selecting a sample of claims for review in the case 
of an abnormal billing pattern.’’. 
(b) EFFECTIVE DATES AND DEADLINES.—
(1) USE
OF
REPAYMENT
PLANS.—Section 
1893(f)(1) of the Social Security Act, as added by 
subsection (a), shall apply to requests for repayment 
plans made after the date of the enactment of this 
Act. 
(2) LIMITATION
ON
RECOUPMENT.—Section 
1893(f)(2) of the Social Security Act, as added by 
subsection (a), shall apply to actions taken after the 
date of the enactment of this Act. 
(3) 
USE
OF
EXTRAPOLATION.—Section 
1893(f)(3) of the Social Security Act, as added by 
subsection (a), shall apply to statistically valid ran-
dom samples initiated after the date that is 1 year 
after the date of the enactment of this Act. 
(4) PROVISION
OF
SUPPORTING
DOCUMENTA-
TION.—Section 1893(f)(4) of the Social Security 
Act, as added by subsection (a), shall take effect on 
the date of the enactment of this Act. 
(5) 
CONSENT
SETTLEMENT.—Section 
1893(f)(5) of the Social Security Act, as added by 
subsection (a), shall apply to consent settlements en-
100
tered into after the date of the enactment of this 
Act. 
(6) NOTICE OF OVERUTILIZATION.—Not later 
than 1 year after the date of the enactment of this 
Act, the Secretary shall first establish the process 
for notice of overutilization of billing codes under 
section 1893A(f)(6) of the Social Security Act, as 
added by subsection (a). 
(7) PAYMENT AUDITS.—Section 1893A(f)(7) of 
the Social Security Act, as added by subsection (a), 
shall apply to audits initiated after the date of the 
enactment of this Act. 
(8) STANDARD FOR ABNORMAL BILLING PAT-
TERNS.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary shall first es-
tablish a standard methodology for selection of sam-
ple claims for abnormal billing patterns under sec-
tion 1893(f)(8) of the Social Security Act, as added 
by subsection (a). 
SEC. 406. PROVIDER ENROLLMENT PROCESS; RIGHT OF AP-
PEAL. 
(a) IN GENERAL.—Section 1866 (42 U.S.C. 1395cc) 
is amended—
(1) by adding at the end of the heading the fol-
lowing: ‘‘; ENROLLMENT PROCESSES’’; and
101
(2) by adding at the end the following new sub-
section: 
‘‘(j) ENROLLMENT PROCESS
FOR PROVIDERS
OF 
SERVICES AND SUPPLIERS.—
‘‘(1) ENROLLMENT PROCESS.—
‘‘(A) IN
GENERAL.—The Secretary shall 
establish by regulation a process for the enroll-
ment of providers of services and suppliers 
under this title. 
‘‘(B) DEADLINES.—The Secretary shall es-
tablish by regulation procedures under which 
there are deadlines for actions on applications 
for enrollment (and, if applicable, renewal of 
enrollment). The Secretary shall monitor the 
performance of medicare administrative con-
tractors in meeting the deadlines established 
under this subparagraph. 
‘‘(C) CONSULTATION
BEFORE
CHANGING 
PROVIDER
ENROLLMENT
FORMS.—The Sec-
retary shall consult with providers of services 
and suppliers before making changes in the pro-
vider enrollment forms required of such pro-
viders and suppliers to be eligible to submit 
claims for which payment may be made under 
this title.
102
‘‘(2) HEARING RIGHTS IN CASES OF DENIAL OR 
NON-RENEWAL.—A provider of services or supplier 
whose application to enroll (or, if applicable, to 
renew enrollment) under this title is denied may 
have a hearing and judicial review of such denial 
under the procedures that apply under subsection 
(h)(1)(A) to a provider of services that is dissatisfied 
with a determination by the Secretary.’’. 
(b) EFFECTIVE DATES.—
(1) ENROLLMENT
PROCESS.—The Secretary 
shall provide for the establishment of the enrollment 
process under section 1866(j)(1) of the Social Secu-
rity Act, as added by subsection (a)(2), within 6 
months after the date of the enactment of this Act. 
(2) CONSULTATION.—Section 1866(j)(1)(C) of 
the Social Security Act, as added by subsection 
(a)(2), shall apply with respect to changes in pro-
vider enrollment forms made on or after January 1, 
2004. 
(3) HEARING RIGHTS.—Section 1866(j)(2) of 
the Social Security Act, as added by subsection 
(a)(2), shall apply to denials occurring on or after 
such date (not later than 1 year after the date of 
the enactment of this Act) as the Secretary specifies.
103
SEC. 407. PROCESS FOR CORRECTION OF MINOR ERRORS 
AND OMISSIONS ON CLAIMS WITHOUT PUR-
SUING APPEALS PROCESS. 
The Secretary shall develop, in consultation with ap-
propriate medicare contractors (as defined in section 
1889(g) of the Social Security Act, as inserted by section 
301(a)(1)) and representatives of providers of services and 
suppliers, a process whereby, in the case of minor errors 
or omissions (as defined by the Secretary) that are de-
tected in the submission of claims under the programs 
under title XVIII of such Act, a provider of services or 
supplier is given an opportunity to correct such an error 
or omission without the need to initiate an appeal. Such 
process shall include the ability to resubmit corrected 
claims. 
SEC. 408. PRIOR DETERMINATION PROCESS FOR CERTAIN 
ITEMS 
AND 
SERVICES; 
ADVANCE 
BENE-
FICIARY NOTICES. 
(a) 
IN
GENERAL.—Section 
1869 
(42 
U.S.C. 
1395ff(b)), as amended by sections 521 and 522 of BIPA 
and section 403(d)(2)(B), is further amended by adding 
at the end the following new subsection: 
‘‘(h) PRIOR DETERMINATION PROCESS FOR CERTAIN 
ITEMS AND SERVICES.—
‘‘(1) ESTABLISHMENT OF PROCESS.—