Medicare Payment Integrity Enhancement Act

Summary#

This bill lets the Secretary of Health and Human Services hire recovery audit contractors to perform prepayment reviews of Medicare claims. It changes how those contractors can be paid: the Secretary must create a payment method that considers how much improper payment the contractor prevented and that encourages timely, accurate prevention without overemphasizing certain claim types. The bill also requires the Secretary to transfer money from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, in proportions the Secretary decides, into the Centers for Medicare & Medicaid Services Program Management Account to pay for these prepayment reviews. The Secretary must issue rules within one year describing the payment method and how to calculate savings from the reviews.

What it means for you#

• Medicare can contract with private recovery auditors to check claims before Medicare pays them.
• The rules for contractor pay and how the work is paid for will be written by the Secretary of HHS within one year.
• The bill does not specify dollar amounts or exact operational details; those will be set in the required rules.

Expenses#

• No dollar amounts are specified in the bill.
• The bill directs transfers from the Medicare Hospital Insurance (Part A) Trust Fund and the Supplementary Medical Insurance (Part B) Trust Fund to the CMS Program Management Account to pay contractors. The Secretary will decide the proportion of transfers and the sums needed.
• The Secretary must also describe the method used to calculate savings generated by prepayment reviews.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.