[Corrected Copy]

 

[First Reprint]

SENATE, No. 89

STATE OF NEW JERSEY

214th LEGISLATURE

 

PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION

 


 

Sponsored by:

Senator  RONALD L. RICE

District 28 (Essex)

Assemblyman  HERB CONAWAY, JR.

District 7 (Burlington and Camden)

 

 

 

 

SYNOPSIS

     Requires licensed health care professionals and facilities to bill Medicare beneficiaries within 90 days of date insurance payment is finalized.

 

CURRENT VERSION OF TEXT

     As reported by the Senate Health, Human Services and Senior Citizens Committee on February 18, 2010, with amendments.

  


An Act concerning health care provider billing for certain patients and supplementing Titles 26 and 45 of the Revised Statutes.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    a.  A health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), which provides a health care service to a Medicare beneficiary, shall bill the beneficiary, within 1[six months of providing the service,] 90 days from the date the payment from Medicare or other third party payer is finalized1 for any amounts due and owing for the service that are not reimbursed by the Medicare program or other third party payer.

     b.    In the event the health care facility does not submit a bill to the beneficiary within 1[six months of the date the service was provided] 90 days from the date the payment from Medicare or other third party payer is finalized1, the health care facility shall not be permitted to report any nonpayment of the bill by the beneficiary to a consumer reporting agency.

     1[Notwithstanding the provisions of this section to the contrary, if the facility can document that payment from the Medicare program or other third party payer has not been finalized or is still in dispute six months after the date the service was provided and the amount due and owing by the beneficiary has not yet been determined, the facility shall have 30 days from the date the payment is finalized to bill the beneficiary.]1

     c.     A health care facility that violates the provisions of this section shall be subject to such penalties as the Commissioner of Health and Senior Services may determine pursuant to sections 13 and 14 of P.L.1971, c.136 (C.26:2H-13 and 26:2H-14).

     d.    As used in this section:

     "Consumer reporting agency" means any person which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages, in whole or in part, in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties, and which uses any means or facility for the purpose of preparing or furnishing consumer reports.

 

     2.    a.  A health care professional licensed pursuant to Title 45 of the Revised Statutes, who provides a health care service to a Medicare beneficiary, shall bill the beneficiary, within 1[six months of providing the service,] 90 days from the date the payment from Medicare or other third party payer is finalized1 for any amounts due and owing for the service that are not reimbursed by the Medicare program or other third party payer.

     b.    In the event the health care professional does not submit a bill to the beneficiary within 1[six months of the date the service was provided] 90 days from the date the payment from Medicare or other third party payer is finalized1, the health care professional shall not be permitted to report any nonpayment of the bill by the beneficiary to a consumer reporting agency.

     1[Notwithstanding the provisions of this section to the contrary, if the health care professional can document that payment from the Medicare program or other third party payer has not been finalized or is still in dispute six months after the date the service was provided and the amount due and owing by the beneficiary has not yet been determined, the professional shall have 30 days from the date the payment is finalized to bill the beneficiary.]1

     c.     A health care professional who violates the provisions of this section shall be subject to such penalties as the Director of Consumer Affairs in the Department of Law and Public Safety may determine pursuant to sections 9 and 12 of P.L.1978, c.73 (C.45:1-22 and 45:1-25).

     d.    As used in this section:

     "Consumer reporting agency" means any person which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages, in whole or in part, in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties, and which uses any means or facility for the purpose of preparing or furnishing consumer reports.

 

     3.    This act shall take effect on the 90th day after enactment and shall apply to health care services provided on or after the effective date.