Medical Billing Services in Houston

Medical billing services in Houston for clinics, EDs and ASCs

Fastora provides medical billing services in Houston for physician clinics, behavioral health groups, freestanding emergency facilities and ambulatory surgery centers. We are headquartered in Austin and work remotely inside your EHR/PM system, from the Texas Medical Center area out to Sugar Land, Katy, Pearland and The Woodlands.

Houston has more facility-based outpatient care than most markets, and facility claims follow different rules from professional claims. This page focuses on those differences: Texas rules for freestanding emergency medical care facilities, ASC claims and payer coverage, and Medicaid billing across the Harris service area.

Freestanding ER billing in Houston

Texas licenses freestanding emergency medical care facilities separately from hospitals, under Health and Safety Code Chapter 254. Some are departments of a hospital (often called satellite EDs) and bill as part of that hospital; others are independent and licensed on their own. That distinction drives almost every billing decision.

Disclosure and notice rules

Since HB 2041 took effect on September 1, 2019, a facility must post notices at its entrance, in treatment rooms, where payment is taken and on its website, in English and Spanish. The notice states that the facility charges rates comparable to a hospital emergency room, may charge a facility fee, and that physicians may bill separately, and it lists the health plans the facility is in network with or says it is out of network for all plans.

The facility must also give patients a written disclosure of its facility and observation fees. Billing teams should keep proof that notices and disclosures were provided, because patient complaints and payer reviews often start there.

Payer coverage and claims

Our emergency medicine billing work covers both facility and professional claims, including E/M level support from documentation and appeals on downcoded visits.

ASC billing in Houston

Ambulatory surgical centers in Texas are licensed by HHSC under Health and Safety Code Chapter 243 and the rules in 25 TAC Chapter 135. Medicare certification is a separate process with its own federal standards, so a licensed center still needs Medicare enrollment before it can bill Novitas Solutions, the Jurisdiction H MAC.

For ASC billing in Houston, the main checks are coverage and authorization. Medicare pays ASC facility fees only for procedures on its ASC covered procedures list, and commercial plans set their own lists and site-of-service rules. We confirm coverage and prior authorization for each scheduled case, match implant and supply charges to the payer's rules, and reconcile payments case by case.

See our ambulatory surgery center billing page for coding and payment detail.

Medicaid billing across the Harris service area

HHSC's Harris service area covers Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton counties. STAR, STAR+PLUS and STAR Kids members in all of those counties choose from the same set of MCOs, so a Houston group with clinics in several suburbs works with one Medicaid plan list.

Medical billing in Sugar Land (Fort Bend County) and medical billing in The Woodlands (Montgomery County) therefore follow the same Medicaid rules as central Houston. What changes from clinic to clinic is usually the commercial mix and which plans each location is contracted with.

We confirm program and MCO on the date of service, check plan-specific authorization lists, and file within the 95-day window that TMHP and the managed care manual set for most claims.

Mental health billing in Houston

Mental health billing in Houston covers a mix of psychiatry groups, therapy practices and substance use treatment programs. Behavioral health benefits are often administered by a different entity than medical benefits, so we verify them separately and track session limits and reauthorization dates.

Medicare has enrolled marriage and family therapists and mental health counselors since January 1, 2024, and many Houston-area LPCs and LMFTs now bill Medicare for the first time. We handle that enrollment and the coding checks that come with it. Learn more about our behavioral health billing work.

Choosing among medical billing companies in Houston

When you compare medical billing companies in Houston, ask how each one handles facility claims, not only professional ones.

• Can they bill both the facility and the professional side of an emergency visit?
• How do they handle out-of-network emergency claims under SB 1264 and the No Surprises Act?
• Do they check ASC covered procedure lists and site-of-service rules before surgery day?
• Will they work inside your EHR/PM system and keep you on a single account contact?
• How is pricing set? Our pricing approach is explained before any quote.

Fastora works remotely with every Houston client: a dedicated account contact, dashboards, monthly reporting and a monthly review call. Our full range of medical billing services and credentialing for new providers and locations is available to Houston practices.

Groups expanding north can also review Dallas medical billing services.