Revealing the Texas Medical Billing Law: What You Need to Know
Texas has recently rolled out a new law, Senate Bill 490, which became effective on September 1, 2023. This law brings more transparency to medical billing, particularly when healthcare providers are seeking payment from patients after giving them medical services. In simple terms, it requires healthcare providers to give patients a detailed bill when they ask for payment. But there are some conditions to this requirement. Let’s break it down and determine whom it impacts and what’s contained within these new itemized bills.
When Does the New Law Apply?
This new rule applies when a healthcare provider seeks payment from a patient after delivering the medical service. If the provider is asking for money before providing the service or goods, like co-payments or coinsurance payments, they don’t need to give an itemized bill.
Who Does This Rule Apply To?
The law applies to what’s called a “health care provider.” This means any facility that has a license, certification, or authorization from the Texas Health and Human Services Commission (HHSC). So, this law mainly impacts places like ambulatory surgical centers and hospitals that have an HHSC license. Private practices without this license don’t have to follow these new billing rules.
What Goes into the Itemized Bill?
The itemized bill has to include three important things:
- Easy-to-Understand Descriptions: Each healthcare service or supply given to the patient should be described in plain language, so patients can understand it easily.
- Billing Codes and Money Info: If the provider uses billing codes when dealing with third parties (like insurance), they must include those codes and show how much was billed and paid by those third parties.
- Patient’s Bill: The itemized bill must clearly show how much the patient needs to pay for each service or supply provided.
Providers have to send this itemized bill no later than 30 days after they get the final payment from a third party. They can send it electronically or through their website’s patient portal. But, if a patient doesn’t want electronic bills, the provider needs to have a written policy for giving out itemized bills through other methods.
Who Ensures Compliance With This Law?
Starting September 1, 2023, HHSC will enforce this law for services and supplies provided in Texas. HHSC can act against law-breaking providers, treating their violations as breaches of licensing laws, ensuring compliance and accountability. HHSC also offers guidance through a letter to assist everyone in comprehending and complying with this new law.
In a nutshell, Senate Bill 490 in Texas is all about making medical billing clearer and more open. It’s good for both healthcare providers and patients. Providers must follow the rules to avoid HHSC issues, ensuring clear, transparent bills, fostering trust in the healthcare system. At Dike Law Group we are working hard to ensure our clients are up to date with the latest regulation and rule changes to maintain compliance.
If you have any questions about this alert or need help making sure you are in compliance, please contact one of our attorneys at Dike Law Group and schedule an intake discussion so we can answer any questions and address your needs at dorismeet.com.