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 specifies that third-party payers cannot refuse to process or pay claims based on the beneficiary's hospital discharge status or treatment completion, provided the claims cover services rendered over a minimum thirty-day period.

Significantly, the bill introduces new provisions that prevent third-party payers from reducing reimbursements to providers based on their own interpretations of service descriptions or diagnosis codes, which are not aligned with established coding guidelines. This includes restrictions on adjustments based on the payer's definitions of services outside of recognized coding systems, as well as limitations on claims for additional services billed on the same day as covered services. The existing section 3901.385 is also repealed, indicating a complete overhaul of the previous regulations.

Statutes affected:
As Introduced: 3901.385