In its continuing efforts to maximize revenue collection, New York State has been aggressively auditing 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), 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.
History
From 1983 to 1997, the State of New York strictly regulated inpatient hospital reimbursement rates under what was known as New York’s Prospective Hospital Reimbursement Methodology (NYPHRM). Under NYPHRM, the state subsidized losses incurred by hospitals that were attributable to uncompensated care, known as Bad Debt and Charity Care (BDCC), for those hospitals that had higher rates of charity services. The program also subsidized approximately 40 percent of the costs of graduate medical education (GME) residency programs in New York. NYPHRM financed both BDCC and GME by setting fixed rates that hospitals could charge for in-patient procedures. There was no competitive rate negotiation.1
This content has been archived. It is available through our partners, LexisNexis® and Bloomberg Law.
To view this content, please continue to their sites.
Not a Lexis Subscriber?
Subscribe Now
Not a Bloomberg Law Subscriber?
Subscribe Now
LexisNexis® and Bloomberg Law are third party online distributors of the broad collection of current and archived versions of ALM's legal news publications. LexisNexis® and Bloomberg Law customers are able to access and use ALM's content, including content from the National Law Journal, The American Lawyer, Legaltech News, The New York Law Journal, and Corporate Counsel, as well as other sources of legal information.
For questions call 1-877-256-2472 or contact us at [email protected]
