SECOND REGULAR SESSION
SENATE BILL NO. 1036
92ND GENERAL ASSEMBLY
INTRODUCED BY SENATOR STEELMAN.
Read 1st time January 12, 2004, and ordered printed.
TERRY L. SPIELER, Secretary.
2730S.01I
AN ACT
To amend chapter 354, RSMo, by adding thereto one new section relating to physician contractual relationships.
Section A. Chapter 354, RSMo, is amended by adding thereto one new section, to be known as section 354.748, to read as follows:
354.748. 1. No health carrier as defined in section 376.1350, RSMo, including preferred provider organizations, health maintenance organizations, independent physician associations, or any other entity that contracts with physicians for health care, shall change or attempt to change any code submitted by the physician for health services without the express written permission of the physician involved and without the examination of the patient record to determine the services provided by the physician. In the event of a dispute, the health carrier shall provide and establish procedures for resolution of the dispute between the physician and health carrier.
2. Every contract between a health carrier or other organization and a physician shall specifically set forth the codes that represent the specific covered health services for which the physician shall be responsible and for which the health carrier or other organization shall provide compensation, remuneration or reimbursement from and the fee, compensation, remuneration or reimbursement for each such code. The code shall refer to the most recent American Medical Association code book and other recognized codes as adopted and used in the Medicare and Medicaid programs of the state and federal government.