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

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

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!

WARNING: Incorrectly submitting claims for out of network or uninsured patient services can expose you to an independent dispute resolution (the newly implemented federal oversight process to ensure No Surprises Act compliance). There are occasions when you could have only four days to file your appeal. Your inability to meet these and other deadlines can mean your practice becomes an audit target by the Feds. And if you are not in compliance, you can be hit with hefty financial penalties.

HHS’ random and targeted investigations are underway to ensure your compliance with out of network billing laws, uninsured patient rules, and other relevant aspects of the No Surprises Act. Don’t risk trying to implement these complex and confusing billing changes yourself. Instead, sign up for this expert-led online training today.

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.