No Surprise Act: Balance Billing Rules and Out-Of-Network Rule

Description:

The U.S. Department of Health and Human Services (HHS) is randomly investigating provider compliance with the No Surprises Act. Providers must comply with the No Surprises Act as they are at risk of being audited and may face heavy penalties. The No Surprises Act is effective from Jan 2022 and was implemented, which established new federal protections against surprise medical bills in addition to good faith estimate requirements for self-pay patients.

The No Surprises Act is one of the more confusing provisions to regulate the health care industry in recent times. The act has changed the process how you balance bill commercial insurance patients and how you bill out-of-network and uninsured patients. The Act also includes an audit procedure for federal oversight, which means they are watching. It consists of tons of confusing federal rules and regulations which you must comply. The healthcare attorney David Vaughn, Esq., CPC, will provide you with actionable strategies on balanced billing, out-of-network billing, and billing uninsured patients.

Learning Objectives:

• Analyze the impact of the Surprise Billing Regulations
• Describe how to develop monitoring tools as new payments are received
• Explain the Independent Dispute Resolution (IDR) Timing and Process
• Learn the difference between billing notice and a good faith estimate notice
• Learn the type of balance billing notices
• Learn balance billing of In-Network and Out-of-Network
• Know the rules for Non-Physician Practitioners(NPPs)
• Know how patient cost-sharing and provider payment determined.
• Learn what obligations exist to provide good-faith estimates to patients.
• When and how can OON provider get consent to balance bill for non-emergency services
• Know when and how can OON provider or facility get consent to balance bill for Post-Stabilization Process.

Areas Covered in the Session:

• Legal and Regulatory Framework
• Federal and State Coordination on Enforcement
• No Surprise Act and Balance Billing
• Documentation Requirements
• Overview of the Services to IDR Process Timelines
• Determination of Patient Cost-Sharing Based upon Recognized Amount
• Payment to OON Provider
• Good Faith Estimate (GFE) for Uninsured or Self-Pay Patients
• State Variation with Insurer and Provider Enforcement Issues
• Hospital-based Physician balance billing
• Notice of Consent
• Live Q&A Session

Suggested Attendees:

• Medical providers, who are involved in the payment process of their practice
• C-level executives
• Office staff and Billing Managers
• Medical Billing Companies
• Hospital Revenue Cycle Staff
• Physician
• Nurses
• Physician Assistants
• Nurse Practitioners
• Medical Assistants
• Practice Manager
• Office Managers
• Billers
• Coders
• Auditors
• CDI Specialists
• Collection Staff
• Front Desk
• IT Specialists
• HIPAA Privacy and Security officers.
• Compliance Officers
• Telemedicine System Vendors
• Patient Accounts Personnel
• Medical record supervisors
• Health Information Management Administrators and Technicians
• Other Personnel Interested in Billing Privileges with the Medicare Program

About the Presenter:

David Vaughn, JD, CPC is one of the top healthcare attorneys in the United States who is is the founding member of Vaughn & Associates, LLC. He graduated from Mississippi College with Special Distinction (Magna Cum Laude) in 1974, graduated from LSU Law School in 1977, and has been a certified coder since 1999. David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.

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 Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6

Internet Speed: Preferably above 1 MBPS

Headset: Any decent headset and microphone which can be used to talk and hear clearly

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: support@skillacquireupdate.com