The Balance Billing Requirement - Why Out-of-Network Providers Must Balance Bill Their Patients

Event Information
Product Format
Prerecorded Event
Presenter(s)
Length
60 minutes
Product Description

Shield Yourself From Non-Compliance Penalties and Health Plan Lawsuits Over Failure to Balance Bill

It’s easy for out-of-network (OON) healthcare providers to make critical mistakes that jeopardize their compliance with state and federal laws. For instance, many providers will tell patients that they accept any payment from their health plans as payment in full. But this practice is risky and may invite accusations of fraud from the health plans.

Recent lawsuits have put the spotlight on billing related errors such as overpayments, negligent misrepresentation, OON write-offs and balance billing, and ended in very real legal nightmares for practices. In addition, HHS is actively watching and waiting to catch billing errors and noncompliant practices. The bottom line is that failure to balance bill patients can lead to large recoupments, audits and litigation for fraud.

In this session, expert speaker Thomas Force, Esq. will instruct OON providers and their revenue recovery staff on how to maintain compliance and avoid litigation while collecting the proper amount of money from patients’ health plans. You’ll also learn about state laws relating to balance billing requirements for OON providers, as well as recent cases in which health plans sued OON providers who failed to balance bill their patients. He will also discuss the penalties for noncompliance and provide a patient-friendly sample balance bill letter and sample charity care policy.

Session Highlights:

  • Why balance billing is required in most jurisdictions
  • The exceptions to balance billing requirements
  • Techniques to balance bill patients without offending or alienating them
  • How to use ERISA to appeal denied and under-reimbursed claims for employer-sponsored plans
  • What a recoupment is, and what you should do when faced with one
  • Penalties for noncompliance

 Session Agenda:

  • Balance billing: Why OONs are required to balance bill
  • Review of Ingenix case and OON reimbursement
  • Reforming OON reimbursement
  • ERISA preemption and why it matters
  • Problematic billing practices
  • Patient protections under the PPACA’s provisions for coverage of emergency services
  • Insights on Medicare, TRICARE/CHAMPUS and balance billing
  • New York’s Emergency Medical Services and Surprise Bills Law
  • How to write patient-friendly balance billing letters, and the best time to send them
  • The importance of a charity care program or financial hardship policy
  • Best practices in transparency and disclosure
  • Relevant case law, including CIGNA vs. Health Diagnostics, Aetna v. Health Diagnostics Laboratory and more

 

Who Should Attend

  • Healthcare practice managers
  • Hospital revenue personnel
  • Healthcare compliance experts
  • Healthcare attorneys

Order Below or Call 1-866-458-2965 Today

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1-866-458-2965

1-800-508-2592

About Our Speaker

Thomas Force - Compliance Coding Expert

Thomas J. Force, Esq. is a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries. He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general...   More Info
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