Bill > HB1314

This bill creates the Arkansas Medical Audit Bill of Rights Act, which establishes a comprehensive set of protections and guidelines for healthcare providers during financial and documentation audits conducted by insurance companies, third-party payors, or claims administrators. The bill defines key terms such as "audit," "healthcare provider," and "clerical or recordkeeping error" and mandates specific procedural requirements for audits, including providing at least one week's notice before an initial audit, limiting the number of claims that can be reviewed (to 50 claims or 0.25% of annual claims), and restricting audits to no more than twice per calendar year. The legislation requires that audits involving clinical judgment be conducted by professionals in the same medical specialty, prohibits treating clerical errors as fraud without intent, and establishes that recoupments must be based on actual overpayments. Healthcare providers are granted at least 60 days to correct claims, and auditors must deliver preliminary and final audit reports within specific timeframes. The bill also prevents auditors from using extrapolation in calculating recoupments and ensures that disputed funds can only be recovered after a complete internal appeals process. Notably, the bill does not apply to Medicaid audits or investigations involving alleged fraud or abuse, and the Insurance Commissioner is tasked with creating rules to implement these provisions.

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https://arkleg.state.ar.us/Bills/Detail?id=hb1314&ddBienniumSession=2025%2F2025R