Print Friendly HOUSE BILL NO. 122 – Anatomic pathology services/billing
HOUSE BILL NO. 122
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H0122.................................................by HEALTH AND WELFARE
ANATOMIC PATHOLOGY SERVICES - Adds to existing law relating to anatomic
pathology services to define terms; to provide who may be billed for
anatomic pathology services; to provide conditions when payment may be
solicited; to provide exceptions; and to provide penalties.
02/07 House intro - 1st rdg - to printing
02/08 Rpt prt - to Health/Wel
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature First Regular Session - 2007
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 122
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO DIRECT BILLING OF ANATOMIC PATHOLOGY SERVICES; AMENDING CHAPTER
3 18, TITLE 54, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 54-1842, IDAHO
4 CODE, TO DEFINE TERMS, TO PROVIDE DUTIES OF A CLINICAL LABORATORY OR
5 LICENSED PRACTITIONER PROVIDING ANATOMIC PATHOLOGY SERVICES FOR PATIENTS
6 IN IDAHO, TO PROVIDE CONDITIONS WHEN PAYMENT FOR ANATOMIC PATHOLOGY SER-
7 VICES MAY BE REQUESTED, TO PROVIDE THAT A VIOLATION OF THIS ACT SHALL REN-
8 DER REIMBURSEMENT CLAIMS VOID, TO PROVIDE APPLICATION, TO PROVIDE EXCEP-
9 TIONS AND TO PROVIDE PENALTIES.
10 Be It Enacted by the Legislature of the State of Idaho:
11 SECTION 1. That Chapter 18, Title 54, Idaho Code, be, and the same is
12 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
13 ignated as Section 54-1842, Idaho Code, and to read as follows:
14 54-1842. DIRECT BILLING OF ANATOMIC PATHOLOGY SERVICES. (1) As used in
15 this section:
16 (a) "Anatomic pathology services" means:
17 (i) Histopathology or surgical pathology, meaning the gross micro-
18 scopic examination and histologic processing of organ tissue per-
19 formed by a physician; or
20 (ii) Cytopathology, meaning the examination of cells from the fol-
21 lowing: fluids, aspirates, washings, brushings or smears including
22 the Pap test examination performed by a physician or under the super-
23 vision of a physician; or
24 (iii) Hematology, meaning the microscopic evaluation of bone marrow
25 aspirates and biopsies performed by a physician, or under the super-
26 vision of a physician, and peripheral blood smears when the attending
27 or treating physician or technologist requests that a blood smear be
28 reviewed by a pathologist;
29 (iv) Subcellular pathology and molecular pathology; and
30 (v) Blood-banking services performed by pathologists.
31 (b) "Licensed practitioner" means any person licensed pursuant to this
33 (2) A clinical laboratory or licensed practitioner located in this state
34 or another state providing anatomic pathology services for patients in Idaho
35 shall present or cause to be presented a claim, bill or demand for payment for
36 these services only to the following:
37 (a) The patient directly;
38 (b) The responsible insurer or other third-party payer;
39 (c) The hospital, clinic, public health clinic or nonprofit health clinic
40 ordering such services;
41 (d) The referring laboratory, other than a laboratory of a physician's
42 office or group practice that ordered the services. A laboratory of a
43 physician's office or group practice that ordered the services may be pre-
1 sented a claim, bill or demand for payment if a physician in the
2 physician's office or group practice is performing the professional compo-
3 nent of the anatomic pathology services;
4 (e) Governmental agencies or their specified public or private agent,
5 agency or organization on behalf of the recipient of the services.
6 (3) Except as provided in subsection (6) of this section, no licensed
7 practitioner in this state shall, directly or indirectly, charge, bill or
8 otherwise solicit payment for anatomic pathology services unless such services
9 were rendered personally by the licensed practitioner or under the licensed
10 practitioner's direct supervision in accordance with section 353 of the Public
11 Health Service Act, 42 U.S.C. section 263a.
12 (4) No patient, insurer, third-party payer, hospital, clinic, public
13 health clinic or nonprofit health clinic shall be required to reimburse any
14 licensed practitioners for charges or claims submitted in violation of this
16 (5) Nothing in this section shall be construed to mandate the assignment
17 of benefits for anatomic pathology services as defined in this section.
18 (6) The provisions of this section do not prohibit billing of a referring
19 laboratory for anatomic pathology services in instances where a sample or sam-
20 ples must be sent to another specialist, except that for purposes of this sub-
21 section, the term "referring laboratory" does not include a laboratory of a
22 physician's office or group practice unless in accordance with subsection
23 (2)(d) of this section.
24 (7) Any licensed practitioner who may request or provide anatomic pathol-
25 ogy services in violation of the provisions of this section may have his
26 license revoked, suspended or denied renewal by the board of medicine.
STATEMENT OF PURPOSE
This legislation will protect Idaho patients against "markup"
charges by prohibiting an ordering physician from billing
patients for anatomic pathology services performed or supervised
by another physician. "Markup" charges occur when a physician
sends a tissue specimen or smear to a laboratory and asks that
the laboratory bill the physician instead of the patient, or the
patient's insurance company, for the service. The physician will
then bill the patient or the insurance company at a higher price
and pocket the difference. This bill complies with American
Medical Association guidelines for billing of services.
There is no impact to the General Fund.
Name: Rep. McGeachin
Phone: 208 332 1000
Idaho Pathology Society
Phone: 208 381 2378
STATEMENT OF PURPOSE/FISCAL NOTE H 122