(6) Keeping track of the morass of medicare
regulations detracts from the time that physicians
have to treat patients.
SEC. 3. DEFINITIONS.
For purposes of this Act:
(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) FISCAL INTERMEDIARY.—The term ‘‘fiscal
intermediary’’ means a fiscal intermediary (as de-
fined in section 1816(a) of the Social Security Act
(42 U.S.C. 1395h(a))) with an agreement under sec-
tion 1816 of such Act to administer benefits under
part A or part B of such title.
(3) 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.
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
(5) HCFA.—The term ‘‘HCFA’’ means the
Health Care Financing Administration.
(6) MEDICARE PROGRAM.—The term ‘‘medicare
program’’ means the program under title XVIII of
the Social Security Act.
(7) MEDICARE
INTEGRITY
PROGRAM.—The
term ‘‘medicare integrity program’’ means the pro-
gram under section 1893 of the Social Security Act
(42 U.S.C. 1395ddd).
SEC. 3. EDUCATION.
(a) USE OF FUNDS.—
(1) CARRIERS.—Each carrier shall devote at
least 3 percent of the funds provided to it under the
medicare program each year (beginning with 2000)
toward education of physicians to ensure that infor-
mation about the operation of the medicare program
is properly disseminated.
(2) 
FISCAL
INTERMEDIARIES.—Each 
fiscal
intermediary shall devote at least 3 percent of the
funds provided it under the medicare program (be-
ginning with 2000) toward education of physicians
to ensure that information about the operation of
the medicare program is properly disseminated.
(3) MEDICARE INTEGRITY PROGRAM.—The Sec-
retary shall ensure that 10 percent of the funds ex-
pended under the medicare integrity program each
year (beginning with 2000) are used for education of
physicians to ensure that information about the op-
eration of the medicare program is properly dissemi-
nated.
(4) PURPOSE.—The purpose of funding under
this subsection is to ensure that physicians learn of
new changes to medicare laws and regulations in a
timely manner.
(5) 
CONSTRUCTION.—Education 
attendance
lists may not be used as evidence of possible
wrongdoings by physicians under the medicare pro-
gram and may not lead to fraud investigations under
that program.
(b) RIGHT TO INFORMATION.—Physicians have the
right to timely and accurate information about changes
and modifications to local carrier guidelines under the
medicare program. Each physician who so desires have the
right to receive this information by electronic or certified
mail (in addition to check stuffers, monthly carrier bul-
letins, the annual ‘‘Dear Doctor’’ letter, individual letters,
seminars, and other means).
(c) ADDITIONAL EDUCATIONAL OUTREACH.—The
Secretary shall initiate additional educational outreach for
physicians for medicare coverage areas that have the most
frequent billing errors. Such outreach shall include issue-
specific e-mails, faxes, mailings, and telephone calls. If,
within 9 months after the date that the additional out-
reach is initiated, a carrier finds that no evidence exists
that physician billing errors under the medicare program
have lessened, then the carrier shall complete an in-person
visit to relevant physician offices.
(d) RIGHT TO TELEPHONE CONVERSATION.—A phy-
sician may request a telephone conversation or in-person
visit with a carrier, without being suspected of fraud, re-
garding questions about billing practices under the medi-
care program.
SEC. 4. INFORMATION.
(a) STRAIGHT ANSWERS.—Carriers shall do their ut-
most to provide physicians with one, straight and correct
answer regarding billing questions under the medicare
program.
(b) WRITTEN REQUESTS.—
(1) IN GENERAL.—The Secretary shall establish
a process under which a physician may request, in
writing from a carrier, assistance in addressing
questionable codes and procedures under the medi-
care program and then the carrier shall respond in
writing within 30 business days respond with the
correct billing or procedural answer.
(2) USE OF WRITTEN STATEMENT.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), a written statement under para-
graph (1) may be used as proof against a fu-
ture audit or overpayment under the medicare
program.
(B) LIMIT
ON
APPLICATION.—Subpara-
graph (A) shall not apply retroactively and shall
not apply to cases of fraudulent billing.
(c) RESTORATION OF TOLL-FREE HOTLINE.—
(1) IN GENERAL.—HCFA shall restore the toll-
free telephone hotline so that physicians may call for
information and questions about the medicare pro-
gram.
(2) AUTHORIZATION
OF
APPROPRIATIONS.—
There are authorized to be appropriated such sums
as may be necessary to carry out paragraph (1).
(d) RIGHT TO REVIEW OF CLAIMS.—
(1) RIGHT TO SUBMIT.—Physicians have the
right to submit claims (but not to exceed 15 claims
in any year) under the medicare program that have
already been acted upon to the carrier for review
and analysis by the carrier.
(2) RIGHT TO REPAY WITHOUT PENALTY.—In
the case of such a claim, if the carrier determines
that the physician—
different HCFA regions (to be specified by the Sec-
retary) to test such guidelines; and
(4) finds that the objectives described in sub-
section (c) will be met in the implementation of such
guidelines.
(b) PILOT PROJECTS.—
(1) LENGTH AND CONSULTATION.—Each pilot
project under this subsection shall—
(A) be of sufficient length to allow for pre-
paratory physician and carrier education, anal-
ysis, and use and assessment of potential E&M
guidelines; and
(B) be conducted, throughout the planning
and operational stages of the project, in con-
sultation with national and State medical soci-
eties.
(2) 
PEER
REVIEW
AND
RURAL
PILOT
PROJECTS.—Of the pilot projects conducted under
this subsection—
(A) at least one shall focus on a peer re-
view method by physicians which evaluates
medical record information for statistical outlier
services relative to definitions and guidelines
published in the CPT book, instead of an ap-
proach using the review of randomly selected
medical records using non-clinical personnel;
and
(B) at least one shall be conducted for
services furnished in a rural area.
(3) STUDY
OF
IMPACT.—Each pilot project
shall examine the effect of the E&M guidelines on—
(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.—
HCFA shall submit a report to the Committees on
Commerce and Ways and Means of the House of
Representatives, the Committee on Finance of the
Senate, and the Practicing Physicians Advisory
Council, six months after the conclusion of the 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.
(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 E&M codes by physi-
cians and their staffs.
(7) The extent to which the tested E&M docu-
mentation guidelines substantially adhere to the
CPT coding rules.
SEC. 5. OVERPAYMENTS.
(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 shall permit physicians to repay
medicare overpayments within 3 months without penalty
or interest and without threat of denial of other claims
based upon extrapolation. If a physician should discover
an overpayment before a carrier notifies the physician of
the error, the physician may reimburse the medicare pro-
gram without penalty and the Secretary may not audit or
target the physician on the basis of such repayment, un-
less 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 within
one year after the date the claim was submitted for reim-
bursement.
(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
month and as soon as the physician submits a corrected
claim, the carrier shall eliminate application of such a pre-
payment screen.
SEC. 6. ENFORCEMENT PROVISIONS.
If a physician is suspected of fraud or wrongdoing
in the medicare program, inspectors associated with the
Office of Inspector General of the Department of Health
and Human Services—
(1) may not enter the physician’s private office
with a gun or deadly weapon to make an arrest; and
(2) may not make such an arrest without a
valid warrant of arrest, unless the physician is flee-
ing or deemed dangerous.
Æ