New billing disclosure requirements for physicians effective Sept. 1

In less than one month, physicians must provide written billing policies and cost estimates to uninsured and indigent patients to comply with provisions in a bill passed during the 80th Legislative Session. Upon request by the patient, all Texas physicians must be able to give information on the discounts they provide for medical services to uninsured and indigent patients by Sept. 1. Insured patients can request billing policies and estimates on out-of-network services from their health insurance company. In addition, uninsured patients, patients in government health programs or insured patients receiving out-of-network services can request a cost estimate of proposed medical services from physicians and health plans.

Senate Bill 1731 by Sen. Robert Duncan, R-Lubbock, aims to provide more information to employers, their employees and Texas patients on the cost of health care services and their responsibilities in paying for them.

Once physicians develop and enforce written policies for discounts provided to uninsured and indigent patients, they must also delineate whether any interest will be applied to billed charges not paid by a third-party payer and what procedures exist for handling patient complaints of these charges. Physicians must post a notice in their offices informing patients of the policies.

Senate Bill 1832, also by Duncan, requires physicians billing for pathology services to disclose billing and contact information to health plans or patients. Physicians must either provide a health plan or third-party payer the name and address of the person or laboratory that performed the anatomic pathology service, and the amount the billing physician paid for the service, or must provide a patient an itemized statement of the services and net charges paid.

According to the bill, the requirement applies to histopathology or surgical pathology, cytopathology, hematology, sub-cellular pathology and molecular pathology, and blood-banking services performed by a pathologist.

TAFP is working with the Texas Medical Association to develop billing policies and other educational materials on SB 1731 and SB 1832. Find more information on the bill’s provisions and how to comply with them on the TMA Web site.

NEW: Go to the Resources page – practice management section of the TAFP Web site to access billing disclosure sample forms from TMA.