The Texas Department of Insurance (TDI) has proposed amendments to Title 28 Texas Administrative Code, Chapter 21, Subchapter KK, Health Care Reimbursement Rate Information. To view, click on the proposal link.
TDI will consider written comments received by 5 p.m., Central time, on December 21, 2015. The proposal contains detailed instructions for submitting comments.
In collaboration with the University of Texas School of Public Health, TDI has worked to improve the quality and relevance of data provided to consumers through the Reimbursement Rate Guide. Current data is orientated around single medical billing codes, but the full cost of a procedure may include multiple claims, each including multiple lines of billing codes. The proposed methodology is intended to present a more accurate procedure costs by using key target codes. For any claim that includes a target code, the issuer will provide the full cost of the claim, inclusive of the target code and other services provided.
In addition to collecting a more comprehensive set of claims costs, the proposed amendments also include an explicit method for grouping different claims related to the same medical service into a treatment event. This will allow TDI to present cost estimates to consumers that represent the total cost of care, rather than separately presenting facility costs, physician costs, and anesthesiologist costs.