No Surprises, No Mistakes: Navigating Billing Compliance for Out-of-Network & Uninsured Patients

No Surprises, No Mistakes: Navigating Billing Compliance for Out-of-Network & Uninsured Patients

Price range: $251.00 through $255.00

 Original price was: $399.00.Current price is: $251.00.
 Original price was: $349.00.Current price is: $254.00.
 Original price was: $349.00.Current price is: $255.00.

Billing out-of-network and uninsured patients can be a nightmare. The rules differ by provider discipline, by facility, by insurance type. Notices are required; specific verbiage is required; specific timing is required. Different rules apply depending on whether the patient is completely insured, not insured at all, or insured but the service provided is not covered. Federal courts have reversed certain portions of the NSA, and DHHS has revised various sections of the NSA. The purpose of the webinar is to add clarity to the current rules, regulations, and cases so providers are not assessed penalties for failure to follow current rules. During this online training, you’ll get clear compliance strategies on balanced billing, out-of-network billing, and billing uninsured patients.

Learning Outcomes:

The goal of this webinar is to educate the attendees on the current state of the law regarding the NSA, including court decisions, changes by DHHS, and the complex rules and requirements for billing insured, uninsured, and partially insured patients, in all types of facilities, for all types of payors.

Areas Covered in the Session:
  • Outline
    • NSA: When it Applies & How it Works
    • OON Billing of Insured Patients
    • Notices for Balance Billing
    • Billing Uninsured Patients
    • Good Faith Estimates
  • NSA: Four Distinct Protections
    • No Balance Billing (“BB”) by OON Providers
    • Rights of Uninsured Patients to get
    • Rights to IDR (independent dispute resolution)
    • Rights of OON Providers to be Paid as In-Network
  • The Act protects 2 types of Pts
    • Protections for Insured Pts
    • Protections for Uninsured
  • Place of Service Matters
    • The BB protections only apply in facilities
    • The GFE protections
    • “Ancillary service providers” cannot BB
      • Even with patient’s consent
      • Anesthesiology, Pathology, Radiology, ER, Neonatology
      • Assistant surgeons, hospitalists, intensivists
      • Includes services NPPs of these disciplines (CRNAs)
  • State Surprise Billing Laws Matter
  • What are “Facilities”?
    • Types of facilities included in the Act:
      • Hospitals
      • HOPDs
      • ASCs
      • Critical access hospitals
  • Act Applies to 4 Types of Services
    • Emergency services for insured Pts
    • Non-emergency services for insured Pts
    • Air ambulance services for insured Pts
    • Uninsured Pt services
  • The Act Does Not Apply to Some Pts
    • Medicare, Medicaid, TRICARE
    • These programs have their own protections
  • Charge Submission & Payment
  • How is Payment Determined?
  • Current Litigation Status
  • IDR Costs are IMPORTANT
  • What Happens if You Only Win Some of the Appealed Claims?
  • Administrative Costs: Batched vs Single Claims
  • When is Batching Allowed
  • IDR Costs: Batched vs Single Claims
  • How the IDR Fees Work
  • Lower Priced IDR Entities Max Out Quickly
  • Wait Times to Get Paid
  • How to Collect Interest from Payers
  • Balance Billing Notices
  • If You Want to Balance Bill, 2 Notices are Required
  • Forms for BB Notices
  • BB Protection Notice is Given x 3
  • Timing of Giving BB Notice & Consent Forms
  • Agreement for Facility to Provide Notices #2 and #3
  • Don’t Give the BB Consent Form to
  • Penalties for Wrongful BB
  • Billing Uninsured Patients
  • Good Faith Estimates (”GFEs”) to Uninsured Patients
  • Methods of Giving Notice of GFE to Uninsured Patients
  • Methods of Giving GFE Itself
  • Timing of the Good Faith Estimate (“GFE”) Itself
  • Where to Download GFE Estimate Form
  • Where to Download GFE Notice
  • Obligations of Convening Provider re the GFE to Uninsured Pts
    • A convening provider/facility is the one who
    • On request for GFE, the convening provider
  • Uninsured IDR Process
    • Uninsured Pt has IDR rights
    • Pt has 120 days from getting your bill to start IDR
    • IDR process takes 30 days
  • Provider’s Burden of Proof
  • Fees
  • No Collection Efforts During IDR Process
Recommended participants:
  • Physician Practices
  • Medical Providers Involved in the Payment Process
  • C-Level Executives in Healthcare
  • Office Staff & Billing Managers
  • Medical Billing Companies
  • Hospital Revenue Cycle Staff
  • Physicians, Nurses, and Specialists
  • Physician Assistants & Nurse Practitioners
  • Medical Assistants
  • Practice Managers
  • Office Managers
  • Medical Billers, Coders, and Auditors
  • CDI Specialists
  • Collection Staff
  • Compliance Officers
  • Patient Accounts Personnel
  • Medical Record Supervisors
  • Health Information Management Administrators and Technicians
  • Billing and Coding Consultants
  • Insurance Verification Teams
  • Healthcare Attorneys & Legal Professionals
  • Healthcare Administrators
  • Revenue Cycle Consultants
  • Other Healthcare Personnel Interested in Billing Compliance and Payment Systems
  • Healthcare Providers (Physicians, NPs, PAs, etc.)
  • Billing Managers
  • Compliance Officers
  • Revenue Cycle Managers
  • Insurance and Payer Relations Professionals
  • Medical Office Administrators
  • Legal Professionals in Healthcare
  • Hospital and Specialty Practice Billing Teams
  • Patients & Advocates
Presenter Biography:

David Vaughn, ESQ., CPC, is an attorney with over 25 years of experience whose practice involves representing healthcare providers around the country regarding billing and healthcare compliance issues. David has also been a certified coder for 25 years. David has previously written articles on the No Surprises Act (“NSA”) and spoken nationally regarding this topic. Over the past 25 years David has been retained to defend healthcare providers in criminal investigations, False Claims Act cases, OIG investigations, FBI investigations, and a myriad of Medicare audits. David and his firm perform internal audits for their own clients to ensure compliant billing.

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
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: +1 800-757-9502
Email: cs@waymoreeducation.com