Federal No Surprises Act – The IDR Process, Good Faith Estimates, and What Providers Need to Know
DURATION: 60 MINUTES
SPEAKER: Thomas J. Force, Esq.
Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period
The Departments of Health and Human Services, Labor, and of the Treasury issued an interim final rule (the “IFR”) concerning the federal No Surprises Act on September 30, 2021. Although the hope was that the IFR would provide clarity as the requirements and dispute resolution programs under the No Surprises Act, it left many questions unanswered and revealed a considerable hindrance to out-of-network providers securing fair and reasonable reimbursement.
In particular, the presumption that the qualifying payment amount (the “QPA”), defined as the plan’s median in-network rate for the applicable geographic area, serves as the primary obstacle to overcome before fair and reasonable reimbursement will be securable. Notably, this position as set forth in the IFR, contradicts Congressional intent, as explained in the recent letter from the U.S. House of Representative’s Committee on Ways and Means. Accordingly, prior to delving into how the QPA can be differentiated and, thus, bypassed, this webinar discusses how and why the healthcare industry must unite as one to combat the inequitable guidelines specified in the IFR. In particular, a call to join together to issue unified comment to the aforementioned Departments is issued.
Join this must-attend Live webinar with healthcare attorney Thomas J. Force. Esq. where he discusses various factors helpful in bypassing the QPA, with explanation as to how these factors can be supported by credible evidence to demonstrate that the QPA is materially different from fair and reasonable out-of-network reimbursements (a requirement set out in the IFR for circumventing the QPA).
Finally, Thomas will discuss, in detail, the requirement to issue good faith estimates to uninsured (or self-pay patients), the questions that remain as related to this process, and the logistics of compliance with the same (a task that will, at least initially, result in a considerable administrative burden, especially in light of the uncertainty as to how the dispute resolution process will play out, as a whole).
Webinar Objectives
This power-packed session seeks to address the unfair nature of many of the IFRs guidelines, how the healthcare industry can fight back against this inequity, and how out-of-network providers (namely who provide services at in-network facilities and are subject to the Act’s regulations) can promote the likelihood of securing fair and reasonable compensation.
In addition, this session seeks to flesh out the logistics of the provider-plan independent dispute resolution process (“IDR” or the “IDR process”), as failure to properly satisfy the steps therein can prevent full and fair compensation from being secured.
Finally, this webinar will advise providers/facilities as to how they can ensure compliance with the good faith estimate requirements for uninsured and self-pay patients.
Webinar Agenda
- General Information and Perceived Bias in Favor of Plans & Carriers
- The IDR Process – A Refresher on Timeframes
- The IDR Process – Open Negotiation
- The IDR Process – Initiation of IDR
- The IDR Process – IDRE selection
- The IDR Process – Submission of Offers
- The IDR Process – Determinations and Factors
- The IDR Process – Getting Around the QPA
- Good Faith Estimates (Generally)
- Good Faith Estimates – Who is an Uninsured/Self-Pay Patient?
- Good Faith Estimates – Steps & Requirements
- Good Faith Estimates – Who’s Responsible?
- Good Faith Estimates – Deferral to State Law (Open Questions)
- Topics Not Discussed and Unanswered Questions
- Key Takeaways
Webinar Highlights
- How the Departments have apparently favored the plans/carriers
- The logistics of the IDR process
- Factors that can be used to your advantage in the IDR process
- How to circumvent the QPA
- How the healthcare industry can fight back (actions that can be taken)
- How to satisfy the good faith estimate requirements
- How the IFR left many unanswered questions / areas where further guidance will still be necessary
Who Should Attend
Out-of-network healthcare providers and facility (ambulatory surgery centers, for example) owners and managers.
The Federal False Claims Act: Enforcement and Recent Updates
DURATION: 60 MINUTES
SPEAKER: William Mack Copeland
The session will provide an overview of the Federal Civil False Claims Act (FCA) and how it works. It will also provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.
We will start with a review of the Federal False Claims Act and discuss how it works and how it is being used to fight health care fraud. We will discuss how the various health care fraud task forces use the Federal False Claims Act and its whistleblower provisions to identify and prosecute health care fraud. The webinar will take the Federal False Claims Act apart and show step by step how an action is filed, how the government responds, and how the courts interpret various elements of the Act. We will discuss proof, damages under the Act, and how the whistleblower is rewarded for bringing a successful case.
The session will also provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as a general review of the AKS available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.
We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law.
Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it. In addition, we will discuss the latest updates to both the False Claims Act and the Anti-Kickback Statute.
Webinar Objectives
To provide attendees with an understanding of the False Claims Act, its various elements, how it works, and how to protect one’s organization from this potent enforcement tool.
Webinar Agenda
- A review of the Federal False Claims Act, its history, how it works, its proof requirements, pleading requirements and damages.
- A review of the Federal Anti-Kickback Statute and the Federal Anti-Referral Act.
- A review of recent cases involving the False Claims Act.
Webinar Highlights
- An overview of the Federal Civil False Claims Act (FCA) and how it works.
- How the various health care fraud task forces use the Federal False Claims Act and its whistle blower provisions to identify and prosecute health care fraud.
- Step by step how an action is filed, how the government responds and how the courts interpret various elements of the Act.
- Proof, damages under the Act and how the whistle blower is rewarded for bringing a successful case.
- An overview of the Anti-Kickback Statute (AKS) and the Federal Anti-Referral Act (Stark) and show how a violation constitutes a false claim under the False Claims Act.
- The latest updates to both the False Claims Act and the Anti-Kickback Statute.
Who Should Attend
- Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOs
- Nursing home executives
- Physicians
- Physician practice managers
- Other healthcare provider executives, and
- Attorneys representing health care providers and practitioners.
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