Pennsylvania Senator David Argall introduced legislation to limit insurance companies' retroactive reimbursement denial and protect healthcare providers from those post-payment reviews.
The Pennsylvania Orthopaedic Society supports this legislation.
"As amazing as it may seem, current law allows an insurer to subject physicians to recoupment of paid claims that are two, three or even four years old," said POS President Thomas Muzzonigro, MD. "Worst yet, an insurer may simply reduce physicians future payments by the alleged overpayment amount the insurer determined. Unfortunately, our only recourse is to appeal that decision to the insurer who conducted the retroactive review. Senator Argall's legislation will remedy this intolerable insurer tactic."
Here are five things to know about the potential new legislation:
1. The legislation would require insurance carriers to review treatment plans, claim forms and billing statements within a reasonable amount of time.
2. The bill specifies insurers are only able to retroactively deny reimbursement during a 12-month period following when the claim was paid.
3. A similar legislative initiative passed the state House of Representatives in 2007 on a vote of 203 to 0.
4. The insurance industry opposes measures to revive this issue and make changes to the current process.
5. There is an expanded coalition of healthcare provider organizations including physicians, chiropractors and hospitals looking to change the General Assembly dynamic and advocate for the new bill.