New Billing
Disclosures
Required
Two new laws went into effect
Sept. 1. Both affect your billing
procedures and policies.
The new laws are a result of
Senate
Bills 1731 and 1832.
Here is what
you need to do.
SB 1731
The spirit of the bill is to ensure Texas patients,
whether insured or uninsured, have access to important information
so they can make better health care decisions. The bill imposes
transparency requirements on all — physicians, hospitals, and
health plans.
All physicians must:
• Post a notice in your waiting room to inform patients they can
request a copy of your billing policies.
• Adopt billing policies and procedures that inform patients:
1. About possible patient discounts for charity care and the
uninsured,
2. Whether late payments will incur interest, and
3. About your billing complaint process and procedures.
Physicians treating out-of-network and uninsured
patients must follow these requirements:
• Patients can request a written estimate of their out-of-pocket
expenses (due within 10 days). The estimate can list these
disclaimers:
1. Charges may vary based on the patient’s condition.
2. The request can delay the scheduling of care.
3. The actual charges may differ from the amount paid by
the third-party payer.
4. The patient is personally liable for the services not paid by
health insurance.
• Health plans must estimate the amount an insured patient will
pay for proposed services if requested. For in-network services,
direct patients to their health plan.
• Patients can request an itemized statement of the charges within
one year. You have 10 business days to comply.
• Your patient can request up to two additional statements for free.
• You must refund a patient overpayment within 30 days.
Facility-based physicians* billing an insured patient for
out-of-network services must disclose:
• Itemized services and supplies,
• Date services were provided, and
• Clear statements that:
1. You are not in the patient’s health plan.
2. The health plan does not cover your total charge.
3. The patient can call to discuss billing arrangements and
4. If a payment arrangement is made, you will not report the
patient to a collection agency if he or she makes payments
according to the agreement.
• You also must provide billing phone number and information
on how to file a complaint with the Texas Medical Board (TMB),
along with TMB’s mailing address and telephone complaint
number.
* Includes radiologists, anesthesiologists, pathologists, emergency
physicians, and neonatologists.
SB 1832
The intent of this bill is to provide
transparency and disclosure for anatomical pathology
services. It applies only to a physician or entity that
bills for the service but neither performs nor supervises
the service.
The disclosure requirements affect only anatomical
pathology services.
Disclosure requirement:
• If you bill for an anatomical pathology service and
do not perform or supervise the service, you must
disclose:
1. The price you paid for the service, and
2. The physician or lab that actually performed
the service.
• The law allows the billing physician to provide
written disclosure to either the patient or the patient’s
health plan.
The Texas Medical Board is drafting rules to implement
this law.
Stay current and in compliance
with Texas laws!
TMA has developed a comprehensive
guide for physician practices:
TMA’s Standard Policies and Procedures Manual
• The manual will be updated to reflect these new
laws and changes to many others.
• The publication will be available in January for
$250 in hard copy and on CD-ROM.
• You can purchase your publication through the
TMA Store.
