(A) different types of physician practices, 
such as large and small groups; and 
(B) the costs of compliance, and patient 
and physician satisfaction. 
(4) REPORT ON HOW MET OBJECTIVES.—Not 
later than 6 months after the date of the conclusion 
of all of the pilot projects under this subsection, the 
Administrator of the Centers for Medicare & Med-
icaid Services shall submit a report to the Commit-
tees on Commerce and Ways and Means of the 
House of Representatives, the Committee on Fi-
nance of the Senate, and the Practicing Physicians 
Advisory Council, on such pilot projects. Such report 
shall include the extent to which the pilot projects 
met the objectives specified in subsection (c). 
(c) OBJECTIVES FOR E&M GUIDELINES.—The objec-
tives for E&M guidelines specified in this subsection are 
as follows (relative to the E&M guidelines and review poli-
cies in effect as of the date of the enactment of this Act): 
(1) Enhancing clinically relevant documentation 
needed to accurately code and assess coding levels 
accurately. 
(2) Reducing administrative burdens. 
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(3) Decreasing the level of non-clinically perti-
nent and burdensome documentation time and con-
tent in the record. 
(4) Increased accuracy by carrier reviewers. 
(5) Education of both physicians and reviewers. 
(6) Appropriate use of evaluation and manage-
ment codes by physicians and their staffs. 
(7) The extent to which the tested evaluation 
and management documentation guidelines substan-
tially adhere to the CPT coding rules. 
(8) Simplifying electronic billing. 
(d) DEFINITIONS.—For purposes of this section and 
section 5: 
(1) PHYSICIAN.—The term ‘‘physician’’ has the 
meaning given such term in section 1861(r) of the 
Social Security Act (42 U.S.C. 1395x(r)). 
(2) CARRIER.—The term ‘‘carrier’’ means a 
carrier (as defined in section 1842(f) of the Social 
Security Act (42 U.S.C. 1395u(f))) with a contract 
under title XVIII of such Act to administer benefits 
under part B of such title. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
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(4) MEDICARE PROGRAM.—The term ‘‘Medicare 
program’’ means the program under title XVIII of 
the Social Security Act. 
SEC. 5. OVERPAYMENTS UNDER THE MEDICARE PROGRAM. 
(a) INDIVIDUALIZED NOTICE.—If a carrier proceeds 
with a post-payment audit of a physician under the Medi-
care program, the carrier shall provide the physician with 
an individualized notice of billing problems, such as a per-
sonal visit or carrier-to-physician telephone conversation 
during normal working hours, within 3 months of initi-
ating such audit. The notice should include suggestions 
to the physician on how the billing problem may be rem-
edied. 
(b) REPAYMENT OF OVERPAYMENTS WITHOUT PEN-
ALTY.—The Secretary of Health and Human Services 
shall permit a physician to repay Medicare overpayments 
made to such physician without penalty or interest and 
without threat of denial of other claims based upon ex-
trapolation, if such repayment is made not later than 3 
months after such physician receives notification of such 
overpayment and if such overpayment was not determined 
by a final adverse action to be the result of fraudulent 
billing. If a physician should discover an overpayment be-
fore a carrier notifies the physician of the error, the physi-
cian may reimburse the Medicare program without penalty 
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and the Secretary may not audit or target the physician 
on the basis of such repayment, unless other evidence of 
fraudulent billing exists. 
(c) TREATMENT OF FIRST-TIME BILLING ERRORS.— 
If a physician’s Medicare billing error was a first-time 
error and the physician has not previously been the subject 
of a post-payment audit, the carrier may not assess a fine 
through extrapolation of such an error to other claims, 
unless the physician has submitted a fraudulent claim. 
(d) TIMELY NOTICE OF PROBLEM CLAIMS BEFORE 
USING EXTRAPOLATION.—A carrier may seek reimburse-
ment or penalties against a physician based on extrapo-
lation of a Medicare claim only if the carrier has informed 
the physician of potential problems with the claim not 
later than one year after the date the claim was submitted 
for reimbursement. 
(e) SUBMISSION OF ADDITIONAL INFORMATION.—A 
physician may submit additional information and docu-
mentation to dispute a carrier’s charges of overpayment 
without waiving the physician’s right to a hearing by an 
administrative law judge. 
(f) LIMITATION ON DELAY IN PAYMENT.—Following 
a post-payment audit, a carrier that is conducting a pre- 
payment screen on a physician service under the Medicare 
program may not delay reimbursements for more than one 
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month and as soon as the physician submits a corrected 
claim, the carrier shall eliminate application of such a pre- 
payment screen. 
Æ 
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