The New Federal No Surprise Act – Impact on Out-of-Network Providers
This webinar by industry expert speaker and renowned attorney Thomas J. Force, Esq. is intended to break down the new Federal No Surprises Act, enacted as part of the Consolidated Appropriations Act, 2011, which is intended to protect patients from “surprise” medical bills, including those arising when out-of-network providers utilize and provide services at an in-network facility. Essentially, the goal of the No Surprises Act is to remove the patient from serving as the intermediary between the insurer/payor and the provider/practice.
The program will first help you determine whether the No Surprises Act affects your practice and, if so, provide considerable insight into the detailed requirements and processes underlying the Act. The No Surprises Act contains many requirements that may result in difficult decisions having to be made, depending on the nature of your practice. Such decisions and considerations will include, among others:
- Whether to provide the notice and secure the consent of the patient required in order to balance bill the patient or, alternatively, refrain therefrom to allow for use of the Independent Dispute Resolution (IDR) process.
- How to proceed through the IDR process, if this is the avenue selected, including how to appropriately calculate the offer submitted to the IDR entity (i.e., the arbitrator that will decide between the amounts submitted by the provider/practice and insurer/payor, respectively).
To aid you in making such determinations in the future, the program will set forth key aspects of the No Surprises Act, such as:
- How future rules and regulations promulgated by HHS in the near future may affect your determinations;
- An overview of the IDR process, including timelines related thereto;
- How the IDR entity makes a decision and the factors that it can consider;
- The IDR waiting period and batching of claims;
- Other cost considerations (e.g., how the IDR entity is paid);
- The impact that previous IDR determinations will have on future negotiations and/or IDR entity determinations;
- The impact of and relationship to State Law; and
- For the notice and consent requirement for balance billing:
- Timeframes for providing notice and securing consent;
- Required notice contents;
- Required consent contents.
Put simply, this program will provide you with the necessary tools and insight to understand how to effectively navigate the road ahead, as a result of the No Surprises Act, based on the specifics of your practice and its operation.
This webinar will address the following areas of concern:
- What to consider in determining whether to balance bill your patients or take advantage of the IDR process established by the No Surprises Act;
- Risks of relying on the IDR process or inappropriately calculating the extent of an “offer” to be submitted to the IDR entity;
- Avoiding delays or other hindrances to your revenue cycle, particularly based on the availability and restrictions of the IDR process; and
- Potential pitfalls experienced in attempting to satisfy the notice and consent requirement for balance billing.
- Introduction to the No Surprises Act
- The Effect of the No Surprises Act on Health Insurers/Payers
- The IDR Process – Overview and Specifics
- Notice and Consent Requirements – Overview and Specifics
- Additional Aspects of the No Surprises Act
- Key Takeaways
- The goals underlying the No Surprises Act
- How your practice may be affected by the No Surprises Act
- The IDR Process – Overview and timeframes
- The IDR Process – Decision-making considerations
- The IDR Process – How to submit an offer that will provide the best results, both for the immediate claim(s) at issue, but also for future claims.
- The IDR Process – Limitations, concerns, and exceptions
- How to satisfy the notice and consent requirements for balance billing
Who Should Attend
Healthcare professionals (doctors, surgeons, mid-level providers – nurse practitioners and physician assistants), particularly those who are out-of-network, as well as medical practice owners, managers, and operators, will find this program beneficial.
Thomas J. Force, Esq.
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