Sec. 505. Reducing improper Medicare payments
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Section 1874A of the Social Security Act ( 42 U.S.C. 1395kk–1 ) is amended— in subsection (a)(4)— by redesignating subparagraph
(G)as subparagraph (H); and by inserting after subparagraph
(F)the following new subparagraph: Having in place an improper payment outreach and education program described in subsection (h). ; and by adding at the end the following new subsection: In order to reduce improper payments under this title, each medicare administrative contractor shall establish and have in place an improper payment outreach and education program under which the contractor, through outreach, education, training, and technical assistance or other activities, shall provide providers of services and suppliers located in the region covered by the contract under this section with the information described in paragraph (2). The activities described in the preceding sentence shall be conducted on a regular basis. The information to be provided under such payment outreach and education program shall include information the Secretary determines to be appropriate, which may include the following information: A list of the providers’ or suppliers’ most frequent and expensive payment errors over the last quarter. Specific instructions regarding how to correct or avoid such errors in the future. A notice of new topics that have been approved by the Secretary for audits conducted by recovery audit contractors under section 1893(h). Specific instructions to prevent future issues related to such new audits. Other information determined appropriate by the Secretary. A medicare administrative contractor shall give priority to activities under such program that will reduce improper payments that are one or more of the following: Are for items and services that have the highest rate of improper payment. Are for items and service that have the greatest total dollar amount of improper payments. Are due to clear misapplication or misinterpretation of Medicare policies. Are clearly due to common and inadvertent clerical or administrative errors. Are due to other types of errors that the Secretary determines could be prevented through activities under the program. In order to assist medicare administrative contractors in carrying out improper payment outreach and education programs, the Secretary shall provide each contractor with a complete list of the types of improper payments identified by recovery audit contractors under section 1893(h) with respect to providers of services and suppliers located in the region covered by the contract under this section. Such information shall be provided on a time frame the Secretary determines appropriate which may be on a quarterly basis. The information described in subparagraph
(A)shall include information such as the following: Providers of services and suppliers that have the highest rate of improper payments. Providers of services and suppliers that have the greatest total dollar amounts of improper payments. Items and services furnished in the region that have the highest rates of improper payments. Items and services furnished in the region that are responsible for the greatest total dollar amount of improper payments. Other information the Secretary determines would assist the contractor in carrying out the program. Communications with providers of services and suppliers under an improper payment outreach and education program are subject to the standards and requirements of subsection (g). . Section 1893(h) of the Social Security Act ( 42 U.S.C. 1395ddd(h) ) is amended— in paragraph (2), by inserting or paragraph
(10)after paragraph (1)(C) ; and by adding at the end the following new paragraph: After application of paragraph (1)(C), the Secretary shall retain a portion of the amounts recovered by recovery audit contractors for each year under this section which shall be available to the program management account of the Centers for Medicare & Medicaid Services for purposes of, subject to subparagraph (B), carrying out sections 1833(z), 1834(l)(16), and 1874A(a)(4)(G), carrying out section 514(b) of the Medicare Access and CHIP Reauthorization Act of 2015 , and implementing strategies (such as claims processing edits) to help reduce the error rate of payments under this title. The amounts retained under the preceding sentence shall not exceed an amount equal to 15 percent of the amounts recovered under this subsection, and shall remain available until expended. Except for uses that support claims processing (including edits) or system functionality for detecting fraud, amounts retained under subparagraph
(A)may not be used for technological-related infrastructure, capital investments, or information systems. Nothing in subparagraph
(A)shall reduce amounts available for payments to recovery audit contractors under this subsection. .
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- 42 USC 1395kk–1
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