Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 510 - PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
Subchapter C - OPERATIONAL REQUIREMENTS
Section 510.45 - Billing Requirements
Universal Citation: 26 TX Admin Code ยง 510.45
Current through Reg. 49, No. 38; September 20, 2024
(a) Itemized statements.
(1) A facility shall
adopt, implement, and enforce a policy to ensure that the facility complies
with Texas Health and Safety Code (HSC) §311.002.
(2) A facility shall comply with the itemized
bill requirements under HSC §185.002.
(b) Audits of billing. A facility shall adopt, implement, and enforce a policy to ensure that the facility complies with HSC §311.0025(a).
(c) Complaint investigation procedures.
(1) A
complaint submitted to the Texas Health and Human Services Commission's
Complaint and Incident Intake relating to billing must specify the patient for
whom the bill was submitted.
(2)
Upon receiving a complaint warranting an investigation, Texas Health and Human
Services Commission (HHSC) shall send the complaint to the facility requesting
the facility to conduct an internal investigation. Within 30 days of the
facility's receipt of the complaint, the facility shall submit to HHSC:
(A) a report outlining the facility's
investigative process;
(B) the
resolution or conclusions reached by the facility with the patient, third party
payor, or complainant; and
(C)
corrections, if any, in the policies or protocols which were made as a result
of its investigative findings.
(3) In addition to the facility's internal
investigation, HHSC may also conduct an investigation to audit any billing and
patient records of the facility.
(4) HHSC may inform a complainant who
identifies themselves by name and address in writing of the receipt and
disposition of the complaint.
(5)
HHSC shall refer investigative reports of billing by health care professionals
who have provided improper, unreasonable, or medically or clinically
unnecessary treatments or billed for treatments which were not provided to the
appropriate licensing agency.
(d) Balance billing.
(1) A facility may not violate a law that
prohibits the facility from billing a patient who is an insured, participant,
or enrollee in a managed care plan an amount greater than an applicable
copayment, coinsurance, and deductible under the insured's, participant's, or
enrollee's managed care plan or that imposes a requirement related to that
prohibition.
(2) A facility shall
comply with Senate Bill 1264, 86th Legislature, Regular Session, 2019, and with
related Texas Department of Insurance rules at 28 TAC Chapter 21, Subchapter
OO, §§21.4901 - 21.4904 (relating to Disclosures by Out-of-Network
Providers) to the extent this subchapter applies to the facility.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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