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HHS defines surprise medical billing, or balance billing, as follows: “when patients receive care from out-of-network providers or facilities and the service costs are not fully covered by the patient’s insurance provider when they expect them to be”. This new rule, since 2022, has been causing confusion on who it applies to, when it applies, and what are is the specific regulatory guidance that providers need to know to make sure not only the patients are protected, but also, the physician and their practices are compliant. This session will provide background and history, share current industry updates on the No Surprises Act, and touch on how to leverage your operations to stay compliant as well as bring the knowledge gained back to your organization.

Learning Objectives:

• What types of providers does the NSA apply to?
• What types of services are under the NSA?
• Is the NSA only for Emergency Services?
• Does the NSA apply to cash or uninsured patients?
• If the patient is in an OON (Out of Network) Facility, so the NSA apply?
• What is the In-Network physician responsibilities relating to Network Provider Directories?

Areas Covered in the Session:

• Understanding the No Surprise Act (NSA) rules for physician practices
• What is a co-provider under the NSA?
• If an out-of-network provider does not like the payment made by a payer what is their recourse?
• What is the IDR (Independent Dispute Resolution) process?
• Balance Billing vs. Patient share of cost billing
• Are there filing fees due once the IDR process is started? Are they refundable?
• Are the payers reasonable in the process?
• What’s a QPA? What is an Arbiter in this IDR process?
• Live Q&A Session

Suggested Attendees:

• Healthcare Administrators
• Physician and NPPs
• Coders
• Billers
• Collectors
• RCM Team
• Anyone who involved an insurance claim
• 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
• Nurses
• Physician Assistants
• Nurse Practitioners
• Medical Assistants
• Practice Manager
• Office Managers
• Auditors
• CDI Specialists
• 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

Presenter Biography:

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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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