The No Surprise Act 2022: New Rules for Balance Billing & it's Impact on Providers

Thomas J. Force, Esq.

Thomas J. Force, Esq.

As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance...
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Pre-recorded
60 Mins
Thomas J. Force, Esq.

Learn what you (as a Practice, Provider or Facility) need to comply immediately to Stay compliant with NSA

The No Surprises Act has partially become effective following a chaotic and incomplete implementation process. During this webinar, healthcare attorney, Thomas J. Force, Esq. will discuss and breakdown what you need to know regarding: 

  • The aspects with which practices, providers, and facilities are expected to immediately comply (e.g., required disclosures and postings; how and when to balance bill your insured patients; etc.); and 
  • The aspects that will not be enforced (or at least won’t be completely enforced) (e.g., the requirement to provide a good faith estimate including co-party estimates to uninsured/self-pay patients).  

In particular, through this program, you will learn, in detail, what is required to satisfy the aforementioned requirements.  As such, you will be educated as to the form, content, and mediums for the various disclosures. Furthermore, you will be informed about the protocols for properly issuing notice and securing a patient’s consent to allow for balancing billing (i.e., over and above the patient’s in-network cost-share). Finally, advice as to the timing, form, and required information for the provision of a good faith estimate to an uninsured/self-pay patient will be shared, bearing in mind that such a good faith estimate serves as the basis for determining whether a patient can initiate a patient-provider dispute to be decided via arbitration.
 
In addition, during this webinar, Mr. Force will update you on the status of the cases brought by the American Medical Association and American Hospital Association, as well as by the Texas Medical Association, among others, against the U.S. Departments of Health and Human Services, Labor, and the Treasury. These lawsuits generally centre around the current version of the regulations regarding the calculation of the out-of-network reimbursement rate and undue pressure being put on in-network providers to accept reduced rates of reimbursement. These legal cases will be pivotal in determining the effect that the No Surprises Act will ultimately have, as the issue being decided is of critical important in determining how out-of-network reimbursement is calculated (i.e., either similar to in-network rates or based on fair and reasonable considerations).

At the conclusion of this program, there will be an opportunity to have your questions answered by Mr. Force, helping to guarantee that you get substantial value from virtually attending this program.

Webinar Objectives


This presentation seeks to provide clarity to a law that has been haphazardly implemented, despite the multitude of requirements it imposes. Despite the uncertainty underlying the implementation of the No Surprises Act, practices, providers, and facilities remain obligated to comply with numerous aspects thereof.

In addition, this presentation seeks to flesh out the logistics of the notice and consent process and the provision of the good faith estimates to uninsured/self-pay patients, as failure to satisfy the requirements of such processed can have significant negative consequences (i.e., difficulty, if not impossibility, of defending patient-provider disputes; inability to balance bill the patient; etc.).

Webinar Agenda


  • Overview and brief summary of the interim final rules, as published by the Departments of Health & Human Services, Labor, and the Treasury
  • Required Disclosures and Notices – General
  • Required Disclosures and Notices – Balance Billing Rights and Protections
  • Required Disclosures and Notices – Good Faith Estimate Availability
  • Balance Billing Patients – Notice & Consent Requirements (General)
  • Balance Billing Patients – Notice Aspect Requirements
  • Balance Billing Patients – Consent Aspect Requirements
  • Balance Billing Patients – Notice to the Plan/Carrier
  • Good Faith Estimates for Uninsured/Self-Pay Patients
  • Discussion and Update of No Surprises Act-Related Litigation 
  • The American Medical Association’s / American Hospital Association’s Case
  • The Texas Medical Association’s Case
  • What’s Next
  • Questions & Answers

Webinar Highlights


  • How to satisfy the disclosure and notice requirements of the No Surprises Act
  • How to satisfy the notice and consent requirements allowing balance billing of patients
  • How to properly secure the patient’s consent to be balance billed
  • Who needs to be notified (and how such parties are to be notified) of the patient’s consent?
  • How to comply with the requirements of good faith estimate provision to uninsured/self-pay patients
  • The status of vital litigation regarding the No Surprises Act and what the present standing of such cases means for the rules underlying the Act

Who Should Attend


Healthcare providers and facilities, Especially out-of-network providers.

 

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