Medicaid Billing Requirements for Service Providers in Texas

Each state has specific Medicaid billing requirements for service providers. In Texas, the service providers must meet the state's Medicaid requirements, and also comply with any other applicable federal and state laws and policies that apply to the services they provide.

Services of Physicians

• Physicians can bill Texas Medicaid for any services they provide that are reasonable and medically necessary, and also within the scope of medical practice or osteopathy under the state law. The physician can provide the services herself or delegate them to qualified persons who will act under her supervision. The delegation of services should comply with the rules of the Texas Medical Board, and the physician should accurately document the supervision. However, the physician cannot bill the state if this billing would result in a duplicate payment for the same service.

Physicians Supervising Physicians

• A physician supervising another physician may also bill Texas Medicaid when he supervises under the auspices of an accredited graduate medical education program. Services that a resident physician performs in an outpatient setting are not eligible for reimbursement, unless the accredited medical education program owns or is affiliated with the facilities or professional practice where the resident provides the outpatient service. The physician's supervision must be medically appropriate and the supervision must be of a resident who is performing a service that Texas Medicaid covers.

Nursing-Related Services

• Texas Medicaid also provides for reimbursement for services that a physician assistant or advanced practice nurse provides. They must provide their services that are within the scope of their license. The services should also be consistent with the rules of the Texas Medical Board and Texas Nursing Board. Texas Medicaid billing rules also set forth billing requirements relating to services that a certified registered nurse anesthetist provides.