Francis J. Serbaroli Insurers, Hospitals Face Audits for Health Care Reform Act Surcharges
In his Health Law column, Francis J. Serbaroli takes another look at the troubles faced by insurers, hospitals and other health care providers when they are subjected to audits of their payments of surcharges required under New York's Health Care Reform Act of 1996. He reviews the history of this law, the services covered and how the surcharges are calculated, and the problems that arise when these audits take place, and offers advice on how to deal with issues raised in the course of these audits.
January 21, 2021 at 12:00 PM
12 minute read
In its continuing efforts to maximize revenue collection, New York state continues to aggressively audit insurers to determine if they have accurately paid statutory surcharges on bills for medical services provided to patients by licensed facilities such as hospitals, clinics, ambulatory surgery centers, and other providers. These surcharges were mandated by the Health Care Reform Act of 1996 (HCRA) (Ch. 639 Laws of 1996), and they apply not just to traditional health insurers and managed care plans, but to all insurers that provide coverage for medical services provided in health care facilities. These include property and casualty insurers, Workers' Compensation carriers, automobile no-fault insurers, and others. They also apply to hospitals and other licensed facilities. We offer here a primer on the HCRA surcharges, how these audits are being carried out, and pitfalls to avoid.
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