque/$ ov]paym5t am\nt 0 calculat$1 includ+1 9 cases 9 :i* extrapolation 0 us$1 ! extrapolation =mula & a description ( h[ ! r&om sample 0 develop$2 4 #c4 ,qualifications ( auditors ,section #ahic7;h77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd77h77#f77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 includ+ k & exp]i5ce 9 applicable ,,icd1 ,,cpt1 & ,,hcpcs codes1 ! =mat & cont5ts ( m$ical records & claims =ms1 & 7= ^? individuals conduct+ m$ical necessity reviews7 lic5sure 9 a cl9ical discipl9e provid+ necess>y exp]tise to det]m9e :e!r cl9ical te/s & proc$ures 7 m$ically necess>y )\t ! b5efit ( exam9+ ! pati5t1 specifically includ+1 = m$ical necessity reviews ( physician records1 a doctor ( m$ic9e or o/eopa?y ( ! same specialty & subspecialty & ) k ( ! cov]age rules be+ appli$ = ! same area z ! physician "u review2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraphs3 7,d7 ,liability = excessive ov]turn$ det]m9ations ,contractors t h a c]ta9 p]c5tage 7z det]m9$ by ! ,secret>y 9 regulations7 ( ov]paym5t det]m9ations ov]turn$ by an ,adm9i/rative ,law ,judge at ! ,(fice ( ,m$ic>e ,he>+s & ,appeals %all be subject to adm9i/rative p5alty e/abli%$ by ! ,secret>y 9 su* regulations4 7,e7 ,provid] comp5sation = c]ta9 contractor errors ,a contractor %all be liable = paym5t to provid]s ( s]vice & suppli]s = reasonable attorneys' fees :5 ! contractor's ov]paym5t det]m9ation is equal to or m ?an d\ble ! f9al ov]paym5t am\nt det]m9$ by an ,adm9i/rative ,law ,judge at ! ,(fice ( ,m$ic>e ,he>+s & ,appeals4 7,f7 ,inc5tive paym5ts = provid] education ,adm9i/rative p5alties collect$ "u subp>agraph 7,d7 %all be available to ! ,secret>y )\t appropriation to provide inc5tive paym5ts to ,m$ic>e adm9i/rative contractors "u section #ahgd;,a to c>ry out improp] paym5t outrea* & education programs "u subsection 7h7 ( su* section4 4 #d4 ,rec\pm5ts 7a7 ,9 g5]al ,section #ahic7;f77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7f77#b77;,a77 is am5d$-- 7#a7 by /rik+ until ! date ! decision on ! reconsid]ation has be5 r5d]$4 & ins]t+ ! foll[+3 until ! date a decision has be5 r5d]$ at ! ?ird level ( appeal by an ,adm9i/rative ,law ,judge at ! ,(fice ( ,m$ic>e ,he>+s & ,appeals42 & 7#b7 by add+ at ! end ! foll[+3 ,any rec\pm5ts made "u ?is subp>agraph bas$ on a decision t is subsequ5tly rev]s$ on appeal %all be return$ to ! provid] ( s]vices or suppli] involv$ n lat] ?an #cj bus9ess days aft] ! date ( ! decision ( rev]sal on appeal4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to rec\pm5ts occurr+ aft] ! date ( ! enactm5t ( ?is ,act4 #e4 ,extrapolation 7a7 ,9 g5]al ,section #ahic7;f77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7f77#c77 is am5d$-- 7#a7 by /rik+ ! la/ s5t5ce2 & 7#b7 by add+ aft] & bel[ subp>agraph 7,b7 ! foll[+3 ,extrapolation may only be us$ if x is bas$ on a /ati/ically valid1 /ratifi$ r&om sample1 ) all z]o paid claims & outli]s remov$4 ,:5 extrapolation is us$1 ! m$ian am\nt %all be us$ z ! c5tral data po9t = calculat+ ov]paym5ts unless ! data are normally di/ribut$1 approximately normally di/ribut$1 or symmetrical4 4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all apply to det]m9ations made aft] ! date ( ! enactm5t ( ?is ,act4 #f4 ,paym5t = ! provision ( support+ docum5tation ,section #ahic7;f77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7f77#d77 is am5d$ by add+ at ! end ! foll[+3 ,! ,secret>y %all require t contractors reimburse provid]s ( s]vices or suppli]s = ! co/ ( su* production at rates e/abli%$ by ! ,secret>y44 #g4 ,notice ( ov]-utilization ( codes ,section #ahic7;f77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7f77#f77 is am5d$ by add+ at ! end ! foll[+3 ,! ,secret>y %all require t contractors provide su* notice ( ov]-utilization ( codes at lea/ #ij days be=e ! date ( initiat+ an audit1 docum5tation reque/1 or rec\pm5t ) respect to ! id5tifi$ ov]-utiliz$ codes aga9/ any memb] ( ! class ( provid]s ( s]vices or suppli]s id5tifi$ by ! contractor z ov]-utiliz+ codes44 #h4 ,*ange 9 look back p]iod ,section #ahic7;h77#d77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77#d77;,b77 is am5d$ by /rik+ #d fiscal ye>s & ins]t+ #b fiscal ye>s4 #i4 ,g5]al effective date ,except z o!rwise provid$1 ! am5dm5ts made by ?is ,act %all apply ) respect to contracts ent]$ into1 or r5ew$1 aft] ! date ( ! enactm5t ( ?is ,act4