Sec. 531.1024. HOSPITAL UTILIZATION REVIEWS AND AUDITS: PROVIDER EDUCATION PROCESS. The executive commissioner, in consultation with the office, shall by rule develop a process for the commission's office of inspector general, including office staff and any third party with which the office contracts to perform coding services, to communicate with and educate providers about the diagnosis-related group (DRG) validation criteria that the office uses in conducting hospital utilization reviews and audits.
Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 11, eff. September 1, 2015.
Structure Texas Statutes
Subtitle I - Health and Human Services
Chapter 531 - Health and Human Services Commission
Subchapter C. Medicaid and Other Health and Human Services Fraud, Abuse, or Overcharges
Section 531.101. Award for Reporting Medicaid Fraud, Abuse, or Overcharges
Section 531.102. Office of Inspector General
Section 531.1022. Peace Officers
Section 531.1023. Compliance With Federal Coding Guidelines
Section 531.1024. Hospital Utilization Reviews and Audits: Provider Education Process
Section 531.1025. Performance Audits and Coordination of Audit Activities
Section 531.103. Interagency Coordination
Section 531.1031. Duty to Exchange Information
Section 531.1032. Office of Inspector General: Criminal History Record Information Check
Section 531.1033. Monitoring of Certain Federal Databases
Section 531.1034. Time to Determine Provider Eligibility; Performance Metrics
Section 531.104. Assisting Investigations by Attorney General
Section 531.105. Fraud Detection Training
Section 531.106. Learning, Neural Network, or Other Technology
Section 531.1061. Fraud Investigation Tracking System
Section 531.1062. Recovery Monitoring System
Section 531.108. Fraud Prevention
Section 531.1081. Integrity of Certain Public Assistance Programs
Section 531.109. Selection and Review of Claims
Section 531.110. Electronic Data Matching Program
Section 531.111. Fraud Detection Technology
Section 531.113. Managed Care Organizations: Special Investigative Units or Contracts
Section 531.1131. Fraud and Abuse Recovery by Certain Persons; Retention of Recovered Amounts
Section 531.1132. Annual Report on Certain Fraud and Abuse Recoveries
Section 531.1135. Managed Care Organizations: Process to Recoup Certain Overpayments
Section 531.114. Financial Assistance Fraud
Section 531.115. Federal Felony Match
Section 531.116. Compliance With Law Prohibiting Solicitation
Section 531.117. Recovery Audit Contractors
Section 531.118. Preliminary Investigations of Allegations of Fraud or Abuse and Fraud Referrals
Section 531.119. Website Posting
Section 531.120. Notice and Informal Resolution of Proposed Recoupment of Overpayment or Debt
Section 531.1201. Appeal of Determination to Recoup Overpayment or Debt
Section 531.1202. Record and Confidentiality of Informal Resolution Meetings
Section 531.1203. Rights of and Provision of Information to Pharmacies Subject to Certain Audits