The bill amends section 3901.385 of the Revised Code to enhance protections for health care providers against unfair practices by third-party payers. It prohibits these payers from engaging in business practices that unnecessarily delay claim processing or payment for health care services. Additionally, it specifically forbids third-party payers from reducing reimbursements to providers based on their own interpretations of service descriptions or diagnosis codes, as well as for billing additional health services on the same date as a covered service.

Key insertions in the bill include a new provision that explicitly states third-party payers cannot reduce reimbursements based on their own descriptions of services or diagnoses, which must align with established coding guidelines. The bill also clarifies that providers should not be penalized for billing additional services on the same day as a covered service. The existing language that allowed for certain practices by third-party payers has been deleted, reinforcing the intent to protect providers from arbitrary reimbursement reductions.

Statutes affected:
As Introduced: 3901.385