NY State Senate Bill 2023-S7076

Senate Bill S7076

2023-2024 Legislative Session

Limits the lookback period for insurance overpayment recovery from health care providers to three months

download bill text pdf

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2024	referred to insurance
May 17, 2023	referred to insurance

2023-S7076 (ACTIVE) - Details

See Assembly Version of this Bill:: A7590
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §3224-b, Ins L

2023-S7076 (ACTIVE) - Summary

Limits the lookback period for insurance overpayment recovery from health care providers to three months.

2023-S7076 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S7076

SPONSOR: SCARCELLA-SPANTON
 
TITLE OF BILL:  An act to amend the insurance law, in relation to
limiting the lookback period for insurance overpayment recovery from
health care providers

 
PURPOSE OR GENERAL IDEA OF BILL:

This bill amends section 3224-b(b) of the Insurance Law by setting the
overpayment recovery effort window for health plans to three months.

 
JUSTIFICATION:

This legislation seeks to address some of the difficulties faced by
health care providers when dealing with health insurance plans. Under
current law, an insurance company must pay a claim within 45 days of
submission. However, once a claim is paid, an insurance company can
still seek to recover this payment for up to two years after the claim
was made. Insurance companies can withhold money owed to health care
providers in an attempt to collect alleged overpayments from past
patient claims. Health care providers must make the difficult choice of

going through the expense and hassle of examining old records to verify
the service and payment or concede to the insurance company's demands.
Insurance company resources far exceed that of the average health care
provider. This lengthy review period is unfair and cumbersome for health
care providers.

This legislation would change the look back window for insurance compa-
nies to seek to recover an overpayment to three months. This change will
establish fair, uniform and consistent procedures for the processing of
overpayment recovery claims for all health care providers.

 
PRIOR LEGISLATIVE HISTORY:

New legislation

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act would take effect on the thirtieth day after it shall have
become law.

2023-S7076 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7076
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               May 17, 2023
                                ___________
 
 Introduced  by Sen. SCARCELLA-SPANTON -- read twice and ordered printed,
   and when printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to limiting the  lookback
   period for insurance overpayment recovery from health care providers
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 3 of subsection (b)  of  section  3224-b  of  the
 insurance law, as amended by chapter 237 of the laws of 2009, is amended
 to read as follows:
   (3) A health plan shall not initiate overpayment recovery efforts more
 than  [twenty-four] THREE months after the original payment was received
 by a health care provider. However, no such time limit  shall  apply  to
 overpayment  recovery efforts that are: (i) based on a reasonable belief
 of fraud or other  intentional  misconduct,  or  abusive  billing,  (ii)
 required  by,  or  initiated  at the request of, a self-insured plan, or
 (iii) required or authorized by a state or federal government program or
 coverage that is provided by this state or a municipality thereof to its
 respective employees, retirees or members. Notwithstanding the aforemen-
 tioned time limitations, in  the  event  that  a  health  care  provider
 asserts  that  a health plan has underpaid a claim or claims, the health
 plan may defend or set off such assertion of underpayment based on over-
 payments going back in time as far as the  claimed  underpayment.    For
 purposes  of  this  paragraph,  "abusive  billing" shall be defined as a
 billing practice which results in the submission of claims that are  not
 consistent with sound fiscal, business, or medical practices and at such
 frequency  and  for  such  a  period  of time as to reflect a consistent
 course of conduct.
   § 2. This act shall take effect on the thirtieth day  after  it  shall
 have become a law.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11372-01-3

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