I 
111TH CONGRESS 
1ST SESSION H. R. 2785 
To reduce the amount of paperwork and improve payment policies for health 
care services, to prevent fraud and abuse through health care provider 
education, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 10, 2009 
Mr. THORNBERRY introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To reduce the amount of paperwork and improve payment 
policies for health care services, to prevent fraud and 
abuse through health care provider education, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Care Paper-
work Reduction and Fraud Prevention Act of 2009’’. 
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SEC. 2. NATIONAL BIPARTISAN COMMISSION ON BILLING 
CODES AND FORMS SIMPLIFICATION. 
(a) ESTABLISHMENT.—There is hereby established 
the Commission on Health Care Billing Codes and Forms 
Simplification (in this section referred to as the ‘‘Commis-
sion’’). 
(b) DUTIES.—The Commission shall make rec-
ommendations regarding the following: 
(1) STANDARDIZED AND SIMPLIFIED FORMS.— 
Standardizing and simplifying credentialing and bill-
ing forms respecting health care claims, that all 
Federal Government agencies would use and that 
the private sector is able (and is encouraged, but not 
required) to use. 
(2) REDUCTION IN BILLING CODES.—A signifi-
cant reduction and simplification in the number of 
billing codes for health care claims. 
(3) REGULATORY AND APPEALS PROCESS RE-
FORM.—Reforms in the regulatory and appeals proc-
esses under the Medicare program under title XVIII 
of the Social Security Act in order to ensure that the 
Secretary of Health and Human Services provides 
appropriate guidance to suppliers and providers of 
services (as such terms are defined in subsections 
(d) and (u), respectively, of section 1861 of such 
Act), including physicians and providers and sup-
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pliers of ambulance services, that are attempting to 
properly submit claims under the Medicare program 
and to ensure that the Secretary does not target in-
advertent billing errors. 
(4) ELECTRONIC FORMS AND PAYMENTS.—Sim-
plifying and updating electronic forms of the Centers 
for Medicare & Medicaid Services to ensure sim-
plicity as well as patient privacy. 
(c) MEMBERSHIP.— 
(1) NUMBER AND APPOINTMENT.—The Com-
mission shall be composed of 17 members, of 
whom— 
(A) four shall be appointed by the Presi-
dent; 
(B) six shall be appointed by the majority 
leader of the Senate, in consultation with the 
minority leader of the Senate, of whom not 
more than 4 shall be of the same political party; 
(C) six shall be appointed by the Speaker 
of the House of Representatives, in consultation 
with the minority leader of the House of Rep-
resentatives, of whom not more than 4 shall be 
of the same political party; and 
(D) one, who shall serve as Chairman of 
the Commission, shall be appointed jointly by 
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the President, majority leader of the Senate, 
and the Speaker of the House of Representa-
tives. 
(2) APPOINTMENT.—Members of the Commis-
sion shall be appointed by not later than 90 days 
after the date of the enactment of this Act. 
(d) INCORPORATION
OF BIPARTISAN COMMISSION 
PROVISIONS.—The provisions of paragraphs (3) through 
(8) of subsection (c) and subsections (d), (e), and (h) of 
section 4021 of the Balanced Budget Act of 1997 shall 
apply to the Commission under this section in the same 
manner as they applied to the National Bipartisan Com-
mission on the Future of Medicare under such section. 
(e) REPORT.—Not later than December 31, 2009, the 
Commission shall submit to the President and Congress 
a report which shall contain a detailed statement of only 
those recommendations, findings, and conclusions of the 
Commission that receive the approval of at least 11 mem-
bers of the Commission. 
(f) TERMINATION.—The Commission shall terminate 
30 days after the date of submission of the report required 
in subsection (e). 
SEC. 3. EDUCATION OF PHYSICIANS AND PROVIDERS CON-
CERNING MEDICARE PROGRAM PAYMENTS. 
(a) WRITTEN REQUESTS.— 
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(1) IN GENERAL.—The Secretary of Health and 
Human Services shall establish a process under 
which a physician may request, in writing from a 
carrier, assistance in addressing questionable codes 
and procedures under the Medicare program under 
title XVIII of the Social Security Act and then the 
carrier shall respond in writing within 30 business 
days 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. 
(b) RESTORATION OF TOLL-FREE HOTLINE.— 
(1) IN
GENERAL.—The Administrator of the 
Centers for Medicare & Medicaid Services shall re-
store the toll-free telephone hotline previously main-
tained by the Centers for Medicare & Medicaid Serv-
ices so that physicians may call for information and 
questions about the Medicare program. 
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(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as may be necessary to carry out paragraph (1). 
(c) DEFINITIONS.—For purposes of this section: 
(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. 
SEC. 4. POLICY DEVELOPMENT REGARDING E&M GUIDE-
LINES UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—The Administrator of the Centers 
for Medicare & Medicaid Services may not implement any 
new evaluation and management guidelines (in this section 
referred to as ‘‘E&M guidelines’’) under the Medicare pro-
gram, unless the Administrator— 
(1) has provided for an assessment of the pro-
posed guidelines by physicians; 
(2) has established a plan that contains specific 
goals, including a schedule, for improving participa-
tion of physicians in the assessment described in 
paragraph (1); 
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(3) has carried out a minimum of 4 pilot 
projects consistent with subsection (b) in at least 4 
different regions (to be specified by the Secretary) 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 
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published in the most recent Current Proce-
dural Terminology book, instead of an approach 
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 potential E&M guide-
lines 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.—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). 
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(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 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)). 
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(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. 
(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-
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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 
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-
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