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Live Webinar

60-minute live streaming program
  • April 27
  • 1:00 - 2:00 pm EST

What to Expect from the No Surprise Act

April 27

Gain an understanding of surprises balance billing, the problems it causes, and the ways the No Surprises Act attempts to address those problems.

This topic is designed to explain the No Surprises Act, including its history, the important problems the Act tries to solve, and how it attempts to solve those problems. Surprise balance billing has been a hot-button issue in state and federal politics for many years. The No Surprises Act radically changes the status quo for health plans, health care providers, and patients with respect to out-of-network care for emergency services, non-emergent services provided by out-of-network providers at in-network facilities, and air ambulance services. The Act goes into effect on January 1, 2022. Health care providers may be subject to steep fines if they impermissibly balance bill patients, and they may be unable to collect additional payment if they do not comply with specific requirements to submit claims to arbitration. Health plans are regulated in new ways that may impose additional financial liability for out-of-network claims. This material will provide you and understanding of the new requirements, challenges of implanting the Act, and strategies to adapt to the new way of paying for these out-of-network services.

Learning Objectives

  • You will be able to describe how the dispute resolution process created by the No Surprises Act will work.
  • You will be able to discuss surprises balance billing, including the problems it causes, and the ways the No Surprises Act attempts to address those problems.
  • You will be able to explain how the No Surprises Act alters the way in which payment for certain out-of-network services is determined.
  • You will be able to identify the out-of-network situations to which the No Surprises Act applies.

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Why Lorman?

Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Introduction to the No Surprises Act
  • What Are Balance Bills?
  • What Are Surprise Balance Bills?
  • What Are the Problems With Balance Bills?
  • What Is the No Surprises Act and How Did It Come to Pass?
  • When Does the No Surprises Act Go Into Effect?
Which Surprise Balance Bill Situations Are Affected by the No Surprises Act?
  • Emergency Services
  • Non-Emergent Services Provided by an Out-Of-Network Provider at an In-Network Facility
  • Air Ambulance Services
  • Everything Else Remains Unaffected
    • Ground Ambulance
    • Non-Emergent Out-Of-Network Services at Out-Of-Network Facilities
How Does the No Surprises Act Affect Surprise Balance Bill Situations?
  • In These Situations, Providers Are Precluded From Balance Billing the Patient
  • Notice and Consent Exception to the Balance Billing Prohibition
  • Initial Health Plan Payments Are Not Regulated and the Current Greatest of Three Rule Will Cease to Exist
  • Open Negotiation Period Between Provider and Plan
  • If Negotiation Is Not Successful, Provider Can Submit the Dispute to a Baseball-Style Arbitration Process
Baseball-Style Arbitration Process
  • Providers Must Act Promptly
  • The Provider and Plan Are Required to Make a Final Offer
  • The Arbitrator Must Select One of the Final Offers as the Required Payment Amount
  • There Are Several Factors the Act Directs Arbitrators to Consider
  • Arbitrators May Also Request, or Parties May Provide Additional Relevant Evidence as Long as It Does Not Refer to Certain Categories of Information That the Act Prohibits Arbitrators From Considering
  • The Losing Party Pays the Arbitrator's Fee
  • Batching of Claims
  • Waiting Period
Implementation of the Arbitration Process
  • Qualifying Payment Is a Central Factor
  • Recent Hospital Pricing Transparency Rule Overlaps
  • Who Will Serve as Arbitrators
  • Other Uncertainty Left to Subsequent Regulations
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Why Lorman?

Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

Live Webinar Registration

  • AL CLE 1.0
     
  • This course or a portion thereof has been approved by the Alabama State Mandatory Continuing Legal Education Commission for a maximum of 1.0 hours credit.
     
  • AR CLE 1.0
     
  • This course has been approved for 1.0 hours of CLE by the Arkansas CLE Board.
     
  • Arizona CLE 1.0
     
  • The State Bar of Arizona does not approve or accredit CLE activities for the Mandatory Continuing Legal Education requirement. This activity may qualify for up to 1.0 hours toward your annual CLE requirement for the State Bar of Arizona.
     
  • CA MCLE 1.0
     
  • Lorman Business Center, LLC. is a State Bar of California approved MCLE sponsor and this course qualifies for 1.0 CLE hours of participatory credit.
     
  • CT CLE 1.0
     
  • Neither the Connecticut Judicial Branch nor the Commission on Minimum Continuing Legal Education approve or accredit CLE providers or activities. This course has been approved for CLE credit in jurisdictions aside from CT and therefore it automatically meets the content and delivery requirements in Connecticut. Credit is based on a 60 minute credit hour and shall be awarded as follows: 1.0 CLE credit(s).
     
  • HI CLE 1.0
     
  • This program was approved by the Hawaii State Board of Continuing Legal Education for 1.0 CLE credit hours.
     
  • IL CLE 1.0
     
  • This course was approved for a total of 1.0 hours of MCLE Credit by the Illinois MCLE Board.
     
  • ME CLE 1.0
     
  • This course has been approved by the State of Maine Board of Overseers of the Bar. Lawyers who complete this course shall receive 1.0 hours of CLE credit under M. Bar R. 12.
     
  • NH MCLE 1.0
     
  • NH MCLE does not approve or accredit CLE activities for the NH Minimum CLE requirement. Lorman Education Services believes this course meets the requirement of NH Supreme Court Rule 53 and may qualify for CLE credit(s). Program Length: 60 Minutes.
     
  • NJ CLE 1.2
     
  • This program has been approved by the Board on Continuing Legal Education of the Supreme Court of New Jersey for 1.2 hours of total CLE credit.
     
  • PA CLE 1.0
     
  • This Distance Learning program has been approved by the Pennsylvania Continuing Legal Education Board for 1.0 hours of substantive law, practice and procedure CLE credit.
     
  • RI CLE 1.0
     
  • This program has been approved by the Rhode Island Mandatory Continuing Legal Education Commission for 1.0 hours of CLE credit.
     
  • VT CLE 1.0
     
  • This program has been approved by the Mandatory Continuing Legal Education Board of Vermont for 1.0 hours of CLE credit.
     
  • WA CLE 1.0
     
  • This program has been approved by the Washington State Board of Continuing Legal Education for 1.0 hours of Law & Legal Procedure credit.
     
  • WI CLE 1.0
     
  • This program has been approved by the Board of Bar Examiners for 1.0 hours for use toward the Wisconsin Mandatory CLE requirement.
     
  • WV MCLE 1.2
     
  • This program has been approved by the West Virginia State Bar MCLE Commission for 1.2 MCLE hours.
     
  • HR Certification Institute 1.0
     
  • This program has been approved for 1.0 (General) recertification credit hours toward aPHR(TM), aPHRi(TM), PHR®, PHRca®, SPHR®, GPHR®, PHRi(TM) and SPHRi(TM)recertification through HR Certification Institute® (HRCI®). For more information about certification or recertification, please visit the HR Certification Institute website at www.hrci.org.
     
  • SHRM 1.0
     
  • Lorman Education Services is recognized by SHRM to offer Professional Development Credits (PDCs) for the SHRM-CPSM or SHRM-SCPSM. This program is valid for 1.0 PDC(s) for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit www.shrmcertification.org.
     

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

Who should attend?

This live webinar is designed for health care providers (financial staff), health insurance brokers and consultants, health insurance professionals, human resource professionals, third-party administrators, self-insured health plan professionals, professional employer organizations, and attorneys.

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Why Lorman?

Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Kristopher R. Alderman

FisherBroyles LLP

  • Partner with FisherBroyles, LLP
  • Litigates cases in state and federal court; represents health plans, fiduciaries, third-party administrators, individuals, and plan participants and beneficiaries in ERISA and managed care cases
  • Has represented clients in cases involving claims for ERISA benefits, allegations of breaches of fiduciary duty, COBRA rights, Section 510 employment discrimination, assignments of benefits, and preemption; he also advises clients on matters related to plan design, ACA compliance, and self-funded plan options
  • Extensive experience representing clients in matters involving health care reimbursement; he defends individuals against balance billing by medical providers; well-versed in health care economics and finance; he also represents employers, health plans, plan administrators, fiduciaries, and claims administrators in health care reimbursement matters
  • Represents patients across the country in hospital billing disputes at no charge to the patient
  • He represents and advocates for his clients’ interests under consumer protection laws, including the Fair Debt Collection Practices Act, the Fair Credit Reporting Act, and deceptive trade practices laws
  • Has extensive experience representing and advising clients with respect to hospital liens and subrogation rights
  • Also represented clients in a wide variety of employment matters, including claims arising under Title VII, ADA, ADEA, FMLA, and ERISA
  • J.D. degree, magna cum laude, Georgia State University College of Law; B.A. degree in English, cum laude, University of Georgia
  • •Can be contacted at 404-596-8887 or [email protected]
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Product ID: 408694
Published 2021
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