SCS/HB 544 - This act modifies provisions relating to medical records and prompt payment.

Physicians are required to maintain adequate and complete medical records for their patients. Such records shall include identification of the patient, appointment dates, current status, observations, diagnosis, plan for treatment including prescriptions, and record of consent. Records must be maintained for at least seven years. Changes to records which occur forty- eight hours after the last entry must be noted. A consultative report will be adequate for certain persons. The Board of Registration for the Healing Arts may not discipline a person solely for violation of this section. Finally, the Board may not obtain a patient's medical record without the patient's written consent or a subpoena.

Provider/health carrier agreements are currently outlined in Section 354.606, RSMo. A new subsection 9 is added to prohibit any contract between a provider and health carrier from mandating the use of a hospitalist. A "hospitalist" is defined as a physician who becomes the physician of record for a patient of a participating provider (such as a primary care provider). The hospitalist may return care to the participating provider when the patient is released from the hospital. (Section 354.606).

Claim reimbursement for health care services is currently required within forty-five days or a notice must be provided stating reasons for refusal. New language provides that electronic claim filings must receive reimbursement after twenty- five days. After April 1, 2002, new language requires a specific description of the additional information required in order to process a claim. The date of receipt of the claim will be three days after the postmarked date or instantly upon receipt by a health carrier or its agents if filed electronically. A confirmation of receipt must be sent within ten days for claims received non-electronically. (Section 376.383).

Currently, a carrier must pay interest if a claim is not paid within forty-five days. New language allows the carrier to combine interest payments into one payment when it reaches five dollars. The current language regarding a provider forwarding interest payments to an enrollee is deleted. Finally, new language allows any person who files a claim for a service to also file a civil action against the health carrier for violations of this section. No action, however, may be filed until ten days after notifying the health carrier of the intent to sue. If a violation is found, the court may award forty to eighty per day, ten days after interest becomes due and may also award the claimed reimbursement, the interest, and reasonable attorney's fees.

Additional duties for health carriers are outlined, including permitting providers to file uniform confirmation numbers and to file reimbursement claims for up to one year. As of January 1, 2003, carriers may accept electronically filed claims and issue prompt confirmation of receipt. Health carriers must accept all codes included in the physician's current procedural terminology and must provide current fee schedules. They may not request a refund more than twelve months after paying a claim. Internet access to current provider directories must be provided. Enrollees must be informed of coverage denials and must receive an enrollee card with all pertinent information. (Section 376.386).

Health insurance companies must currently cover newborns from the moment of birth. A health carrier may require notification of birth and enrollment of the newborn within thirty-one days of birth. New language provides that if such information is required and has been provided by the enrollee in order to continue coverage beyond the thirty-one days, then the health carrier must provide the enrollee with the necessary forms and instructions to complete enrollment. Ten additional days will be allowed to do so. (Section 376.406).

Sections 354.606 and 376.383 through 376.406 are substantially similar to SB 445.
ERIN MOTLEY