Summary: H.R.868 — 107th Congress (2001-2002)All Information (Except Text)

There is one summary for H.R.868. Bill summaries are authored by CRS.

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Introduced in House (03/06/2001)

Medicare Education and Regulatory Fairness Act of 2001 - Amends title XVIII (Medicare) of the Social Security Act (SSA) concerning: (1) prospective application only of certain regulations prescribed by the Secretary of Health and Human Services (HHS); and (2) certain requirements for judicial and regulatory challenges of regulations.

Requires the Secretary, with respect to Medicare audits, except when clear and convincing evidence exists of fraud or similar fault, to give a physician, provider of services, or provider of ambulance services (physicians or providers) the option of entering into: (1) an arrangement to offset alleged overpayments against future payments; or (2) a repayment plan with its carrier or fiscal intermediary to recoup such an overpayment.

Prohibits the Secretary from taking any action to recoup an overpayment or to impose a penalty during the period in which a physician or provider is appealing a determination that such an overpayment has been made or the amount of the overpayment.

Prohibits carriers, absent cause, from demanding the production of records or documentation before paying a Medicare claim.

Amends SSA title XI with respect to prohibited extensions of remuneration to a Medicare-eligible individual to influence a choice of provider, practitioner, or supplier. Excludes from the meaning of remuneration any waiver of copayment made in a written, mailed communication with existing patients.

Amends SSA title XVIII with regard to: (1) construction of hearing rights related to decisions to deny or not renew a physician enrollment agreement; (2) the post-payment audit process; (3) definitions relating to physicians or providers; and (4) the right to appeal on behalf of deceased beneficiaries.

Amends SSA title XVIII to require carriers, fiscal intermediaries, and contractors to conduct education programs (funded from the Medicare Integrity Program) for physicians and providers on billing, coding, cost reporting, and documentation regulations and procedures.

Outlines provisions with regard to certain information requests from physicians and providers.

Amends SSA title XVIII to provide for the inclusion of regulatory costs in the calculation of the sustainable growth rate with respect to the costs of physicians' services.

Prohibits the Health Care Financing Administration (HCFA) from implementing any new evaluation and management documentation guidelines under Medicare, unless it: (1) has provided for an assessment of the proposed guidelines by organizations representing physicians; (2) has established a plan that contains specific goals, including a schedule, for improving use of such guidelines; (3) has completed a minimum of four pilot projects to test such guidelines; and (4) finds that specified objectives will be met in the implementation of such guidelines.