Introduction

January Grand Rounds – The Surprise Billing Rules Are Here – Let’s Talk About Them

January 4, 2022 - 1:00 pm to 2:00 pm (ET)

On September 30, 2021, HHS issued a supplement to Part I of the Surprise Billing Rules called “Requirements Related to Surprise Billing; Part II.” These rules were issued pursuant to the No Surprises Act, which is a part of the Consolidated Appropriations Act, 2021, and will take effect for health care providers and facilities on January 1, 2022.

Part II of the Surprise Billing saga provides additional protections against surprise and balance billing by providers. In part, the new rule:

  • Creates an independent dispute resolution process to determine out-of-network payment amounts.
  • Requires the issuance of good faith estimates for items or services provided to individuals who are uninsured or self-pay.
  • Institutes a dispute resolution process between patients and providers or facilities to determine amounts owed.

Part II leaves us with a lot to do. Tune in on Tuesday, January 4, 2022 where HortySpringer attorneys Dan Mulholland, Henry Casale, and Mary Paterni will explain the most recent additions to the rule and explore some of the things you will need to consider, and act on, in the New Year, including:

  • Good faith estimates: when they are needed, what they include, and how to draft them.
  • The effect of the independent dispute resolution process on future dealings between providers or facilities and health plans and the effect it will have on negotiations.
  • How to draft a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before you can bill at a higher out-of-network rate.
  • What you need to do NOW to comply.

Learning Objectives

By the end of this audio conference, participants should have a greater understanding of:

  • Good faith estimates: when they are needed, what they include, and how to draft them.
  • The effect of independent dispute resolution process on future dealings between providers or facilities and health plans and the effect it will have on negotiations.
  • How to draft a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before you can bill at higher out-of-network rate.
  • What you need to do NOW to comply.

Education Credit

Instructions on how to obtain your Continuing Education certificate for audio conferences will be e-mailed to the contact person for your organization at the conclusion of this audio conference.

Category 1 CME

Joint Provider Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Pittsburgh School of Medicine and HortySpringer Seminars.  The University of Pittsburgh is an affirmative action, equal opportunity institution.  The University of Pittsburgh School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

CEUs Credit

Other health care professionals are awarded 0.1 continuing education units (CEUs), which is equal to 1 contact hour.

NAMSS Continuing Education Credit

This course has been approved for National Association of Medical Staff Services (NAMSS) continuing education credit and NAMSS hereby awards 1.0 NAMSS continuing education credits for participation in this activity.  Accreditation of this educational content in no way implies endorsement or sponsorship by NAMSS.

HortySpringer Audio Conference Disclaimer

The information presented during an audio conference and any supplementary materials provided to registrants are intended for educational and informational purposes only. Nothing contained therein is to be considered as the rendering of legal advice for specific cases or circumstances.

No one should act or refrain from acting on the basis of any information presented during an audio conference without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer practicing as permitted by applicable laws, regulations or rules of professional conduct. No attorney-client relationship is formed by registration for an audio conference or the use of the supplementary materials.

About Grand Rounds

Designed for even the busiest hospital and medical staff leaders, registration for the year-long series is a quick and inexpensive way for Medical Staff Officers, members of the Medical Executive Committee, Department Chairs, Chairs of the Credentials and Peer Review Committees, and the Chairs of other key Medical Staff committees to have access to the most up-to-date health care information at their fingertips while obtaining valuable CME credits as well.

  • The audio conference series consists of twelve audio conferences spread over the course of the year (one AC/month)
  • Each audio conference is offered the first Tuesday of each month from 1:00 – 2:00 p.m. (Eastern Time).
  • Registration includes an MP3 containing the audio conference at no additional charge following each conference.
  • CME credit issued for live conference participation only.

Registration

To help your staff and medical professionals adhere to social distancing guidelines, we will waive the extra line fee for up to 3 additional lines so others in your organization are able to safely listen from their home or office.

Audio Conferences/Grand Rounds Registration: $250 and includes:

      • 1 AMA PRA Category 1 Credit™*
      • 1.0 NAMSS continuing education credit*
      • One MP3 recording to share with your staff throughout the year.
      • Three phones lines. You may purchase additional lines for $50/line, per audio conference.

Can’t make the live audio conference? No problem! We offer single MP3 recordings for $250/each (Separate MP3 purchase does not qualify for CME credits. CMEs will only be given for live participation the day of the AC).

*Not all audio conferences will be approved for continuing medical education credits.

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