H.R.4077 - Medicare Established Provider Act of 2015114th Congress (2015-2016)
|Sponsor:||Rep. Williams, Roger [R-TX-25] (Introduced 11/18/2015)|
|Committees:||House - Ways and Means; Energy and Commerce|
|Latest Action:||House - 11/20/2015 Referred to the Subcommittee on Health. (All Actions)|
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Summary: H.R.4077 — 114th Congress (2015-2016)All Information (Except Text)
Introduced in House (11/18/2015)
Medicare Established Provider Act of 2015
This bill amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services (HHS) to develop a system for designating providers that represent a low risk of submitting fraudulent Medicare claims as "established providers" for purposes of applying for special treatment in the claim review process.
To qualify as an established provider, a provider must demonstrate that, within a specified timeframe: (1) at least 90% of Medicare claims submitted by the provider were determined to be eligible for full or partial payment, and (2) the provider appealed at least 90% of all Medicare claims that were not initially determined to be eligible for payment.
HHS may withhold payment for a Medicare claim made by an established provider only if a final determination has been made that the claim is ineligible for payment. If such a final determination is made, the provider shall repay such payment electronically and within a specified timeframe.