Finally, No More Surprises in the No Surprises Act
Presented by Thomas LaGreca
As presented at HBMA's 2024 Fall Conference September 17th-19th, 2024.
Description:
The federal regulators responsible for implementing the NSA had interpreted the law in ways that were extremely challenging to the medical community. Those interpretations have included: 1. Affording the median in-network rate, the factor most favorable to the insurance industry, preferential treatment. 2. Requiring arbitrations to be on a per-CPT-code basis, rather than a per-claim basis. 3. The filing costs and arbitrator fees dramatically increased from 2022 to 2023, making many arbitrations cost prohibitive. 4. The delays alone in resolving payment disputes have caused hundreds of billions of dollars in damage to the medical community. There is cause for genuine optimism, however. A federal district court in Texas on 4 occasions has ruled in favor of the medical community, and this same court is addressing the issues of the per-code requirement and the filing cost increase. As a result, the medical community's success rate has greatly improved, the awards are for greater amounts, the cos structure is less prohibitive, and the timeline for resolutions has become much shorter. The delays and frustrations of the past two years are largely behind us, and, for this reason, it is critical that the medical community be involved in the NSA arbitration process and stays updated on the newest interpretations of the law and how it is being implemented. It is fast becoming the forum for all things out-of-network.
Learning Objectives
Course participants will be able to:
- To convey the most up-to-date information regarding the NSA, so that revenue cycle managers can adjust their behavior accordingly.
- To ask whether your revenue cycle process is staying abreast of the latest developments?
- To enable practices to predict what the revenue cycle landscape might look like in the near- and long-term.
Member Price: $99.00
Non-Member Price: $149.00