IN HB 1271: Payment of health claims.

Indiana HB 1271, enacted as Public Law 88, imposes a series of obligations on hospitals regarding payment assistance program disclosures. Specifically, the law requires hospitals to: (1) disclose information concerning payment assistance programs; (2) post signs about those programs in specified locations within the hospital; and (3) make program information available through the hospital's patient portal. Hospitals must also make a reasonable effort to notify individuals of available payment assistance programs before initiating any collection action against them.

The law prohibits the practice of downcoding in a specified manner, restricting providers from reducing the specificity or value of submitted codes in the prohibited fashion. It also bars providers from using an automated process, system, or tool to submit a health benefits claim without review by a provider or other person involved in developing the claim for submission. These provisions directly regulate claim submission conduct by providers.

With respect to insurers issuing accident and sickness insurance policies and health maintenance organizations (HMOs), the law prohibits retroactive reductions in reimbursement rates for any CPT code. The law also sets forth specific timeframe limitations governing when an insurer or HMO may request repayment of an overpayment, adjust a subsequent claim, recoup a paid claim, or retroactively audit a paid claim, and when they are required to correct a payment error to a provider.

Finally, the law provides that if an insurer or HMO recoups payment from a provider due to an error in coordination of benefits, the provider is permitted to submit a claim for the same services to the appropriate insurer or HMO. The Indiana Department of Insurance (IDOI) is identified as a subject agency in connection with this legislation.