Federal No Surprises Act: Introduction, Impact, IDR Process & More!

Session 1: The New Federal No Surprise Act – Impact on Out-of-Network Providers

This webinar by industry expert speaker and renowned attorney Thomas J. Force, Esq. is intended to break down the new Federal No Surprises Act, enacted as part of the Consolidated Appropriations Act, 2011, which is intended to protect patients from “surprise” medical bills, including those arising when out-of-network providers utilize and provide services at an in-network facility. Essentially, the goal of the No Surprises Act is to remove the patient from serving as the intermediary between the insurer/payor and the provider/practice.

The program will first help you determine whether the No Surprises Act affects your practice and, if so, provide considerable insight into the detailed requirements and processes underlying the Act. The No Surprises Act contains many requirements that may result in difficult decisions having to be made, depending on the nature of your practice. Such decisions and considerations will include, among others:

Whether to provide the notice and secure the consent of the patient required in order to balance bill the patient or, alternatively, refrain therefrom to allow for use of the Independent Dispute Resolution (IDR) process.
How to proceed through the IDR process, if this is the avenue selected, including how to appropriately calculate the offer submitted to the IDR entity (i.e., the arbitrator that will decide between the amounts submitted by the provider/practice and insurer/payor, respectively).

To aid you in making such determinations in the future, the program will set forth key aspects of the No Surprises Act, such as:

How future rules and regulations promulgated by HHS in the near future may affect your determinations;
An overview of the IDR process, including timelines related thereto;
How the IDR entity makes a decision and the factors that it can consider;
The IDR waiting period and batching of claims;
Other cost considerations (e.g., how the IDR entity is paid);
The impact that previous IDR determinations will have on future negotiations and/or IDR entity determinations;
The impact of and relationship to State Law; and
For the notice and consent requirement for balance billing:
- Timeframes for providing notice and securing consent;
- Required notice contents;
- Required consent contents.

Put simply, this program will provide you with the necessary tools and insight to understand how to effectively navigate the road ahead, as a result of the No Surprises Act, based on the specifics of your practice and its operation.

Webinar Objectives

This webinar will address the following areas of concern:

What to consider in determining whether to balance bill your patients or take advantage of the IDR process established by the No Surprises Act;
Risks of relying on the IDR process or inappropriately calculating the extent of an “offer” to be submitted to the IDR entity;
Avoiding delays or other hindrances to your revenue cycle, particularly based on the availability and restrictions of the IDR process; and
Potential pitfalls experienced in attempting to satisfy the notice and consent requirement for balance billing.

Webinar Agenda

Introduction to the No Surprises Act
The Effect of the No Surprises Act on Health Insurers/Payers
The IDR Process – Overview and Specifics
Notice and Consent Requirements – Overview and Specifics
Additional Aspects of the No Surprises Act
Key Takeaways

Webinar Highlights

The goals underlying the No Surprises Act
How your practice may be affected by the No Surprises Act
The IDR Process – Overview and timeframes
The IDR Process – Decision-making considerations
The IDR Process – How to submit an offer that will provide the best results, both for the immediate claim(s) at issue, but also for future claims.
The IDR Process – Limitations, concerns, and exceptions
How to satisfy the notice and consent requirements for balance billing

Session 2: Federal No Surprises Act – The IDR Process, Good Faith Estimates, and What Providers Need to Know

Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period

The Departments of Health and Human Services, Labor, and of the Treasury issued an interim final rule (the “IFR”) concerning the federal No Surprises Act on September 30, 2021. Although the hope was that the IFR would provide clarity as the requirements and dispute resolution programs under the No Surprises Act, it left many questions unanswered and revealed a considerable hindrance to out-of-network providers securing fair and reasonable reimbursement.

In particular, the presumption that the qualifying payment amount (the “QPA”), defined as the plan’s median in-network rate for the applicable geographic area, serves as the primary obstacle to overcome before fair and reasonable reimbursement will be securable. Notably, this position as set forth in the IFR, contradicts Congressional intent, as explained in the recent letter from the U.S. House of Representative’s Committee on Ways and Means. Accordingly, prior to delving into how the QPA can be differentiated and, thus, bypassed, this webinar discusses how and why the healthcare industry must unite as one to combat the inequitable guidelines specified in the IFR. In particular, a call to join together to issue unified comment to the aforementioned Departments is issued.

Join this must-attend Live webinar with healthcare attorney Thomas J. Force. Esq. where he discusses various factors helpful in bypassing the QPA, with explanation as to how these factors can be supported by credible evidence to demonstrate that the QPA is materially different from fair and reasonable out-of-network reimbursements (a requirement set out in the IFR for circumventing the QPA).

Finally, Thomas will discuss, in detail, the requirement to issue good faith estimates to uninsured (or self-pay patients), the questions that remain as related to this process, and the logistics of compliance with the same (a task that will, at least initially, result in a considerable administrative burden, especially in light of the uncertainty as to how the dispute resolution process will play out, as a whole).

Webinar Objectives

This power-packed session seeks to address the unfair nature of many of the IFRs guidelines, how the healthcare industry can fight back against this inequity, and how out-of-network providers (namely who provide services at in-network facilities and are subject to the Act’s regulations) can promote the likelihood of securing fair and reasonable compensation.

In addition, this session seeks to flesh out the logistics of the provider-plan independent dispute resolution process (“IDR” or the “IDR process”), as failure to properly satisfy the steps therein can prevent full and fair compensation from being secured.

Finally, this webinar will advise providers/facilities as to how they can ensure compliance with the good faith estimate requirements for uninsured and self-pay patients.

Webinar Agenda

General Information and Perceived Bias in Favor of Plans & Carriers
The IDR Process – A Refresher on Timeframes
The IDR Process – Open Negotiation
The IDR Process – Initiation of IDR
The IDR Process – IDRE selection
The IDR Process – Submission of Offers
The IDR Process – Determinations and Factors
The IDR Process – Getting Around the QPA
Good Faith Estimates (Generally)
Good Faith Estimates – Who is an Uninsured/Self-Pay Patient?
Good Faith Estimates – Steps & Requirements
Good Faith Estimates – Who’s Responsible?
Good Faith Estimates – Deferral to State Law (Open Questions)
Topics Not Discussed and Unanswered Questions
Key Takeaways

Webinar Highlights

How the Departments have apparently favored the plans/carriers
The logistics of the IDR process
Factors that can be used to your advantage in the IDR process
How to circumvent the QPA
How the healthcare industry can fight back (actions that can be taken)
How to satisfy the good faith estimate requirements
How the IFR left many unanswered questions / areas where further guidance will still be necessary