Bill Submitted to Congress for Trusted Provider Status for Medicare

A bill was submitted to the House of Representatives to create an “Established Provider” status for providers with a positive claim review history. The intent of the Medicare Established Provider Act of 2013 is to designate providers who present a low risk for submitting fraudulent claims for payment.

Facilities would apply for the trusted status, which affords the facility less audits and quicker payment of claims. A facility may qualify as an Established Provider if at least 75% of claims submitted for review were found to be eligible for payment for the first year of the program. Subsequent years have the percentage rising to 80%, then 90% of all claims reviewed. The preferred providers would be subject to periodic reviews, but would benefit from faster reimbursement and limited timeframes for the “reconsideration process,” according to Rep. Roger W. Williams, who introduced the bill.

The bill provides an incentive for facilities to proactively ensure accuracy in their MDS and Medicare claims processes.   

Contact:  Michelle Synakowski, msynakowski@leadingageny.org , 518-867-8850