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Ellmers Introduces The AIR Act

Congresswoman Renee Ellmers (R-NC-02) released the following statement this afternoon after introducing H.R. 5083 - The Medicare DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) Audit Improvement and Reform (AIR) Act of 2014:

"Thousands of small businesses across the country are facing complex and unnecessary burdens just so they can get compensated for the medical equipment they are providing for our seniors. This is happening because of an excessive auditing system enforced by the Department of Health and Human Services (HHS)."

"The current auditing process has important merits and was put in place because of the fraud and abuse that exists within the Medicare system. But instead of targeting illegal practices and bad actors, HHS is instead choosing to focus on people who are playing by the rules and providing jobs for millions of hardworking Americans. At the same time, third-party contractors are profiting over these excessive audits and being used by HHS to halt payments to providers for as many as three years."

"I have seen this first hand in my district. One of our local businesses provides essential medical equipment, including oxygen and hospital beds. Over the past year they have been audited nearly 50 percent of the time. This is a practice that has to end, and that's why I have introduced legislation that will address this issue, reform the system, and focus on targeting the fraudulent practitioners that need to be held accountable."

This morning, Congresswoman Ellmers introduced H.R. 5083 - The Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014 - with strong bipartisan support. Specifically, under the AIR Act:

  • DMEPOS suppliers will receive a score on their error rates. Suppliers with low errors rates will receive fewer audits.
  • DMEPOS suppliers with error rates of 15 percent or lower will only be subject to one random audit for the year they have a low error rate.
  • Clinical inference is restored in the audit process.
  • Look-back periods are limited to three years rather than five years for MACs and four years for RACs.
  • MACs and RACs must provide quarterly training on avoiding frequent payment errors, including notice of all new audit procedures and education to avoid clerical errors.

MACs and RACs were created through the Medicare Modernization Act of 2003 to identify and recover improper payments to healthcare providers under Medicare plans. While MACs and RACs have successfully recovered millions in improper payments, they have also strained providers with increased administrative burdens. This bill will reform the Medicare audit process for DMEPOS claims and make it more efficient. The AIR Act will also increase transparency, education and outreach, and reward suppliers that have low error rates on audited claims.

Click Here to view H.R. 5083 - The AIR Act