1. (a) Itemized statements. A facility shall adopt, implement, and enforce a policy to ensure that the facility complies with the Health and Safety Code (HSC), §311.002 (relating to Itemized Statement of Billed Services).
2. (b) Audits of billing. A facility shall adopt, implement, and enforce a policy to ensure that the facility complies with HSC, §311.0025(a) (relating to Audits of Billing).

3. (c) Complaint investigation procedures.

   1. (1) A complaint submitted to the department relating to billing must specify the patient for whom the bill was submitted.

   2. (2) Upon receiving a complaint warranting an investigation, the department shall send the complaint to the facility requesting the facility to conduct an internal investigation. Within 30 days of the facility' receipt of the complaint, the facility shall submit to the department:

      1. (A) a report outlining the facility's investigative process;
      2. (B) the resolution or conclusions reached by the facility with the patient, third party payor or complainant; and
      3. (C) corrections, if any, in the policies or protocols which were made as a result of its investigative findings.
   3. (3) In addition to the facility's internal investigation, the department may also conduct an investigation to audit any billing and patient records of the facility.
   4. (4) The department may inform in writing a complainant who identifies themselves by name and address in writing of the receipt and disposition of the complaint.
   5. (5) The department 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.

Source Note:The provisions of this §510.45 adopted to be effective January 1, 2004, 28 TexReg 5154; transferred effective June 1, 2019, as published in the Texas Register May 17, 2019, 44 TexReg 2469.