2023 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.