Physicians, hospitals, and healthcare providers: have you updated your billing practices?
As of September, any individual or facility licensed or certified to provide healthcare services in Texas must provide an itemized bill of charges for healthcare services or related supplies provided to a patient prior to requesting payment for such services or related supplies from the patient. The itemized bill must include:
- The amount the healthcare provider agrees to accept as full payment for each healthcare service and supply that provider provided to the patient.
- A plain language description of each distinct healthcare service or supply (examples of plain language terms and phrases can be found at Plain Language Terms and Phrases | Texas Health and Human Services).
- If reimbursement is sought from a third party, any billing code submitted to the third party and the amounts billed to and paid by that third party.
The itemized bill may be issued electronically, including through a patient portal on the provider’s Internet website. Additionally, a patient is entitled to obtain from the healthcare provider an itemized bill on request at any time after the itemized bill was initially issued.
If a healthcare provider does not provide an itemized bill compliant with the above requirements, then the healthcare provider is prohibited from collecting the debt from the patient. Therefore, it is critically important that all healthcare providers review their bills to ensure they contain a plain-language description of each service or supply, the amount the provider will accept as full payment of each service or supply, and any amounts billed to and paid by a third party (including the codes submitted). Since all of the new billing requirements must be met in order to collect a debt from a patient, a mere technical failure (i.e., failure to provide billing codes billed to a third party) could bar the healthcare provider from collecting from patients.
If you have questions regarding Texas’ new healthcare provider requirements, Jackson Walker’s Healthcare team will be happy to help.
The opinions expressed are those of the author and do not necessarily reflect the views of the firm, its clients, or any of its or their respective affiliates. This article is for informational purposes only and does not constitute legal advice. For questions related to these cases, please contact Jeff Frost or a member of the Healthcare practice.
Jeffrey H. Frost draws on more than 20 years of experience as in-house counsel to advise clients on healthcare regulatory matters, hospital operations, and medical staff issues. As the former Deputy General Counsel at an integrated health network in Northern California, Jeff’s experience includes advising medical staff, medical groups, and hospitals on a full range of credentialing, privileging, peer review, and quality assurance topics, as well as assisting hospital administration with governmental investigations, fraud and abuse claims, agency complaints, and medical staff hearings.
Companies and professionals engaged in the healthcare industry face a tangled web of state and federal laws and regulations. Our Healthcare practice group offers all facets of legal advice to healthcare industry clients, including compliance plan implementation, self-disclosure decisions, defense, entity structure and formation, day-to-day operations, licensing, and reimbursement. Healthcare regulations, and the internal processes needed to deal with them effectively, are constantly changing. Our team represents hospitals and healthcare systems in all aspects of healthcare regulations, including federal regulations such as the Anti-Kickback Statute, Stark Law, False Claims Act, and Civil Monetary Penalties Law, as well as state licensing, state anti-kickback, anti-referral, healthcare fraud laws, and laws regarding medical practice structure.