Catherine Short speaks with Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX, on the topic of “The No Surprises Act – What You Need to Know.” Effective January 1, 2022, the No Surprises Act has implications for patients, providers, and insurance companies alike. The impetus behind the legislation, as well as the regulations, is to prevent patients from receiving bills for certain services that were performed or delivered by providers out of their plan’s network. The scope is limited and providers and plans alike need to take steps to understand the appeal process when a payment or claim is challenged. The purpose of this episode is to provide a brief overview of the evolution of the United States’ healthcare system and its relevance to the No Surprises Act. From there, the No Surprises Act and regulations will be explained, along with the appeal process. Finally, compliance tips will round out the show.
Enacted in late 2020 as part of the Consolidated Appropriations Act of 2021 with an effective date of Jan. 1, 2022, the No Surprises Act (NSA) underscores its primary purpose is to protect patients from surprise medical bills when receiving certain services from – emergency services, non-emergency services from nonparticipating providers at participating facilities, and air ambulance service from nonparticipating providers. (86 Fed. Reg. 36872 (Jul. 13, 2021)).
Melody W. Mulaik, MSHS, FAHRA, CRA, RCC, RCC-IR, CPC, CPC-H is the President of Revenue Cycle Coding Strategies LLC and our esteemed presenter. 2022 was scheduled to be the the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay will occur it does not change the direction of the program or the need to prepare and test. As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.
Catherine Short speaks with Melody Mulaik, President of Revenue Cycle Coding Strategies, a dynamic company that works with physician practices, healthcare systems, billing companies and other industry stakeholders to provide auditing, education and other collaborative consulting solutions to meet their coding and compliance needs. First Healthcare Compliance is a proud partner of Revenue Cycle Coding Strategies and our clients have enjoyed many webinars and previous podcasts by this team of experts. Melody joins us to address a current hot topic, “AUC – Delayed but not Gone.” 2022 was scheduled to be the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay has occurred, it does not change the direction of the program or the need to prepare and test. As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.
Courtney Tito, Member of the Health Law group at McDonald Hopkins, LLC in its West Palm Beach office recently presented the webinar “Don’t Let a Medicare Revocation End Your Practice.” Courtney returned to answer many commonly asked questions from the webinar.
C.Trey Scott, Coordinating Attorney at Kennedy, Attorneys & Counselors at Law leads this webinar. Waivers and discounts are normal business activities that occur throughout the US daily as a way to reward customers or to assist when an invoice or bill may too expensive. However, in a healthcare context, the normal rules for waivers and discounts don’t apply. This presentation will highlight what waivers and discounts are, how they work, and when they are problematic/illegal.
Cindy Groux, CHBME/Board Member at HBMA and CEO, President and Owner of Health Care Practice Management, will address new CPT codes for 2021 to include prolonged services and clinical staff services, documentation changes to reduce the administrative burden, decreased needs for audits and how to promote coding consistency, and new rules for time billing.
Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX presents on these new updates. On November 20, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a Final Rule related to the Medicare Physician Self-Referral Law (Stark Law). Nearly simultaneously, the Office of the Inspector General, Department of Health and Human Services (HHS-OIG), released a Final Rule, which amends various safe harbors to the Federal Anti-Kickback Statute (AKS). The changes appear to be based, in large part, on value-based healthcare delivery and payment systems. The purpose of this presentation is to highlight the key changes, along with the similarities and differences in the language between the two Final Rules.
Successful employee education is an integral part of a comprehensive healthcare compliance program. Compliance professionals must consider which topics should be offered to the workforce. Of course, proper training depends on variables such as type of healthcare organization, roles of employees and location of the entity. States may impose specific requirements that go beyond federal requirements. Generally, four broad categories cover the topics imperative to the start of a comprehensive healthcare compliance program.
Catherine Short speaks with Melody Mulaik, President of Revenue Cycle Coding Strategies to address a current hot topic, “Appropriate Use Criteria: What you Need to Know.” 2021 is also going to be an official CMS testing year for AUC/CDS implementation. This episode will identify specific areas of concern for your organization regarding AUC/CDS implementation, help you to facilitate discussions with all stakeholders to ensure all perspectives are heard and addressed, and assist in designing actions that can be taken to facilitate a successful implementation to ensure revenue is not negatively impacted.