Senate Finance Committee Readies Bill to Improve Medicare Audit & Appeals Process

Senator Hatch Announces Markup of Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015

The committee leaders, Senators Hatch and Wyden

The committee leaders, Senators Hatch and Wyden

Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) bring their new bipartisan bill, the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, before the Senate Finance committee on Wednesday, June 3, 2015, at 10 a.m., for “markup” before they send it to the Senate floor.

“Increased Medicare payment appeals from a range of Medicare providers and suppliers has resulted in a substantial backlog, causing financial and administrative problems that sometimes last years,” Hatch and Wyden said in a press release.  “This legislation is designed to improve the appeals process at HHS while upholding the integrity of the audit process so that providers and beneficiaries are not indefinitely left in limbo.  We look forward to a constructive markup on this common sense, bipartisan legislation.”

Senator Hatch is the committee’s Chairman while Senator Wyden is the Ranking Member.

The Chairman’s “mark” (version of the bill the Chairman would like to see) can be downloaded here.

What is “Markup”?

“Markup” is the process by which congressional committees and subcommittees debate, amend, and rewrite proposed legislation. The connotation of a markup session is that the language of the original measure is analyzed line-by-line or section-by-section, and then “marked up”, i.e., changed or amended. If the bill is extensively amended, the committee’s version may be introduced as a separate bill, with a new number, before being considered by the full House or Senate.

During a Markup session, amendments are considered, as well. Amendments are actually the preferred method of changing the original bill.

Known Proposed Amendments

On the committee’s website is a list of amendments already being offered. The following list was extracted at 5:30 PM ET on June 2, 2015:

Author & Number Amendment Summary

Grassley/Warner #1

Medicare Orthotics and Prosthetics Improvement Act of 2015

Thune #1

An amendment to expedite appeals for critical access hospitals (CAHs)

Thune #2

To ensure that the federal workforce is not permanently expanded

Burr #1

Look-Back Study
Burr #2 Work with Review Entity Contractors

Heller #1

Availability of medical records based on accuracy
Stabenow #1 Strike Contractor Document Collection Language
Stabenow #2 Recovery Auditor Payment Structure
Carper #1 Providing Improved Transparency Through a Medicare Provider Claim Audit Web Portal

Cardin #1

Improving Accuracy and Transparency of Federal Reporting of Recovery Auditor (RA) Auditing and Appeals

Brown #1

Ensuring the continued independence of Medicare Magistrates, ALJs, and the Departmental Appeals Board
Brown #2 Clarifying that Existing Laws & Regulations Preempt CMS Policies and Regulations

Brown #3

Ensuring Beneficiary Access to the Provider and Supplier Ombudsman for the Purposes of Appeals and Guaranteeing Communication Between the Beneficiary Ombudsman and the Provider and Supplier Ombudsman for Purposes of the Appeals Process

The text of the amendments is available as a PDF here.

Recording of the Meeting

We will be recording the meeting, if it is streamed via the committee’s website. At the moment, it is not listed among the offerings on C-SPAN, but we will be looking for any video access.

Some additional information on the AFIRM Act can be found here, although this is a very short document and does not really explain much.

Also See: Press Release: Finance Committee Announces Markup of Audit & Appeal Fairness, Integrity, and Reforms in Medicare Act of 2015

Stay tuned for our complete analysis of the amendments and anything we can learn from the meeting itself, in the next few days.

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