Balanced Billing Laws: Prevent Avoidable Violations and Penalties

Length: 60 Minutes Expert: Rachel V. Rose, JD, MBA CEU: 1.0
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Writing off patient out-of-network co-payments or deductibles without meeting individual financial hardship exceptions will land you in hot water with the OIG – unless you know exactly how to comply with complicated, ever-changing Balanced Billing Laws.

Many states now require you to get out-of-network payments directly from health plans, not your patients. What makes it worse is that CMS and private payer auditors are actively watching and waiting for you to slip up. The only way to avoid being targeted is to master the complexities of balanced billing laws. Even a simple mistake can result in massive violation penalties and even jail time – really.

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

This is where attorney Rachel V. Rose, JD, MBA, can help. During her 60-minute online training, Rachel will walk you through EXACTLY when and how to use waivers, comply with CMS, OIG, and federal and state Balanced Billing laws, correctly manage write-offs and right and wrong way to write off patient amounts due, 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
  • Mitigate routine waiver use and write-offs that raise auditor red flags
  • 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
  • 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 numerous avoidable 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

Rachel V. Rose
JD, MBA Attorney, Law, PLLC.

Rachel successfully advises and represents clients on healthcare, cybersecurity, securities, and qui tam compliance, transactional, litigation, and government enforcement matters. Ms. Rose is also an Affiliated Member with the Baylor College of Medicine’s Center for Medical Ethics and Health Policy, where she teaches bioethics. She has served as a consultative expert and testifying expert, as well as being often quoted in publications.

In addition to being extensively published and a sought-after presenter and quoted expert, Ms. Rose holds an MBA with minors in healthcare and entrepreneurship from Vanderbilt University, and a law degree from Stetson University College of Law, where she graduated with various honors, including the National Scribes Award. Ms. Rose also attained a Certificate in Negotiation and Leadership from Harvard University.

Ms. Rose is licensed in Texas and is a Fellow of the Federal Bar Association. Currently, she serves as a Director on the FBA’s National Board, is a Member of and the Immediate Past Chair of the Federal Bar Association’s Government Relations Committee, an Advisory Board member of the Federal Bar Association’s Qui Tam Section, the co-editor of the American Health Lawyers Association’s Enterprise Risk Management Handbook for Healthcare Entities (2nd Edition), as well as a co-author of the ABA’s books The ABCs of ACOs and What Are International HIPAA Considerations? She is extensively published and presents on a variety of matters related to her practice.

She has been named consecutively to the Texas Bar College, the National Women Trial Lawyers Association’s Top 25, Houstonia Magazine’s Top Lawyers (healthcare), the National Trial Lawyers Association’s Top 100 and The Nation’s Top One Percent. Ms. Rose was awarded 1st Healthcare Compliance’s 2019 and 2022 Top Presenter Award. In 2023, she was selected for Super Lawyers (healthcare).

Reviews

The presenter was very clear about the subject and very knowledgeable.
Cynthia Watland
CEO, Watland Billing Consultants
It was very interesting to hear the history of the insurance industry.  The webinar provided a good speaker, lots of history and good information!
Cristina Linder
Business Office Manager, Eye Surgical Associates