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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).
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.
Who Should Attend
Out-of-network healthcare providers and facility (ambulatory surgery centers, for example) owners and managers.
|Jun 09, 2022||Understanding the NSA: New Rules for Surprise/Balance Billing||60 Mins||$199.00|
|Jun 24, 2021||An Effective Out-of-Network Workflow to Increase Reimbursement and Stay Compliant||60 Mins||$199.00|
|Jun 01, 2021||How to Draft Appeal Letters & To Resolve Denials Effectively 2021 Updates||120 Mins||$349.00|
|Apr 14, 2021||The Successful Clinical Appeal – A Guide for the reconsideration and Appeal of Medical Necessity Denials||60 Mins||$199.00|
|Mar 23, 2021||The New Federal No Surprise Act – Impact on Out-of-Network Providers||60 Mins||$199.00|
|Aug 20, 2020||Lessons Learned from the Cigna and Aetna cases against Humble Surgical Hospital||60 Mins||$199.00|
|Jun 16, 2020||How to Defend Against Insurance Company Recoupments, Repayment Demands, and SIU Audits||60 Mins||$199.00|