Lessons on Balance Billing & Fee Forgiveness From Recent Lawsuits Against Out-of-Network Providers

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Recent Compliance Developments from Federal Healthcare Lawsuits On Out Of Network Healthcare Providers

The compliance problem faced by out of network healthcare providers today is fee forgiveness. Most out of network healthcare providers avoid balance billing for fear of receiving patient complaints, reprimand from hospital CEOs where they have privileges and losing patients to in-network facilities. There is a way to balance bill patients in a manner that will not jeopardize your practice’s revenue stream. The health plans are targeting out of network practices that don’t balance bill, and suing them for insurance fraud. This important presentation will help the practitioner stay compliant and avoid being audited or sued by the health plans.

Participants in the presentation with expert speaker Thomas J. Force, Esq. will learn how to avoid compliance pitfalls and litigation by health plans relating to failure to balance bill patients or otherwise collect patient coinsurance and deductibles. A case-by-case analysis of health plan litigation against out of network health care providers relating to “fee forgiveness” will help participants understand why “balance billing” of patients is necessary, while learning health plan audit strategies.

In this program, you will learn:

  • The type of disclosures that must be provided by the out of network provider to their patients prior to services being rendered.
  • The type of practice written policies that must be in effect so as to assist the practices succeed against healthcare audits.
  • The purpose of patient assignment a benefit forms.
  • The impact of anti-assignment provisions in healthcare plan documents.
  • The danger of not collecting from insurance, deductibles or otherwise balance billing out of network patients.

Session highlights:

  • Network Participation
    • In-network vs. Out-of-Network
    • Patient Cost Sharing
    • Balance Bill
  • Best Practices
    • Transparency and Disclosure
    • Practice Management
  • Case studies
    • Out-of-Network Reimbursement
    • Fee Forgiveness
    • Excessive Fees
    • Assignment on Benefit Cases


By attending this informative session, you will learn strategies which will assist your practice in avoiding health plan audits and litigation based upon fee forgiveness and failure to balance bill patients. You will be provided disclosure and other patient forms, and practice policies which will assist out of network practices to remain in compliance with state federal laws.  Best practices for compliance will be discussed.

Who should attend

  • Out of network medical practice billing and collection staff
  • Revenue cycle personnel
  • Attorneys
  • Practice administrators

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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 counsel and...   More Info
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