Stricter supervision of Medicare billing agencies

22Feb10

The new health reform law signed by President Obama on March 23, 2010 includes a requirement that billing agents, clearinghouses, and any other alternate payee that submits Medicaid claims on behalf of a healthcare provider, must register with the State and Secretary of HHS “in a form and manner specified by the Secretary.”

UPDATE 3/23/10 – The proposal discussed in the balance of this article was not included in legislation enacted by Congress and signed by the President.

The health reform proposal just posted on the White House website would go farther by adopting a provision from a bill sponsored by Representative Mark Kirk (R-IL) and 12 Republican co-sponsors that would impose significant new requirements on any “individual or entity” that compiles or submits Medicare claims seeking reimbursement on behalf of someone else.

Under a provision in H.R. 3970 (the “Medical Rights and Reform Act of 2009”), billing agencies and agents who submit claims to Medicare, who will be required to register with HHS and may be denied registration  for various reasons. They would also become subject to exclusion from Medicare for submitting a Medicare claim that the biller knew or should have known was false or fraudulent.

Criminal background checks would be conducted before an agent or agency is permitted to register, and registration would be denied to applicants found to have  history of acts that indicate that their registration “would be detrimental to the best interests” of the Medicare program or its beneficiaries.  Such “acts” may include bankruptcy, any act resulting in a civil judgment against the applicant,  or any felony conviction under federal or state law.

Once registered, the billing agency or agent remains subject to periodic targeted reviews.



4 Responses to “Stricter supervision of Medicare billing agencies”

  1. 1 Paul Jones

    What is the current status of this legislation? When did it pass the Senate? Thanks for your help.

    • The Senate bill passed 60-40 on December 24, 2009. News media reports indicate (as of this morning) that enactment of a statute containing the provisions of the Senate bill, with amendments based on the 11-page proposal put forth by President Obama last week, is looking increasingly likely. For status, stay tuned to your favorite media outlet(s). (There is a link to the President’s proposal in a post on the Commentary page of this blog.)

  2. 3 Paul Jones

    Thanks Jennifer for the quick reply. The Medical Rights and Reform Act of 2009 has passed the Senate, what is the status of the House version? I take it the provisions of this bill are being morphed into the healthcare reform/proposal set forth last week and not as a seperate bill?

    • Actually, the bill that passed the Senate is called the “Patient Protection and Affordable Care Act.” The House version, which passed on November 7, 2009, is called the “Affordable Health Care for America Act.”

      There are a number of provisions in the House bill that are not likely to make it into the final product (assuming it passes). According to news reports, the current plan is that the House will pass the Senate version of the bill “as is,” and then both houses of Congress will pass (in one new bill) a limited series of amendments to the Senate bill, using a procedure that allows an up-or-down vote in the Senate without the possibility of a filibuster.

      The details of exactly what will be in those amendments is not yet known.



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