Recovery Audit Reform Bill Calls for Financial Penalties

Recovery Auditor transparency
The reform bill also introduces something that providers nationwide have been calling for—greater transparency. If passed, the Secretary would publish on the Internet information about:

Audits
Denials
Denial rates
Appeals
Appeal rates
Appeals outcomes at each of the five stages of appeal
Net denials

In addition, the Secretary will publish results of any performance evaluation of the Recovery Auditor conducted by independent entities selected by the Secretary.

Rebilling: A/B demonstration and accurate payment for rebilled claims
The bill also contains a section on the Medicare Part A/B rebilling demonstration. According to the bill, the Secretary may not prohibit any hospital appeal for the inpatient hospital services provided when the Recovery Auditor denies the admission as not reasonable and medically necessary.

The bill also states that the resubmission of a specified claim shall be deemed to be an original claim for purposes of payment under Part B and provisions under this title relating to:

• The authority of a hospital to resubmit a claim for payment under the appropriate section of this title
• Requirements for the timely submission of claims, including under sections 1814(a), 1842(b)(3), and 1835(a)

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