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.
AI-Generated Summary
This bill proposes to add a new subchapter to Arkansas Code Title 23, Chapter 99, concerning recoupment practices by healthcare insurers. The primary aim is to prohibit healthcare insurers from recovering payments made to healthcare providers for services more than one year after the payment was initially made. This limitation on recoupment would apply unless the recoupment is related to fraud, waste, or abuse committed by the healthcare provider. The bill also defines key terms such as "abuse," "fraud," "health benefit plan," "healthcare insurer," "healthcare provider," and "recoupment." It outlines specific requirements for healthcare insurers when exercising recoupment, including providing written statements detailing the basis for the recovery and allowing for internal appeals by the provider. The bill further addresses situations where recoupment may not be exercised, such as when a provider verifies patient eligibility and acts in good faith reliance on that verification, with specific exceptions for verification errors. Failure to comply with these provisions would be considered an unfair trade practice under existing Arkansas law.
Potential Impact Analysis
Who Might Benefit?
The primary beneficiaries of this bill, if enacted, would be healthcare providers in Arkansas. By establishing a one-year limit on recoupment for healthcare insurers, providers would have greater certainty regarding payments received for services rendered. This would reduce the risk of unexpected financial liabilities arising from retrospective claims audits conducted by insurers well after payment has been made. The bill's provisions requiring detailed explanations for recoupment and establishing appeal rights also benefit providers by offering more procedural fairness in disputes with insurers.
Who Might Suffer?
Healthcare insurers in Arkansas would likely be the primary entities negatively impacted by this bill. The proposed one-year limitation on recoupment would restrict their ability to recover payments made due to errors, overpayments, or undetected fraud, waste, or abuse by healthcare providers that are discovered beyond that timeframe. While exceptions for fraud, waste, and abuse are included, the overall reduction in the period for recoupment could lead to increased financial exposure for insurers if their auditing and verification processes are not sufficiently robust within the new timeframe. The bill's procedural requirements and limitations could also add administrative complexity and costs for insurers.