§ 2807-E — Uniform bills

§ 2807-e. Uniform bills. 1. Definitions. For the purposes of this\nsection, unless the context clearly requires otherwise:\n (a) "Ambulatory care services" shall mean ambulatory surgical\nservices, diagnostic and treatment services, emergency services,\nhospital outpatient services and physician services.\n (b) "Superintendent" shall mean the superintendent of financial\nservices.\n (c) "Third-party payor" shall mean those payors within the payor\ncategories specified in paragraphs (a) and (b) of subdivision one of\nsection twenty-eight hundred seven-c of this article, except for\npayments made for persons who are eligible as beneficiaries of title\nXVIII of the federal social security act (medicare).\n (d) "Bill," other than a patient bill, shall include a claim form for\na third-party payor.\n 2. Uniform bills. (a) Notwithstanding any inconsistent provisions of\nlaw, the commissioner shall, on or after July first, nineteen hundred\nninety-five, develop a uniform patient bill for the purpose of providers\nproviding a health care consumer with a patient bill for hospital and\nhealth-related services, in consultation with the superintendent of\nfinancial services, statewide organizations representative of providers\nof hospital and health-related services, third-party payors as described\nin paragraphs (a) and (b) of subdivision one of section two thousand\neight hundred seven-c of this article, and representatives of health\ncare consumers. Such patient bill shall be in such form and shall\ncontain such information as may be required in accordance with rules and\nregulations developed by the commissioner, provided that distinct\nuniform patient bills may be developed for each type or level of\nhealth-related service.\n (b) No provider of hospital or health-related services shall provide a\nhealth care consumer with any patient bill, on or after September first,\nnineteen hundred ninety-five, for services provided to such consumer\nexcept such uniform patient bill as developed by the commissioner\npursuant to paragraph (a) of this subdivision.\n (c) Notwithstanding any inconsistent provision of this article or any\nother law, beginning on or after April first, nineteen hundred\nninety-four, each general hospital providing inpatient services shall\nuse a uniform data set, developed by the commissioner in consultation\nwith representatives of providers and third-party payors, for the\npurpose of billing a third-party payor for inpatient services containing\nsuch information as may be required in accordance with rules and\nregulations of the commissioner.\n (d) Notwithstanding any inconsistent provision of this article or any\nother law, beginning on or after September first, nineteen hundred\nninety-four, each general hospital, diagnostic and treatment center, or\nambulatory surgery center providing ambulatory care services shall use a\nuniform bill, developed by the commissioner in consultation with\nrepresentatives of providers and third-party payors, for the purpose of\nbilling a third-party payor for ambulatory care services containing such\ninformation as may be required in accordance with rules and regulations\nof the commissioner.\n (e) Notwithstanding any inconsistent provision of this article or any\nother law, beginning on or after January first, nineteen hundred\nninety-five, each physician providing physician services shall use a\nuniform bill, developed by the commissioner in consultation with\nrepresentatives of providers and third-party payors, for the purpose of\nbilling a third-party payor for physician services containing such\ninformation as may be required in accordance with rules and regulations\nof the commissioner.\n (f) Notwithstanding any inconsistent provision of this article or any\nother law, the commissioner in consultation with the superintendent and\nthe commissioner of social services shall establish procedures for\nrequiring any payor for inpatient services, ambulatory care services or\nphysician services making payment pursuant to the provisions of this\nsection to utilize a uniform bill for patient services required pursuant\nto paragraphs (c), (d) and (e) of this subdivision.\n * 3. Fiscal intermediary. Notwithstanding any inconsistent provision\nof law, the commissioner shall not enter into an agreement for a pilot\nprogram which provides for among its purposes a single fiscal\nintermediary for the processing of hospital bills in a region, unless\nthe commissioner shall first notify the chairs of the senate and\nassembly standing committees on health not less than one hundred\ntwenty-days prior to entering into such agreement. Such notification\nshall include, but need not be limited to, the following:\n (a) the source of funding and anticipated expenditures for such\nprogram;\n (b) the geographic region and participants in such program;\n (c) the nature and policy objectives of such program, including its\nrelationship to long range policy objectives, and including but not\nlimited to its relationship to establishing a universal health insurance\ncoverage system;\n (d) a discussion of the design, proposed implementation, and\ntime-frames for such program; and\n (e) a copy of any proposed agreements or other contractual\narrangements relating to the program.\n In the event the commissioner subsequently enters into an agreement\nfor such a pilot program the commissioner shall promptly provide a copy\nof such agreement to such chairs. The commissioner shall report every\nsix months thereafter on the progress of implementation of such program\nand provide a final evaluation of the program upon its conclusion.\n * NB Expired July 1, 2017\n 4. Electronic transfer of claims information. (a) Claims submitted to\nthird-party payors for payment for inpatient hospital services provided\nby a general hospital on or after April first, nineteen hundred\nninety-four shall be submitted in electronic formats consistent with\nthis section.\n (b) Claims for payment made to third-party payors for ambulatory care\nservices provided by a general hospital, diagnostic and treatment center\nor ambulatory surgery center on or after January first, nineteen hundred\nninety-five shall be submitted in electronic formats consistent with\nthis section.\n (c) Claims for payment made to third-party payors for physician\nservices on or after July first, nineteen hundred ninety-five shall be\nsubmitted in electronic formats consistent with this section.\n (d) The provisions of this section shall not apply to claims for\npayment to third-party payors for which the content, processing and\npayment thereof are regulated solely by federal law or regulation,\nprovided, however that such third-party payors may voluntarily\nparticipate in the electronic submission of claims information.\n (e) Consistent with their capabilities hospitals, diagnostic and\ntreatment centers, physicians, other practitioners and third-party\npayors may be permitted to elect to submit claims information\nelectronically prior to the above dates.\n (f) The commissioner shall delay or waive the implementation of this\nsection in particular instances for diagnostic and treatment centers or\npractitioners and, in consultation with the superintendent, third-party\npayors where such diagnostic and treatment centers, practitioners or\nthird-party payors have a small volume of services or business.\n (g) The commissioner, in consultation with the superintendent and the\ncommissioner of social services, shall establish procedures for\nrequiring third-party payors to accept the electronic submission of\nclaims information for inpatient or ambulatory care services made\npursuant to the provision of this section.\n 5. The commissioner, in consultation with the superintendent, shall\nmake recommendations, to the legislature, by June thirtieth, nineteen\nhundred ninety-four, for improving the efficiency of processing\nelectronic claims by health care providers and third-party payors;\nincluding but not limited, to the use of electronic claims\nclearing-house.\n