4-Part Series: Master No Surprises Act New Rules, Reduce Errors and Increase Your Reimbursement

Billing mistakes will cost you so much more than just lost revenue. You can be accused of violating the No Surprises Act, and if found guilty your practice could be in serious legal hot water.

Learning the ins and outs of billing out-of-network patients – including mastering the new IDR (Independent Dispute Resolution) rules for denied out-of-network claims, billing your self-pay patients compliantly, and knowing when you need to send a Good Faith Estimate, will help you avoid significant mistakes and get you paid for your services more quickly.

But don’t panic – There’s help to cut through the confusion so you can comply with the No Surprises Act changes correctly the first time. Get practical, step-by-step advice from nationally recognized experts so you can overcome the intricacies of the law and properly bill your patients in this 4-part online training series. Check out the information below for more details on each training session.

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PART 1: Get Paid for Out-of-Network Denied Services with New IDR Process

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Finally, you can get paid for more of your out-of-network services – even if your claims are denied. The catch is that you must master CMS’ recently implemented IDR process (Independent Dispute Resolution).

Sounds easy enough, right? Wrong.

The new IDR process is complex and confusing. In fact, CMS recently reported that 90% of the over 90,000 disputes were related to CPT codes, and most were submitted with missing or incorrect information – meaning that they are not getting paid. But it doesn’t have to be this way. With a bit of expert help, you can successfully maneuver your way through the complexities of the new IDR process and get more of your out-of-network services paid.

Luckily, healthcare attorneys Daphne Kackloudis, Esq. and Ashley Watson, Esq. can help. Daphne and Ashley are presenting a 60-minute online training that will take you through the complete IDR process one step at a time. This online training will help you submit your out-of-network claim disputes into the IDR process portal correctly the first time and get you paid for these services more quickly.

Here are just a few of the plain-English IDR process tactics questions you’ll get answered by attending this 60-minute online training:

• What is the deadline to formally request an open negotiation?
• What information is necessary to qualify for the IDR process initiation?
• What are the formalized IDR notice requirements?
• How long is the open negotiation period, and who is responsible for its initiation?
• What items should you include when calculating your offer?
• When must multiple IDR items and services be batched before submission?
• What evidence can you submit that will influence a Qualified Payment Amount?
• How should you calculate IDR fees to avoid duplication?
• When are IDR rules bifurcated between federal and state regulations?
• When are you expected to submit an offer to the Certified IDR Entity?
• How can you qualify for and file a deadline extension?
• What information are you required to include at the time of the offer?
• How can you dispute a Certified IDR Entity’s ruling?
• Who should you notify if a payer fails to comply after an IDR ruling?
• And so much more…

PART 2: Comply w/Out-of-Network & Uninsured Patient Billing Rules

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Your failure to adhere to the recently changed out of network billing laws and uninsured patient rules will result in your inability to get paid and leave you exposed to pay significant government penalties.

These recently implemented government regulations are related to the No Surprises Act and affect how you document, bill, and appeal your out of network and uninsured patient claims. They also include mandated audit processes for federal oversight to ensure your compliance.

The No Surprises Act itself is massive. It contains hundreds of pages of confusing federal rules and regulations — all of which you MUST master. Add to this the recent changes to the out of network billing laws and uninsured patient rule, and it can feel impossible to get a handle on these requirements.

Fortunately, you don’t have to do it alone…

Thankfully, that’s where healthcare attorney David Vaughn, Esq., CPC, can help. During his online training, David will provide you with actionable step-by-step tactics to make it easier for you to comply with the complexities of the recent out of network billing laws and uninsured patient rule changes. During this online training, you’ll get clear compliance strategies on balanced billing, out of network billing, and billing uninsured patients. You’ll also get a breakdown of the No Surprises Act documentation and notification requirements to ensure your practice is compliant.

Here are just a few of the questions you’ll get answered during this online training that will help you comply with the recent out of network billing laws and uninsured patient rules:

• Can you balance bill a patient whose insurance is in-network?
• Do you have to provide balance billing notices for services in your office?
• Do you have to give good faith estimates to uninsured patients in your office?
• Are balance billing notices given to self-pay patients?
• What is the difference between a balance billing notice and a good faith estimate notice?
• What are the two types of balance billing notices and how are they different?
• How much do you get paid if you are OON?
• What are the time frames when you can negotiate your fees or appeal a low-ball payment?
• How much does it cost to appeal a low payment by an insurer?
• Are Non-Physician Practitioners also required to comply with out of network billing laws?
• How much time do you have to provide written notice and get consent?
• Does the No Surprises Act apply to Medicare and Medicaid patients?
• Who is the convening provider and what are its obligations?
• Are you allowed to negotiate a better out of network rate with the payer?
• Can patient notifications be provided electronically, or must they be paper?
• What recourse do you have if a payer fails to pay correctly for out of network services?
• When is a notice of consent required for billing out of network?
• How to get penalties waived if they are assessed against you?
• Are you required to post an out of network billing notice? If yes, where?
• How should you respond if a patient or payer initiates an independent dispute resolution?
• Can hospital-based physicians balance bill (i.e., anesthesiology, pathology, etc.)?
• And so much more!

PART 3: No Surprises Act: Boost Self-Pay Collections, Stop Hefty Fines

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Recent changes to the No Surprises Act have made it harder than ever for you to get paid what you’re due from your self-pay patients. The Act also expands your risk with errors driving penalties of up to $10,000 per violation.

Some of the riskiest areas of the No Surprises Act include how, when, and what you can bill your self-pay patients, what is a Good Faith Estimate, and when are you required to provide one to your self-pay patients…it’s all enough to make your head spin.

Missing even one piece of this frequently evolving regulation when billing and collecting from your self-pay patients can cost you thousands in lost revenue and penalties – driven by you not implementing the rules correctly.

Thankfully, that’s where healthcare attorneys, Daphne L. Kackloudis, Esq., and Ashley B. Watson, Esq., can help. During this online training session, they’ll provide you with easy-to-follow No Surprises Act expert advice to ensure you’re billing and collecting your self-pay patients compliantly. You’ll reduce your error risk and the massive penalties that can accompany them.

Here are just a few of the practical No Surprises Act questions you’ll get answered by attending this 60-minute online training:

• What are the allowable rates for self-pay patients?
• How can you calculate your Qualifying Payment Amount (QPA)?
• Which self-pay patients are excluded from the No Surprises Act rules?
• Are Good Faith Estimates required for uninsured same-day appointments?
• How should you bill a self-pay patient receiving same-day services?
• When are diagnosis codes required on your Good Faith Estimates?
• What if the insurance won’t pay, and the patient is left to self-pay?
• When are you required to notify self-pay patients of the No Surprises Act?
• How does co-provider care change your Good Faith Estimate Change?
• What is the best way to handle notifications for future visits?
• For recurring services, are you required to provide an estimate every time?
• How can you check if there has been a No Surprises Act complaint against you?
• What if a patient is insured but chooses to self-pay?
• How should you handle unforeseen services that occur during a visit?
• What if the patient refuses to sign the estimate, but still wants care?
• What if a patient comes in for a procedure and no longer has insurance?
• How long are you required to keep a copy of a Good Faith Estimate?
• How can you indicate recurring services on patient Good Faith Estimates?
• And so much more…

PART 4: No Surprises Act: Stop Fines, Ace Self-Pay Good Faith Estimates

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As of January 1^st, 2022, your practice is required to comply with the No Surprises Act, which includes providing your uninsured (self-pay) patients with an “accurate Good Faith Estimate” for your services.

Sounds easy enough, right? WRONG. The federal regulations regarding how you must supply accurate Good Faith Estimates are vague and confusing, and if not done right, they leave you exposed to significant financial penalties from HHS. Penalties range from the full waiver of a patient’s bill to a fine of up to $10,000 per offense.

So, if the federal requirements are not clear on how to provide an accurate Good Faith Estimate, how are you expected to comply?

Fortunately, there is help available. During her 60-minute online training, expert and healthcare attorney, Gina L. Campanella, Esq., FACHE, will walk you through exactly how to prepare a correct, compliant Good Faith Estimate. Gina will boil down the Good Faith Estimate process into clear, understandable steps. She’ll cut through the No Surprises Act legal jargon of supplying an accurate Good Faith Estimate and help you avoid errors that lead to lost revenue, audits, and sky-high monetary penalties.

Here are just a few of the questions you’ll get answered during this upcoming 60-minute online training that will help you comply with the complexities of providing an accurate Good Faith Estimate to your uninsured (self-pay) patients:

• How should you respond to a patient dispute resolution based on your estimate?
• What charges should be included and excluded on an estimate?
• How far in advance of a procedure must you provide a Good Faith Estimate?
• What disclaimers must be included on each Good Faith Estimate to comply with the law?
• Does the type of service you provide dictate the format of your estimate?
• Are you ever required to provide estimates to Medicare/Medicaid patients?
• If a patient has insurance but chooses to self-pay, are you required to provide a Good Faith Estimate?
• What format must your Good Faith Estimate be in: hard copy or electronic?
• Are you required to include possible financial assistance options on your estimates?
• How long are you required to keep the estimate if the patient chooses not to be treated?
• Is an accurate Good Faith Estimate required if the patient has no financial responsibility?
• Should your estimate include services from all providers that may treat the patient?
• How can you provide an accurate Good Faith Estimate without a diagnosis?
• If your practice posts its prices, are you still required to provide a Good Faith Estimate?
• What if your initial Good Faith Estimate needs to be changed?
• How detailed must your Good Faith Estimate be (i.e., supplies, etc.)?
• Does providing your estimate over your patient portal comply with requirements?
• Are there specific patient questions to help you comply (i.e., do you have internet access)?
• Are you required to provide your Good Faith Estimate to HHS as well as the patient?
• And so much more!

Past Webinar Reviews:

“The webinar highlighted specific requirements of the NSA. I appreciated reviewing exactly what we (providers) need to be doing for this regulation.”
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