Balance Billing Considerations and Legal Landmines

Event Materials (Key Required)

Course Description

Balance billing in healthcare, especially in relation to Government Programs – Medicare, Medicaid, TRICARE, etc. – poses a significant risk of enforcement action. Routinely writing off out-of-network or government program copayments or deductibles without meeting individual financial hardship exceptions will likely lead to legal liability. Two recent opinions from the Fifth Circuit finally provide answers regarding certain No Surprises Act provisions. The purpose of this webinar is to provide insights on complying with the fraud, waste and abuse laws and the No Surprises Act to avoid legal landmines while establishing a culture of compliance.

Learning Objectives

• Appreciate the history of copays, deductibles and balance billing
• Learn where balance billing is unlawful and how to mitigate liability
• Understand the holdings of the Fifth Circuit regarding the No Surprises Act (NSA)
• Glean compliance tips to avoid legal liability under fraud, waste & abuse laws & the NSA
• Recognize permissible and impermissible copay and deductible waivers
• Understand how EMTALA affects “free” care and balance billing practices
• Identify the key components of the No Surprises Act billing requirements
• Learn how to develop and maintain effective compliance programs to reduce risk
• Analyze recent Fifth Circuit opinions for practical application in healthcare billing
• Explore strategies to foster a culture of compliance and prevent enforcement actions

Areas Covered in the Session

• Definitions
• Evolution of Insurance and Government Programs
• Relevant Fraud, Waste and Abuse Laws
• Permissible and Impermissible Copay and Deductible Waivers
• “Free” Care Under EMTALA
• No Surprises Act billing Components
• NSA Fifth Circuit Opinions
• Compliance Program Requirements
• Live Q&A Session

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Suggested Attendees

• Compliance Professionals / Compliance Officers
• Consultants
• Billers and Coders
• Lawyers, Including In-House, External, Healthcare Attorneys, Defense Counsel, and Relator’s Counsel
• Physicians and Physician Assistants
• Students
• Healthcare CEOs, CFOs, and COOs
• Revenue Cycle Specialists
• Government Organizations
• Cybersecurity Professionals and Consultants
• Anyone in Healthcare

About the Presenter

Rachel V. Rose, JD, MBA is a Principal with Rachel V. Rose – Attorney at Law, P.L.L.C. (Houston, TX). Ms. Rose successfully advises clients on compliance, transactions, government enforcement actions and litigation in healthcare, cybersecurity, corporate and securities law, while successfully representing plaintiffs in False Claims Act and Dodd Frank whistleblower cases.

A Fellow of the Federal Bar Association and the American Bar Association. Currently, she serves on the Foundation Federal Bar Association Board of Directors, is a Member and Immediate Past-Chair of the Federal Bar Association’s Government Relations Committee, and an advisory board member of the Federal Bar Association’s Qui Tam Section. Ms. Rose is the co-editor of the American Health Law Association’s Enterprise Risk Management Handbook for Healthcare Entities (2nd Edition), as well as a co-author of the ABA’s books The ABCs of ACOs, What Are International HIPAA Considerations? and International HIPAA, Privacy, and Security Law Considerations. She has also co-authored a variety of chapters for medical textbooks.

In addition to being extensively published and a sought-after presenter and quoted expert, Ms. Rose holds an MBA with minors in healthcare and entrepreneurship from Vanderbilt University, and a law degree from Stetson University College of Law, where she graduated with various honors. She also holds an Executive Certificate in Negotiation from Harvard Law School.

She has been named consecutively to SuperLawyers (healthcare), the Texas Bar College, the National Women Trial Lawyers Association’s Top 25, Houstonia Magazine’s Top Lawyers (healthcare), the National Trial Lawyers Association’s Top 100, The Nation’s Top One Percent, as well as a two-time 1^st Healthcare Compliance Top Presenter and NBI Distinguished Faculty. Ms. Rose is also an Affiliated Member with the Baylor College of Medicine’s Center for Medical Ethics and Health Policy, where she teaches bioethics.

Additional Information

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.

Can’t Listen Live? No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience.

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

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