‘‘Definitions Relating to Protections for Physicians,
Suppliers, and Providers of Services
‘‘(uu) For purposes of provisions of this title relating
to protections for physicians, suppliers of medical equip-
ment and supplies, and providers of services:
‘‘(1) APPLICABLE AUTHORITY.—The term ‘ap-
plicable authority’ means the carrier, contractor
under section 1893, or fiscal intermediary that is re-
sponsible for making any determination regarding a
payment for any item or service under the medicare
program under this title.
‘‘(2) EXTRAPOLATION.—The term ‘extrapo-
lation’ means the application of an overpayment dol-
lar amount to a larger grouping of physician claims
than those in the audited sample to calculate a pro-
jected overpayment figure.
‘‘(3) PREPAYMENT
REVIEW.—The term ‘pre-
payment review’ means the carriers’ and fiscal inter-
mediaries’ practice of withholding claim reimburse-
ments from eligible providers even if the claims have
been properly submitted and reflect medical services
provided.’’.
SEC. 203. RIGHT TO APPEAL ON BEHALF OF DECEASED
BENEFICIARIES.
Notwithstanding section 1870 of the Social Security
Act (42 U.S.C. 1395gg) or any other provision of law, the
Secretary shall permit any health care provider to appeal
any determination of the Secretary under the medicare
program on behalf of a deceased beneficiary where no sub-
stitute party is available.
TITLE III—EDUCATION
COMPONENTS
SEC. 301. DESIGNATED FUNDING LEVELS FOR PROVIDER
EDUCATION.
(a) EDUCATION PROGRAMS FOR PHYSICIANS, PRO-
VIDERS OF SERVICES, AND SUPPLIERS.—Title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.) is amend-
ed by adding at the end the following new section:
‘‘EDUCATION PROGRAMS FOR PHYSICIANS, PROVIDERS OF
SERVICES, AND SUPPLIERS
‘‘SEC. 1897. (a) DEFINITIONS.—In this section:
‘‘(1) EDUCATION PROGRAMS.—The term ‘edu-
cation programs’ means programs undertaken in
conjunction with State and local medical societies
and specialty societies that focus on current billing,
coding, and documentation laws, regulations, and
carrier manual instructions and that place special
emphasis on billing, coding, and documentation er-
rors that the Secretary has found occur with the
highest frequency and remedies for these improper
billing, coding, and documentation practices.
‘‘(2) ELIGIBLE PROVIDERS.—The term ‘eligible
provider’ means a physician (as defined in section
1861(r)), a provider of services (as defined in sec-
tion 1861(u)), or a supplier of medical equipment
and supplies (as defined in section 1834(j)(5)).
‘‘(b) CONDUCT OF EDUCATION PROGRAMS.—
‘‘(1) IN GENERAL.—Carriers and fiscal inter-
mediaries shall conduct education programs for any
eligible provider that submits a claim under para-
graph (2)(A).
‘‘(2) ELIGIBLE PROVIDER EDUCATION.—
‘‘(A) 
SUBMISSION
OF
CLAIMS
AND
RECORDS.—Any eligible provider may volun-
tarily submit any present or prior claim or med-
ical record to the applicable authority (as de-
fined in section 1861(uu)(1)) to determine
whether the billing, coding, and documentation
associated with the claim is appropriate.
‘‘(B) PROHIBITION OF EXTRAPOLATION.—
No claim submitted under subparagraph (A) is
subject to any type of extrapolation (as defined
in section 1861(uu)(2)).
‘‘(c) SAFE HARBOR.—No submission of a claim or
record under this section shall result in the carrier, a con-
tractor under section 1893, or any law enforcement agency
beginning an investigation or targeting an investigation
based on any claim or record submitted under such sub-
paragraph.
‘‘(3) TREATMENT
OF
IMPROPER
CLAIMS.—If
the carrier or fiscal intermediary finds a claim to be
improper, the eligible provider shall have the fol-
lowing options:
‘‘(A) CORRECTION
OF
PROBLEMS.—To
correct the documentation, coding, or billing
problem to appropriately substantiate the claim
and either—
‘‘(i) remit the actual overpayment; or
‘‘(ii) receive the appropriate additional
payment from the carrier or fiscal inter-
mediary.
‘‘(B) REPAYMENT.—To repay the actual
overpayment amount if the service was not cov-
ered under the medicare program under this
title or if adequate documentation does not
exist.
‘‘(4) PROHIBITION
OF
ELIGIBLE
PROVIDER
TRACKING.—The applicable authorities may not use
the record of attendance of any eligible provider at
an education program conducted under this section
or the inquiry regarding claims under paragraph
(2)(A) to select, identify, or track such eligible pro-
vider for the purpose of conducting any type of audit
or prepayment review.’’.
(b) FUNDING OF EDUCATION PROGRAMS.—
(1) MEDICARE INTEGRITY PROGRAM.—Section
1893(b)(4) of the Social Security Act (42 U.S.C.
1395ddd(b)(4)) is amended by adding at the end the
following new sentence: ‘‘No less than 10 percent of
the program funds shall be devoted to the education
programs for eligible providers under section 1897.’’.
(2) CARRIERS.—Section 1842(b)(3)(H) of the
Social Security Act (42 U.S.C. 1395u(b)(3)(H)) is
amended by adding at the end the following new
clause:
‘‘(iii) No less than 2 percent of carrier
funds shall be devoted to the education
programs for eligible providers under sec-
tion 1897.’’.
(3) 
FISCAL
INTERMEDIARIES.—Section
1816(b)(1) of the Social Security Act (42 U.S.C.
1395h(b)(1)) is amended—