Clean CLAIMS Act

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Introduced on May 7, 2024 by David Schweikert

Cosponsors

Legislation Details

  • Amends title XI of the Social Security Act to initiate a demonstration project for automatic Medicare claim submissions.
  • Establishes the “Clean Commitment to Leveraging Artificial Intelligence to Improve Medicare Sustainability Act” or the “Clean CLAIMS Act”.
  • Requires the Secretary to partner with a Medicare Administrative Contractor (MAC) for the demonstration project.
  • The demonstration project must start within a year of the enactment or when sufficient physician education is completed, and end 3 years after the start date.
  • Involves at least 500 physicians who will voluntarily participate and be educated on using an AI-powered platform for clean claims processing.
  • The AI platform will automatically create and submit claims after recording patient-physician encounters, apply payer guidelines, and populate medical record documentation.
  • A request for proposal will be published within 6 months after enactment to find a suitable platform service provider.
  • Participants receiving care under this project will not be responsible for cost-sharing for incorrectly billed or uncovered services.
  • Claims submitted through this project are exempt from the Medicare Fee for Service Recovery Audit Program.
  • A report analyzing the project’s data, evaluating physician feedback, recommending improvements, and other relevant information must be submitted to Congress within a year after the project starts.
  • Defines “jurisdiction” as the geographic area a MAC operates in and clarifies the meaning of “MAC”.

Last updated 8/17/2024