HB1299
To Prohibit Healthcare Insurers From Exercising Recoupment For Payment Of Healthcare Services More Than One Year After The Payment For Healthcare Services Was Made.
Last Action (Jan. 29, 2025): WITHDRAWN BY AUTHOR
Sponsors
AI-Generated Summary
House Bill 1299 seeks to restrict the ability of healthcare insurers to perform recoupments—the recovery of previously paid claims—from healthcare providers. The bill establishes a 365-day time limit for insurers to exercise recoupment after an initial payment has been made, except in cases involving fraud, waste, or abuse. It mandates that insurers provide detailed written documentation for any recoupment attempt, including specific reasons and claim identification. The bill further prohibits insurers from recouping payments if a provider verified patient eligibility in good faith prior to providing services, with narrow exceptions for verification errors. If a provider initiates an internal appeal, the insurer must suspend recoupment efforts until the appeals process is exhausted. Finally, the legislation classifies non-compliance with these new standards as an unfair trade practice under existing state law.
Potential Impact Analysis
Who Might Benefit?
Healthcare providers, including physicians, hospitals, and medical clinics, are the primary beneficiaries of this bill. By limiting the time period for recoupment and requiring detailed justification for clawbacks, the bill provides providers with greater financial stability and reduces the administrative burden and unpredictability associated with insurers retracting payments long after services have been rendered. Additionally, providers are protected from liability in instances where they acted in good faith after verifying patient eligibility.
Who Might Suffer?
Healthcare insurance companies, health maintenance organizations, and self-insured health benefit plans would be most directly and negatively impacted. These entities would face stricter limitations on their ability to recover overpayments or correct billing errors, potentially increasing their administrative and operational costs. Insurers would be required to implement more rigorous and timely audit processes and could see an increase in financial losses related to claims that cannot be corrected or recouped due to the new one-year statute of limitations.
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