Comply w/New Billing Rules for Out-of-Network & Uninsured Patients

Length: 60 Minutes Expert: David Vaughn, JD, CPC

Effective Jan 1st, you are required to be in compliance with the No Surprises Act, or risk being audited and hit with significant federal penalties when handling out of network billing.

The No Surprises Act seriously changes how you balance bill commercial insurance patients, and how you bill out-of-network and uninsured patients. The Act also includes an audit procedure for federal oversight, which means they are watching. This brand-new law is massive. It has hundreds of pages of confusing federal rules and regulations – all of which you are expected to master.

Failing to comply with the new No Surprises Act really isn’t an option. It can open your practice up to an independent dispute resolution – from both payers and patients. You can be targeted by the Feds and audited, and if you are not compliant, you can be hit with hefty financial penalties.

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 and less complicated for you to comply with the No Surprises Act. 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 Act’s documentation and notification requirements to ensure your practice is compliant.

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

  • 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 the No Surprises Act?
  • 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!

WARNING: HHS is expected to implement processes for random and targeted investigations on provider compliance with the No Surprises Act. Accordingly, it is imperative that you ensure your compliance with the No Surprises Act before these investigation rules are finalized. Don’t risk trying to implement No Surprise Act billing changes yourself. Sign up for this expert-led online training today.

Note: Access to this training is limited to 50 to ensure that all attendees have the opportunity to get their specific questions answered by expert presenter and healthcare attorney David Vaughn, Esq., CPC.

Meet Your Expert

David Vaughn
JD, CPCHealthcare Attorney, Vaughn & Assoc., L.L.C.

David is one of a limited number of healthcare attorneys in the United States who is also a Certified Professional Coder®, certified by the American Academy of Professional Coders® (“AAPC®”).

David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.

He graduated from Mississippi College with Special Distinction (Magna Cum Laude) in 1974, graduated from LSU Law School in 1977, and has been a certified coder since 1999.


The speaker was very good and knowledgeable.
Bridget Haynes
Revenue Cycle Optimization VP, Collaborative Imaging