BILL NUMBER: S1818

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to timely filing of
Medicaid claims

 
PURPOSE:

To provide a mechanism to file and pay Medicaid claims when submission
is delayed due to implementing a new or upgraded medical record system.

 
SUMMARY OF PROVISIONS:

Amend SSL § 367-b to require the department to establish a delay reason
code for claims that are not submitted within the State's timely filing
requirements due to complications caused by a new or upgraded medical
record system.

 
              

JUSTIFICATION:

Medicaid providers are under increasing pressure to install electronic
medical records (EMRs) in order to comply with paver requirements. At
first, most EMR systems were home-brewed innovations building on comput-
ers already used by a clinic. Newer systems are not only more functional
but also interoperable with third party payers and other clinicians. The
transition from older systems to new can require up to a year and still
not anticipate all the issues that arise when a system finally goes
live.

In order to be paid, Medicaid regulations require that all claims be
initially submitted within 90 days of the date of service, unless the
claim is delayed due to circumstances outside the control of the provid-
er. If a claim is submitted after 90 days, Medicaid requires a delay
reason code or the claim will be denied. Currently, there is no delay
reason code covering the problems in transitioning EMR systems.  This
bill will provide a means by which providers can move forward with both
improving EMRs and providing patient care.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
90 days after enactment provided that the Commissioner may make regu-
lations beforehand that would become effective at the same time as the
law.