Relating to billing and reimbursement for certain medical equipment, devices, and supplies provided to Medicare enrollees; creating a criminal offense.

Contracts

• Patient Intake Forms: You must draft a specific "Texas Medicare Excess Charge Waiver." Standard financial responsibility forms are insufficient. This document must explicitly state that Medicare reimburses only 80% of the approved amount and that Medigap plans are not liable for the excess charges.
• Collections Agreements: Review contracts with third-party debt collectors immediately. You must prohibit them from attempting to collect amounts exceeding the 115% cap unless you provide the specific signed waiver. Collecting on an invalid debt under this statute triggers DTPA liability.

Hiring/Training

• Front Desk/Intake Staff: Staff must be trained on a "Stop-Bill" Protocol. They cannot dispense equipment priced above the 115% cap until the waiver is signed and payment/rental terms are agreed upon. Retroactive signatures are not legally binding under this statute.
• Billing Department: Staff must understand that "balance billing" is no longer standard practice for these codes; it is the exception requiring specific documentation.

Reporting & Record-Keeping

• Waiver Retention: You must retain the signed Excess Charge Waiver indefinitely. In the event of a consumer complaint or audit, failure to produce this specific document results in automatic liability.
• System Logic: Your billing software must be updated to flag Medicare enrollees and automatically cap invoices at 115% of the allowable rate unless a manager overrides the system with a confirmed waiver on file.

Fees & Costs

• Legal Costs: Budget for outside counsel to draft the specific waiver language to ensure it meets the statutory "clear and conspicuous" standard.
• Potential Revenue Loss: If your current pricing model relies on balance billing without explicit prior consent, you will lose that revenue stream immediately upon the effective date.