Senate Finance Committee Passes Audit Reform

Audit & Appeal Fairness, Integrity, and Reforms in Medicare Act aims to add transparency, oversight to audits and appeals process.

The Senate Finance Committee passed the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, a bill designed to improve the Medicare audit and appeals process.

Passed with bi-partisan support out of the Committee by a voice vote, the bill creates more transparent and accountable oversight in the audit and appeal process.

Specifically, the legislation accomplishes several key reforms:

  • Improves the oversight for HHS and CMS to increase the integrity of the claims and appeals process.
  • Establishes a voluntary alternative dispute process to allow for multiple pending claims with similar issues to be settled as one group rather than individual appeals.
  • Coordinates efforts between auditors and CMS to ensure that all parties are receiving accurate and transparent data in regards to audit practices. CMS is also to offer incentives/disincentives in the effort to improve auditor accuracy.
  • Institutes a new Medicare Magistrate program that would allow attorneys with expertise in Medicare law and polices to adjudicate the same way as ALJs. This would ultimately free up space for the ALJs for more complex cases.
  • Allows for sampling and extrapolation methods to make the appeals process more efficient.

“Today, the Committee took an important bipartisan step toward streamlining the Medicare audit and appeals process to help healthcare providers better serve millions of patients across the nation,” said Senate Finance Committee Chairman Orrin Hatch (R-Utah). “This is a common sense bill that will help untangle the web of red tape that ensnares the current audit and appeals process and guarantee Medicare patients continue to have access to high-quality care. I look forward to continuing to work with my colleagues on both sides of the aisle to move this bill forward.”

“The Finance Committee has passed a strong, bipartisan bill that will begin to ease the tremendous backlog of Medicare appeals that have been frustrating seniors and providers in Oregon and across the country,” added Ranking Member Ron Wyden (D-Ore.). “Making the Medicare audits and appeals process more efficient will help resolve cases quickly and at the earliest possible step. I will be working hard to see swift action to help fix this broken system.”

An executive summary of the committee markup will be posted here. Additional information on the AFIRM Act can be found here

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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