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

1. The amount the healthcare provider agrees to accept as full payment for each healthcare service and supply that provider provided to the patient.
2. 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).
3. 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.