H.R. 3580: Oversight of Medicare Billing Code Cost Act

This bill, known as the Oversight of Medicare Billing Code Cost Act, aims to enhance the oversight and transparency of billing codes used in the Medicare program, which is part of the Social Security Act. It includes two main components:

1. Study by the Department of Health and Human Services (HHS) Inspector General

The bill requires the Inspector General of HHS to conduct a comprehensive study focusing on various aspects of the processes used by the Centers for Medicare & Medicaid Services (CMS) to manage billing codes. This study will examine:

• The types and levels of data and analysis used in the management of these codes.
• Trends regarding the addition, modification, removal, or revaluation of codes.
• Medical areas or specialties where there is significant growth in billing codes.
• How CMS monitors the effects of billing codes on healthcare outcomes, costs, and related issues.

After completing the study, the Inspector General must provide Congress with a report within 12 months that details the study's findings and includes recommendations for any necessary legislative or administrative actions to improve transparency and oversight of the billing code processes.

2. Annual Reporting on Medicare Billing Codes

Beginning June 1, 2025, and continuing each year thereafter, the Secretary of Health and Human Services will be required to submit an annual report to Congress and make it publicly available online. This report will include:

• A list of all new billing codes added to Medicare during the previous year.
• Information about the volume of services billed under these new codes.
• Information about expenditures related to these codes within the Medicare program.

The goal of these requirements is to create greater accountability and insight into how billing codes affect Medicare and its beneficiaries, ensuring that the processes used to manage these codes are clear and subject to oversight.

Relevant Companies

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