Texas House Bill HB4192

Texas 2019 - 86th Regular

Caption

Relating to claims and overpayment recoupment processes imposed on health care providers under Medicaid and other public benefits programs.

Impact

The impact of HB 4192 on state laws includes the amendment and addition of various mandates under the Government Code. It requires managed care organizations to inform healthcare providers of overpayment intentions within specific timeframes and establishes a 60-day period for providers to rectify claims before any recovery attempts. Additionally, the bill limits audit durations to 24 months and stipulates that no overpayment acts can proceed until after providers exhaust all appeal rights. These changes aim to provide a more balanced approach between the recovery efforts of managed care organizations and the protections of healthcare providers.

Summary

House Bill 4192 addresses claims and overpayment recoupment processes imposed on healthcare providers under Medicaid and other public benefits programs. The bill includes provisions that amend the Government Code, aiming to streamline the process by which managed care organizations can recover overpayments. Specifically, it establishes clear timelines for notification and allows healthcare providers a minimum period to address any identified claim defects before collections can begin, thus enhancing the due process afforded to providers facing recoupment efforts.

Contention

Notably, there may be points of contention surrounding the implementation of these changes, particularly regarding the regulatory burdens they place on managed care organizations versus the protections they afford to healthcare providers. While proponents argue that such measures enhance transparency and protect healthcare providers from arbitrary recoupment actions, critics may express concerns regarding the compliance costs for managed care organizations and potential delays in addressing fraudulent claims through extended due process notifications.