The No Surprise Billing Act (NSBA) was created to protect consumers from receiving surprise medical bills from out-of-network providers at in-network facilities. The No Surprise Billing Act has completely transformed the managed care health insurance payer contracting landscape resulting in a dramatic shift in payer behavior. Many health insurers are now forcing more providers into out-of-network status in an effort to reduce their payments through the host of consumer protections created in the NSBA. More out-of-network providers results in more out-of-network payment disputes, which allows the insurer to get out of paying providers in a timely manner and ties up provider time and increases administrative costs and burden to collect reimbursement. There have been many recent legal challenges in 2023 that have further complicated the NSBA requirements.
The NSBA applies to not only people covered under group and individual health insurance plans, but also protects uninsured and self-pay patients. The NSBA rule requires a whole new host of compliance considerations for healthcare organizations to work through to ensure compliance with federal law. These new requirements include providing good faith estimates to patients prior to receiving services, ensuring fees are reasonable and customary within the respective medical market, and participating in payment disputes via the new independent dispute resolution (IDR) process. This webinar will drill down into the NSBA provisions extensively, discuss the role of good faith estimates, explain the IDR process, discuss recent legal challenges, and provide you with tangible information that can be put into action immediately.
The No Surprise Billing Act (NSBA) was enacted as a consumer protection measure in response to unprecedented rates of surprise medical bills. This session will discuss the key NSBA provisions, discuss the good faith estimate requirements, explain the IDR process and common challenges, and provide tips for complying with the NSBA.
Toni Elhoms is an internationally known speaker and recognized subject matter expert on medical coding, reimbursement, compliance, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Ms. Elhoms’ expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. Ms. Elhoms serves as ACE’s Senior Consultant and conducts training and educational seminars across the country on a variety of topics including, but not limited to, Medical Coding, Medical Billing, Practice Management, Managed Care, Revenue Cycle Management, Revenue Maximization, Regulatory Compliance, etc.
