Course Description:

The Federal No Surprises Act (NSA), passed by Congress in 2020, protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities. The legislation also establishes an independent dispute resolution process in the event disputes regarding reimbursement arise between providers and insurers. Many physicians will be affected by the NSA including emergency department practices, anesthesiologists, radiologists, pathologists, and hospitalists. It is vital that physicians understand what is contained in the NSA, how it impacts your practice and what steps should be taken to ensure compliance.

Key aspects of the bill include:

• Rules relating to balance-billing in non-emergency services at in-network facilities and emergency services at hospitals or emergency departments
• Provision of good faith estimates for self-pay and uninsured patients
• Provision of disclosure notice on patient protections against surprise billing
• Independent dispute resolution process for certain out-of-network claims

Statement of Need:

Physicians are unaware of the provisions surrounding the No Surprises Act and how it will impact their billing process.

Objectives:

At the end of this module physicians will be able to:

• Describe the provisions of the No Surprises Act
• Access required/suggested CMS forms and documents to support compliance
• Implement new processes related to disclosure and good faith estimates for patients
  
  

  Disclosure:

  The following planners disclose that they have no relevant relationships with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients:

  • Heather Lathan
  • Miranda Mosley