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| Public Act 098-1127 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Medical Patient Rights Act is amended by | ||||
adding Section 3.3 as follows: | ||||
(410 ILCS 50/3.3 new) | ||||
Sec. 3.3. Prohibition on the markup of anatomic pathology | ||||
services. | ||||
(a) A physician who orders, but who does not supervise or | ||||
perform, an anatomic pathology service shall disclose in a bill | ||||
for such service presented to the patient: | ||||
(1) the name and address of the physician or laboratory
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that provided the anatomic pathology service; and | ||||
(2) the actual amount paid or to be paid for each | ||||
anatomic pathology service provided to the patient by the | ||||
physician or laboratory that performed the service. | ||||
(b) A physician subject to the requirement of subsection | ||||
(a) of this Section when billing a patient, insurer, or | ||||
third-party payer shall not markup, or directly or indirectly | ||||
increase, the amount subject to disclosure under paragraph (2) | ||||
of subsection (a) of this Section in any bill presented to a | ||||
patient, insurer, or third-party payer. | ||||
(c) This Section does not prohibit a referring physician | ||||
from charging a specimen acquisition or processing charge if: | ||
(1) the charge is limited to actual costs incurred for | ||
specimen collection and transportation; and | ||
(2) the charge is separately coded or denoted as a | ||
service distinct from the performance of the anatomic | ||
pathology service, in conformance with the coding policies | ||
of the American Medical Association. | ||
(d) The requirements of this Section do not apply to an | ||
anatomic pathology service ordered or provided by: | ||
(1) facilities licensed under the Hospital Licensing | ||
Act or the University of Illinois Hospital Act or clinical | ||
laboratories owned, operated by, or operated within | ||
facilities licensed under the Hospital Licensing Act or the | ||
University of Illinois Hospital Act; | ||
(2) any public health clinic or nonprofit health | ||
clinic; or | ||
(3) any government agency, or their specified public or | ||
private agents. | ||
(e) No patient, insurer, or other third-party payer, shall | ||
be required to reimburse any licensed health care professional | ||
for charges or claims submitted in violation of this Section. | ||
(f) A person who receives a bill for an anatomic pathology | ||
service made in knowing and willful violation of this Section | ||
may maintain an action to recover the actual amount paid for | ||
the bill. | ||
(g) The Department of Insurance shall enforce the | ||
provisions of this Section for any bill submitted to a payer in | ||
violation of this Section. | ||
(h) For the purposes of this Section, "anatomic pathology | ||
services" means: | ||
(1) histopathology or surgical pathology, meaning the | ||
gross and microscopic examination performed by a physician | ||
or under the supervision of a physician, including | ||
histologic processing; | ||
(2) cytopathology, meaning the microscopic examination | ||
of cells from (A) fluids, (B) aspirates, (C) washings, (D) | ||
brushings, or (E) smears, including the Pap smear test | ||
examination performed by a physician or under the | ||
supervision of a physician; | ||
(3) hematology, meaning the microscopic evaluation of | ||
bone marrow aspirates and biopsies performed by a | ||
physician, or under the supervision of a physician, and | ||
peripheral blood smears when the attending or treating | ||
physician or technologist requests that a blood smear be | ||
reviewed by a pathologist; | ||
(4) sub-cellular pathology or molecular pathology, | ||
meaning the assessment of a patient specimen for the | ||
detection, localization, measurement, or analysis of one | ||
or more protein or nucleic acid targets; and | ||
(5) blood-banking services performed by pathologists.
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