January 27, 2005, Introduced by Rep. Kahn and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 3157 (MCL 500.3157).
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3157. (1) A physician, hospital, clinic, or other person
or institution lawfully rendering treatment to an injured person
for an accidental bodily injury covered by personal protection
insurance, and a person or institution providing rehabilitative
occupational training following the injury, may charge a reasonable
amount for the products, services, and accommodations rendered. The
charge shall not exceed the amount the person or institution
customarily charges for like products, services, and accommodations
in cases not involving insurance.
(2) All charges under subsection (1) that are billed by paper
shall use the same claim forms and coding policies required for
seeking payment under title XVIII of the social security act, 42
USC 1395 to 1395hhh, and the same code sets required under the
standards for electronic transactions, 45 CFR parts 160 and 162,
adopted pursuant to sections 1320d to 1320d-8 of the health
insurance portability and accountability act of 1996, 42 USC 1320d
to 1320d-8. If an insurer establishes an electronic claims
submission process and the charges under subsection (1) are billed
electronically, those charges shall be billed in accordance with
the standards for electronic transactions, 45 CFR parts 160 and
162, adopted pursuant to sections 1320d to 1320d-8 of the health
insurance portability and accountability act of 1996, 42 USC 1320d
to 1320d-8, and shall be submitted using the same coding policies
required for seeking payment under title XVIII of the social
security act, 42 USC 1395 to 1395hhh.
(3) If claim forms, coding policies, or standards for
electronic transactions under subsection (2) are amended after the
effective date of the amendatory act that added this subsection,
the commissioner shall determine whether those changes shall apply
to charges submitted under subsection (1). In making this
determination, the commissioner shall consider whether the
amendments further the goal of uniform submission of charges under
subsection (1).
(4) All charges under subsection (1) shall be billed to the
appropriate insurer within 60 days after each product or service is
rendered or within 60 days after the date that the person or
institution knew or should have known the identity of the
appropriate insurer, whichever period is later.
(5) All initial and subsequent charges billed to an insurer or
the injured person shall be accompanied by updated treatment notes
indicating diagnosis and further treatment plans. These updated
treatment notes and plans shall be provided at no cost to the
insurer or the injured person.
(6) A physician, hospital, clinic, or other person or
institution lawfully rendering treatment in this state to an
injured person for an accidental bodily injury covered by personal
protection insurance, and a person or institution providing
rehabilitative occupational training in this state following the
injury, shall be fully licensed or registered as required by this
state to render such treatment or training.
(7) Charges submitted that are not in compliance with this
section are not payable by the insurer or the injured person and
are not considered received or overdue under this chapter.