Compliance W/ Out-of-Network & Uninsured Patient Billing Rules of No Surprises Act

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:

• Clarify the current rules on billing insured and uninsured patients.
• Discuss recent court cases and recent rule changes by DHHS.
• Distinguish billing insured patients who receive non-covered services.
• Learn about the different rules affecting different places of service.
• Distinguish the rules for Medicare, Medicare Advantage, Medicaid,and commercial insurance.
• Learn about good faith estimates, their notices, and timing.
• Learn about the balance billing notices, forms, and timing.
• Discuss the IDR process and how you get paid.
• Analyze the different obligations affecting “convening providers.”
• Address the difference between emergency and non-emergency services.
• Understand the limitations on billing for “ancillary services.”
• Determine if balance billing is allowed for patients with in-network insurance plans.
• Review the requirements for providing balance billing disclosures in physician offices.
• Examine when good faith estimates must be shared with uninsured patients during office visits.
• Identify whether self-pay patients are entitled to balance billing notifications.
• Understand how good faith estimate notices differ from balance billing disclosures.
• Break down the two categories of balance billing notices and what sets them apart.
• Calculate expected reimbursement when providing services as an out-of-network provider.
• Outline the time-sensitive steps for fee negotiation or appealing an underpayment.
• Estimate the costs involved in challenging low reimbursement via the federal dispute process.
• Evaluate how the rules apply to nurse practitioners, PAs, and other non-physician practitioners.
• Know how much lead time is required to issue patient notices and obtain valid consent.
• Clarify whether the No Surprises Act applies to patients covered under Medicare and Medicaid.
• Understand who qualifies as the convening provider and what compliance duties they have.
• Assess your options for negotiating higher out-of-network rates directly with payers.
• Confirm whether patient notifications can be sent electronically or must be delivered in print.
• Explore the steps to take if a health plan underpays or fails to pay for an out-of-network claim.
• Determine when written consent is mandatory before billing a patient for out-of-network care.
• Identify strategies for requesting a waiver or reduction of penalties for non-compliance.
• Learn where and how out-of-network billing notices must be publicly posted.
• Respond appropriately when a patient or insurer initiates the independent dispute resolution (IDR) process.
• Review balance billing restrictions specific to hospital-based specialists like anesthesiologists and radiologists.
• Live Q&A Session

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: