N.Y. Public Health Law § 2807-e: Uniform bills

§ 2807-e. Uniform bills. 1. Definitions. For the purposes of this

section, unless the context clearly requires otherwise:

(a) "Ambulatory care services" shall mean ambulatory surgical

services, diagnostic and treatment services, emergency services,

hospital outpatient services and physician services.

(b) "Superintendent" shall mean the superintendent of financial

services.

(c) "Third-party payor" shall mean those payors within the payor

categories specified in paragraphs (a) and (b) of subdivision one of

section twenty-eight hundred seven-c of this article, except for

payments made for persons who are eligible as beneficiaries of title

XVIII of the federal social security act (medicare).

(d) "Bill," other than a patient bill, shall include a claim form for

a third-party payor.

2. Uniform bills. (a) Notwithstanding any inconsistent provisions of

law, the commissioner shall, on or after July first, nineteen hundred

ninety-five, develop a uniform patient bill for the purpose of providers

providing a health care consumer with a patient bill for hospital and

health-related services, in consultation with the superintendent of

financial services, statewide organizations representative of providers

of hospital and health-related services, third-party payors as described

in paragraphs (a) and (b) of subdivision one of section two thousand

eight hundred seven-c of this article, and representatives of health

care consumers. Such patient bill shall be in such form and shall

contain such information as may be required in accordance with rules and

regulations developed by the commissioner, provided that distinct

uniform patient bills may be developed for each type or level of

health-related service.

(b) No provider of hospital or health-related services shall provide a

health care consumer with any patient bill, on or after September first,

nineteen hundred ninety-five, for services provided to such consumer

except such uniform patient bill as developed by the commissioner

pursuant to paragraph (a) of this subdivision.

(c) Notwithstanding any inconsistent provision of this article or any

other law, beginning on or after April first, nineteen hundred

ninety-four, each general hospital providing inpatient services shall

use a uniform data set, developed by the commissioner in consultation

with representatives of providers and third-party payors, for the

purpose of billing a third-party payor for inpatient services containing

such information as may be required in accordance with rules and

regulations of the commissioner.

(d) Notwithstanding any inconsistent provision of this article or any

other law, beginning on or after September first, nineteen hundred

ninety-four, each general hospital, diagnostic and treatment center, or

ambulatory surgery center providing ambulatory care services shall use a

uniform bill, developed by the commissioner in consultation with

representatives of providers and third-party payors, for the purpose of

billing a third-party payor for ambulatory care services containing such

information as may be required in accordance with rules and regulations

of the commissioner.

(e) Notwithstanding any inconsistent provision of this article or any

other law, beginning on or after January first, nineteen hundred

ninety-five, each physician providing physician services shall use a

uniform bill, developed by the commissioner in consultation with

representatives of providers and third-party payors, for the purpose of

billing a third-party payor for physician services containing such

information as may be required in accordance with rules and regulations

of the commissioner.

(f) Notwithstanding any inconsistent provision of this article or any

other law, the commissioner in consultation with the superintendent and

the commissioner of social services shall establish procedures for

requiring any payor for inpatient services, ambulatory care services or

physician services making payment pursuant to the provisions of this

section to utilize a uniform bill for patient services required pursuant

to paragraphs (c), (d) and (e) of this subdivision.

* 3. Fiscal intermediary. Notwithstanding any inconsistent provision

of law, the commissioner shall not enter into an agreement for a pilot

program which provides for among its purposes a single fiscal

intermediary for the processing of hospital bills in a region, unless

the commissioner shall first notify the chairs of the senate and

assembly standing committees on health not less than one hundred

twenty-days prior to entering into such agreement. Such notification

shall include, but need not be limited to, the following:

(a) the source of funding and anticipated expenditures for such

program;

(b) the geographic region and participants in such program;

(c) the nature and policy objectives of such program, including its

relationship to long range policy objectives, and including but not

limited to its relationship to establishing a universal health insurance

coverage system;

(d) a discussion of the design, proposed implementation, and

time-frames for such program; and

(e) a copy of any proposed agreements or other contractual

arrangements relating to the program.

In the event the commissioner subsequently enters into an agreement

for such a pilot program the commissioner shall promptly provide a copy

of such agreement to such chairs. The commissioner shall report every

six months thereafter on the progress of implementation of such program

and provide a final evaluation of the program upon its conclusion.

* NB Expired July 1, 2017

4. Electronic transfer of claims information. (a) Claims submitted to

third-party payors for payment for inpatient hospital services provided

by a general hospital on or after April first, nineteen hundred

ninety-four shall be submitted in electronic formats consistent with

this section.

(b) Claims for payment made to third-party payors for ambulatory care

services provided by a general hospital, diagnostic and treatment center

or ambulatory surgery center on or after January first, nineteen hundred

ninety-five shall be submitted in electronic formats consistent with

this section.

(c) Claims for payment made to third-party payors for physician

services on or after July first, nineteen hundred ninety-five shall be

submitted in electronic formats consistent with this section.

(d) The provisions of this section shall not apply to claims for

payment to third-party payors for which the content, processing and

payment thereof are regulated solely by federal law or regulation,

provided, however that such third-party payors may voluntarily

participate in the electronic submission of claims information.

(e) Consistent with their capabilities hospitals, diagnostic and

treatment centers, physicians, other practitioners and third-party

payors may be permitted to elect to submit claims information

electronically prior to the above dates.

(f) The commissioner shall delay or waive the implementation of this

section in particular instances for diagnostic and treatment centers or

practitioners and, in consultation with the superintendent, third-party

payors where such diagnostic and treatment centers, practitioners or

third-party payors have a small volume of services or business.

(g) The commissioner, in consultation with the superintendent and the

commissioner of social services, shall establish procedures for

requiring third-party payors to accept the electronic submission of

claims information for inpatient or ambulatory care services made

pursuant to the provision of this section.

5. The commissioner, in consultation with the superintendent, shall

make recommendations, to the legislature, by June thirtieth, nineteen

hundred ninety-four, for improving the efficiency of processing

electronic claims by health care providers and third-party payors;

including but not limited, to the use of electronic claims

clearing-house.