Sec. 2. Combined additional documentation request limit

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The Secretary of Health and Human Services shall establish a process under which the number of additional documentation requests made to a hospital (as defined in subsection (c)(3)) by Medicare contractors (as defined in subsection (c)(1)) pursuant to prepayment and postpayment audits that require a hospital to submit a medical record for audit purposes, as required under chapter 3 of the Medicare Program Integrity Manual, or otherwise, shall be subject to a single, combined maximum limit of additional documentation requests per year for the Medicare contractors specified in subsection (c)(1).

However, such maximum limit shall be applied incrementally as a limit for requests for additional documentation in 45-day periods during the year so that the maximum number of such requests in a 45-day period is 500 or, in the case of a hospital that receives less than $100,000,000 in Medicare inpatient hospital payments in the previous year, 350. In addition to the limit established under subsection (a), the Secretary shall establish a distinct additional documentation request limit for each hospital claim type (as defined in subsection (c)(2)) for each hospital for a 45-day period in a year.

For a hospital for each hospital claim type for a 45-day period in a calendar year, the additional documentation request limit under this subsection for a claim type shall be 2 percent of the total number of hospital discharges for such hospital for the previous calendar year divided by 8. In this section: The term Medicare contractor means any of the following: A Medicare administrative contractor under section 1874A of the Social Security Act (42 U.S.C. 1395kk), including a fiscal intermediary and a carrier under sections 1816 and 1842, respectively.

A recovery audit contractor under section 1893(h) of such Act ( 42 U.S.C. 1395ddd(h) ). A Comprehensive Error Rate Testing

(CERT)program contractor with a contract with the Secretary of Health and Human Services to review error rates under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). Each of the following shall be considered a separate hospital claim type : A claim for payment under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) made by a hospital for furnishing inpatient hospital services. A claim for payment under section 1833(t) of such Act ( 42 U.S.C. 1395l(t) ) made by a hospital for furnishing covered OPD services. A claim for payment for inpatient or outpatient critical access hospital services, whether under section 1814(l) of such Act ( 42 U.S.C. 1395f(l) ) or under section 1834(g) of such Act ( 42 U.S.C. 1395m(g) ). A claim for payment under section 1886(j) of such Act ( 42 U.S.C. 1395ww(j) ) made by a hospital for furnishing inpatient rehabilitation services. A claim for payment under any other provision of section 1886 of such Act ( 42 U.S.C. 1395ww ) made by a hospital for furnishing inpatient hospital services, such as subsection

(s)(relating to inpatient hospital services furnish by a psychiatric hospital) or subsection

(m)(relating to inpatient hospital services furnish by a long term care hospital). A claim for payment under section 1888(e) of such Act ( 42 U.S.C. 1395yy(e) ) made by a hospital for furnishing covered skilled nursing facility services. The term hospital means the campus of a hospital (as defined in subsection

(e)of section 1861 of the Social Security Act ( 42 U.S.C. 1395x )) or of a psychiatric hospital (as defined in subsection

(f)of such section), a comprehensive outpatient rehabilitation facility (as defined in subsection (cc)(2) of such section), a critical access hospital (as defined in subsection

(mm)of such section), or a long-term care hospital (as defined in subsection

(ccc)of such section), as identified by the tax identification number of the hospital, and includes all inpatient hospital facilities under such number located in the same area as such campus. This section takes effect on the date of the enactment of this Act and shall apply with respect to claims submitted for payment under title XVIII of the Social Security Act for items or services furnished by providers of services or suppliers on or after the first day of the first month beginning 60 days after the date of the enactment of this Act.

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