Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 357 - HEARINGS
Subchapter M - FRAUD OR ABUSE INVOLVING MEDICAL PROVIDERS
Section 357.595 - Obligation of Health Care Practitioners and Providers
Universal Citation: 1 TX Admin Code ยง 357.595
Current through Reg. 49, No. 38; September 20, 2024
(a) Each provider is responsible for ensuring that items or services furnished personally by, at the medical direction of, or on the prescription or order of an excluded physician are not billed to the Titles XIX and XX programs after dates specified in this subchapter.
(b) Providers must not bill recipients for services or items specified in subsection (a) unless:
(1) the recipient is informed, before
delivery of the item or service, that those services are not reimbursed by the
department; and
(2) the provider
obtains and retains before delivery of the item or service, a signed consent
from the recipient indicating that the recipient understands he is responsible
for the payment of these services and that he still requests the
service.
(c) Providers who violate department rules by billing recipients are subject to all applicable administrative sanctions described in Subchapter V of this chapter (relating to Fraud and Abuse).
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