Head Off Avoidable Balanced Billing Violations & Massive Fines

Routinely writing-off out-of-network co-payments or amounts due to financial hardship will most certainly land you in hot water with the OIG – unless you know exactly how to comply with the new balanced billing laws.

Balanced billing laws and regulations continue to be more complicated each year. Many states now require you to get out-of-network payment from your health plan, not your patient. What makes it worse is that CMS and private payer auditors actively watch and wait for you to slip up. The only way to avoid being targeted is to master the complexities of balanced billing requirements.

For example, you must have a firm handle on when and how much you can write off for out-of-network providers or patients with financial hardships. Even simple mistakes when complying with balanced billing laws can lead to massive violation penalties and even jail time – really.

But, with some help, you can comply with the complexities of balanced billing laws, avoid stressful audits and steer clear of the massive penalties the violations can bring.

This is where attorney Heidi Kocher, BS, MBA, JD, CHC, can help. During her 60-minute online training session, Heidi will show you the right and wrong way to write off patient amounts due. This training will help you more easily comply with CMS, OIG, and federal and state Balanced Billing rules.

During this training, Heidi will walk you through EXACTLY when and how to use waivers, comply with balanced billing laws, and correctly manage write-offs, so you hold onto your reimbursements and stay out of legal trouble.

Here are just a few of the step-by-step balanced billing law compliance tactics you’ll receive by attending this online session:

  • Uncover how to legally write off some balances when billing out of network
  • Meet billing requirements to avoid criminal prosecution
  • Stop OIG fraud charges from your use of routine waivers and write-offs
  • Pin down the difference between professional courtesy and insurance only
  • Implement policies to monitor your write-offs and bad debt
  • Determine when and if you can really offer professional courtesy
  • Identify the possible punishment and penalties for improper balance billing
  • Train staff to avoid discount compliance dos and don’ts
  • Avoid violating Stark and Kickback statutes due to balance billing
  • Proven tips to keep your billing compliant and legal
  • Identify when and if it is okay to write off co-pays or deductibles
  • And so much more…

WARNING: There are actual cases where physician practices, just like yours, tried to do everything right and still got into trouble for not complying with balanced billing laws. For example, a California physician got five days in jail and a $562,500 fine, another practice was required to repay $4.3 million after being sued by an insurance carrier for balanced billing, and a pulmonology practice paid $10,000 in fines and had to repay $2.5 million in collected funds.

It’s essential that you master how to correctly maneuver through the legal pitfalls of balanced billing laws, or you could end up like the physicians in the cases above. Don’t take a chance. Sign up for this expert-led online training session today.

Meet Your Expert

Heidi Kocher
B.S., M.B.A, J.D., CHCHealthcare Attorney, Liles Parker PLLC

Heidi has 20 years of experience in health care legal and compliance related issues. Her experience includes positions at a large hospital corporation, serving as a compliance officer for a sleep lab/DME company and a compliance director, chief privacy officer and interim chief compliance officer at a medical device manufacturer.

In addition, she has represented and advised critical access and long-term care hospitals, physician groups, home health agencies, DME companies, pharmacies (including compounding pharmacies), non-profit organizations, and licensed individuals. As a result, she understands the complexities and challenges that providers large and small face in complying with increasingly varied and complex laws.

She is an expert in all aspects of compliance and privacy programs, including developing and deploying policies, procedures and training. Her experience includes implementing the various requirements and aspects of a Corporate Integrity Agreement, responding to and defending audits from Medicare, Medicaid and private insurers up through the ALJ level, guiding clients through voluntary self-disclosures, seeking advisory opinions from the OIG, and defending FDA audits.

Heidi developed criteria for and implemented an aggregate spend system, permitting a medical device manufacturer to timely report correct information under the Physician Open Payments Acts (also known as the Physician Payments Sunshine Act).

In addition, she is experienced in developing and implementing a compliance program to address Foreign Corrupt Practices Act requirements, including Eucomed guidelines. She also has significant reimbursement experience, addressing coverage policy issues, challenging denials, recoupments, and loss of billing privileges, obtaining HCPCS codes, and other reimbursement related issues.