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101

What You Need to Know about The No Surprises Act

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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.

102

What you need to know about the No Surprises Act

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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)).

103

Appropriate Use Criteria – Delayed but Not Gone

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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.

104

Hardware Hacking Trends – The Insecurity of Everything

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John Shegerian of ERI and co-author of the cybersecurity book, “the Insecurity of Everything” will be presenting a talk about cybersecurity titled “The Insecurity of Everything: How Hardware Data Security is Becoming the Most Important Topic in the World” and will share some of the latest information about the very real problem of hardware hacking in the world of healthcare and beyond and how that issue became even more serious during the pandemic, with so many people working from home. He will also be explaining critical information for health-related businesses to help them keep their private data – and the data of their patients and customers – protected!

105

Recent Developments in Health Information Privacy: HIPAA Right of Access

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Catherine Short speaks with Sheba Vine, Attorney and Senior Manager in the Global Privacy Office at Exact Sciences Corporation, on the topic of “Recent Developments in Health Information Privacy: HIPAA Right of Access.” We will review recent developments including OCR Enforcement Highlights, HIPAA Right of Access & Ciox Health Decision, NPRM, and 21st Century Cures Act Information Blocking Regulation.

106

Appreciating the Content of a Business Associate Agreement

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Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX will be presenting with us. Business Associate Agreements (BAA) are not new; however, some individuals are new to healthcare and others never understood what a BAA is exactly. A BAA is a contract that fundamentally gives assurances that the parties are complying with the Security Rule and Privacy Rule, setting parameters in the event of a reportable security incident or a breach, and states how the sensitive data will be returned and destroyed at the end of the relationship. Some of the items in a BAA are required, while others are optional but common. This presentation not only seeks to dispel myths about why certain language is prevalent in nearly all BAAs, but also provides insight into other provisions, and items for consideration, in light of the 21st Century Cures Act.

110

Battlefield Medicine, DNR Directives and Ventilator Allocation in the Wake of the Coronavirus Pandemic

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COVID-19 is raising issues around the globe regarding the application of battlefield medicine, the allocation of resources (i.e., ventilators and equipment) and the invocation of universal DNR orders. Interestingly, there is an intersection among mass casualty response, allocation of resources and DNR orders. This article will address battlefield triage medicine, allocation of resources (specifically ventilators) and DNR orders in relation to the COVID-19 pandemic.