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Sponsor testifies HB 429 would bar payers from reinterpreting code sets, block denial of same‑day service claims
Summary
Jim Hoopes told the Ohio House Insurance Committee that House Bill 429 would prevent third‑party payers from reducing reimbursements by applying nonstandard definitions outside CPT, ICD‑10, CDT or HCPCS, and would prohibit denial of same‑day service claims; lawmakers asked about bundled billing and the difference between reduced reimbursement and non‑payment.
Jim Hoopes presented sponsor testimony for House Bill 429, telling the committee the bill aims to protect Ohio health‑care providers from what he described as unfair payment and reimbursement practices by third‑party payers.
"House Bill 429 seeks to protect Ohio's health care providers from unfair payment and reimbursement practices by third party payers," Hoopes said. He described two primary provisions: prohibiting payers from reducing reimbursements based on definitions or standards that fall outside the most current CPT, ICD‑10, CDT and HCPCS code sets, and prohibiting third‑party payers from denying same‑day service claims.
Hoopes offered an example: a patient who comes for an annual checkup and on the same day receives a biopsy; under current payer practices, Hoopes said, the checkup alone may be reimbursed while the biopsy is not, even though both services were provided the same day. "Policies like this make no sense," he said, and argued that requiring a follow‑up appointment to secure reimbursement can delay care.
Representative Barhorst asked whether the bill addresses "bundled billing" or code unbundling; Hoopes said he was not certain of the technical term but that the bill targets the situation where providers are denied reimbursement for services performed the same day. Ranking Member Hall pressed on the distinction between reducing reimbursements (which are negotiated) and simply not reimbursing a service; Hoopes responded that the bill's goal is to stop payers from "redefining" approved codes and ensure medical decisions occur between providers and patients, not payers.
Hoopes said the bill is intended to ensure fair, consistent reimbursement practices and help smaller community providers avoid payment disputes that can affect their operations. The committee did not take a vote on HB 429 during the session.
