HB 460 -- Health Insurance Coding

Co-Sponsors:  Pearce, Threlkeld, Schaaf, Portwood, Harris (23),
Page, Cooper (155), Stefanick

This bill limits the practice of health insurers who change or
attempt to change any health service procedure code submitted by
a physician for billing and reimbursement purposes.

If any health insurer changes or attempts to change any health
service procedure code, the express written permission of a
physician must be obtained and an examination of the patient's
medical record must be conducted in order to determine the
services provided by the physician.

If a dispute arises between a physician and a health insurer
concerning a health service procedure code submission, the health
insurer is responsible for establishing procedures for resolving
the dispute.

The bill also requires contracts between health insurers and
physicians to clearly contain the health service procedure codes
which are utilized by the contracting physician and are covered
by the health insurer.  The contracts must also list the fee,
compensation, or reimbursement rate associated with each health
service procedure code.

Missouri House of Representatives
Last Updated July 25, 2003 at 10:12 am