NY Pub Health L § 2807-E (2021)
2021 New York Laws PBH - Public Health Article 28 - Hospitals 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.