Heather K. Lopez, Vice President of Physician Payment & Practice at the Medical Society of the State of New York (MSSNY), joined the NERUCA Payer Relations meeting on May 21st to share insight on how MSSNY is making a significant impact on provider reimbursement across New York State. Over the past year, Lopez has successfully helped recover more than $14 million in payments for healthcare providers, underscoring the scale of underpayments and administrative challenges facing the industry.
Her work highlights the importance of understanding and navigating New York State's regulatory framework, particularly Section 3224-b, which governs the processing of health claims and the handling of overpayments to physicians. These rules establish critical timelines for payers, including a two-year clawback period for commercial insurance plans and up to seven years for Medicare and Medicaid.
Lopez emphasizes that proactive oversight is essential for providers seeking to protect their revenue. She strongly recommends that practices conduct annual audits to ensure reimbursement aligns with contracted rates and to identify discrepancies early. According to Lopez, many providers are unaware of the extent of underpayments until a detailed review is conducted.
Beyond financial recovery, Lopez's work is also contributing to broader advocacy efforts. By providing real-world examples of reimbursement challenges and payer behavior, she is helping inform legislative discussions and policy initiatives aimed at improving transparency, fairness, and sustainability in healthcare reimbursement.
As reimbursement pressures continue to impact providers across the state, Lopez's efforts serve as both a resource and a call to action for healthcare organizations to take a more active role in monitoring and protecting their financial health. The Northeast Regional Urgent Care Association extends its sincere thanks to Heather K. Lopez and the Medical Society of the State of New York team for their ongoing support of New York State providers. Their dedication to advancing fair reimbursement and advocating for the needs of urgent care continues to make a meaningful impact across the region.