Medicare Audit Improvement Act of 2015

Medicare Audit Improvement Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to require that any records or documentation of an orthotist or prosthetist who furnished an orthotic, prosthetic, or prosthetic device to an individual shall be considered part of the individual's medical record in determining whether the item is reasonable and necessary.

Medicare administrative contractors (MACs) shall determine that payment may not be made to a supplier of durable medical equipment (DME) or of orthotics and prosthetics for which a claim is made because the supplier does not meet requirements for licensing or accreditation by a National Board.

Recovery audit contractors (RACs) shall consider an overpayment that must be recouped any payment for DME, orthotics, or prosthetics that should not have been made because the supplier failed to meet licensing or accreditation criteria.

RACs are prohibited from reviewing payments for certain DME, orthotics, or prosthetics to which prior Medicare authorization applies.

The Secretary of Health and Human Services must report annually to Congress certain information on determinations by MACs that payment cannot be made, and by RACs that payment should not have been made, under Medicare for items and services.

Payment is prohibited under part B (Supplementary Medical Insurance) of Medicare for orthotics and prosthetics furnished by a supplier without a supplier number. To obtain such a number a supplier must meet specified criteria.

The Secretary must: (1) review annually the coverage and utilization of orthotics and prosthetics to determine whether they should be subjected to coverage and utilization review criteria, and if appropriate (2) develop and apply such criteria.

Patients are not liable for payment of furnished orthotics and prosthetics which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Competitive acquisition programs shall not apply to off-the-shelf items and services furnished by certain orthotists or prosthetists who are either licensed or, in a state without licensing requirements, meet specified training, education, certification, or credentialing criteria.

Recoupment of payments to a qualifying provider or supplier may not be made before completion of an administrative law judge appeals process.

Payment under Medicare is denied to suppliers and providers unless they meet certain licensing or other qualifications.