Major Issues for Compliant Health Care Billing Practices Under the No Surprises Act

By: Michael S. Kolber
– American Health Law Association

Manatt Health Partner Michael Kolber authored an article for American Health Law Association on the implementation challenges surrounding certain provisions of the No Surprises Act (NSA) that impact the financial relationships among health plans, providers, and patients. 

In the article, Kolber explained three areas of focus to inform health care providers and facilities, including “updating (or creating) procedures for providing estimates to self-pay or uninsured patients; developing workflows to obtain a patient’s consent to pay full billed charges for out-of-network care when permitted; and planning for arbitrating health plan out-of-network reimbursement.” Implementation of these policies is complicated by the fact that federal regulators have issued little guidance on how to apply them. In an effort to provide clarity, Kolber discussed providers’ responsibilities for providing good faith estimates to out-of-network or uninsured patients; the rules allowing out-of-network providers to obtain patients’ consent in order to waive NSA protections; and the new independent dispute resolution process for health plans seeking arbitration for out-of-network reimbursement. 

American Health Law Association subscribers can read the full article here



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