Rep. Roger W. Williams (R-TX) introduced the “Medicare Established Provider Act” on September 20, 2013 to cut down on a reimbursement backlog by identifying providers that are at low risk for fraud.
The preferred providers would be subject to periodic reviews, but would benefit from faster reimbursement and limited timeframes for the reconsideration process. In order to maintain Established Provider System status, providers of services and suppliers must hold a success rate of 75% for all claims.
Medicare Administrative Contractors are already processing 1.2 billion claims a year, and this number is set to rise. Rep. Williams has been quoted as saying that it is “no surprise” that the Government Accountability Office recently found that outpatient therapy is a high-risk area for fraud and inappropriate payments, but said this is not a good reason to “blindly” cast a net over all providers.
So—is there some hope that our future may hold some relief from the cumbersome Medicare denial and appeal processes? Time will tell if this bill passes and streamlines the reimbursement and claims review processes for some long-term care operators.
Click here to see the text of the bill.