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.