Saturday, November 30, 2002

Looking beyond CB

Q: All the talk's about nationwide competitive bidding (NCB). What else is going on in Washington?

A: The attention garnered by NCB proposal has drawn focus to the importance of the industry's involvement in the legislative process. Provisions introduced and addressed in both House and Senate Medicare reform bill language this year need the attention of our industry to ensure they come to fruition in the 108th Congress. Some more important issues include the limitation on the recovery of overpayments by Medicare. Language in both House bill H.R. 4954 and the Senate bill S.3018 states that there cannot be any recovery of overpayments until the supplier has received a decision by a Qualified Independent Contractor during a reconsideration. Interest would be provided to a supplier if an appeal is overturned at the ALJ level.

Another issue is the limitations on extrapolation. This indicates the Medicare contractor may not use extrapolation to determine overpayment amounts unless there is a sustained or high level of payment error (as defined by the Secretary) or documented educational intervention has failed to correct the payment error. These bills also allow for a process for suppliers to make corrections of minor errors and omissions. This provision directs the Secretary to develop a process whereby, in the case of minor errors or omissions, a supplier is given an opportunity to correct such error or omission without the need to initiate an appeal.

Martin Szmal is director of gov't affairs for Pride Mobility Products. Reach him at (800) 800-8586.