New Texas Medical Billing Requirements in Effect

Posted By Madilyn Moeller, Wednesday, October 18, 2023

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What Is the Texas Medical Billing Law?

A new law recently went into effect in Texas requiring greater transparency in medical billing. Senate Bill (SB) 490 went into effect September 1, 2023, and requires health care providers to submit a written, itemized bill, of the cost of each service and supply provided to a patient when a provider is requesting payment from a patient after providing service. The itemized bill is only required if the provider is attempting to collect money from the patient after services are rendered. A provider is not required to provide an itemized bill to collect payment from a patient before a service or good is delivered, including co-payments or coinsurance payments.

Who This Applies to?

A “health care provider” is defined as a “facility licensed, certified, or otherwise authorized.” Therefore, this requirement only applies to facilities licensed by the Texas Health and Human Services Commission (“HHSC”) such as ambulatory surgical centers and hospitals. Private practices which do not have a facilities license from the HHSC are not required to meet these new billing requirements.

What Must Be Included in the New Itemized Bill?

The itemized bill must include: (1) a plain language description of each health care service or supply provided to the patient, (2) any billing code submitted to a third party and the amounts billed to and paid by that third party, and (3) the amount the provider alleges is due from the patient for each service and supply provided to the patient. The itemized bill must be submitted no later than the 30th day after the provider receives a final payment on the provided service or supply from a third party. This can be provided electronically or through a patient portal on the provider’s website, but the provider must implement a written policy for delivering itemized bills to patients who choose not to receive documents electronically. The policy must also address how the provider documents requests from patients who choose to opt out of receiving an itemized bill.

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