Dave Brener

Since the No Surprises Act went into effect, the law has prevented more than two million surprise billing claims in its first two months of enactment, according to a survey from AHIP and the Blue Cross Blue Shield Association (BCBSA).

Implementation of the federal No Surprises Act, intended to protect patients from unanticipated medical expense after receiving care from an out-of-network physician, other health professional, hospital, or other provider, is very much a work in progress.

The new federal law, which took effect in January of this year, bars surprise billing for emergency care and some nonemergency care at in-network facilities. The law and implementing regulations have established a process to determine payment for physicians, health care organizations and others that includes the IDR process.

It’s a capital-efficient way to achieve growth without being pigeonholed into one strategy, and differs from the value-based blueprints of peers UnitedHealth and Humana.

HIPAA, for better or worse, is a part of every healthcare business. It does not matter if your company is a traditional clinic or a cutting-edge AI platform powered by PHI (protected health information). There are different approaches to comply with HIPAA, and organizations as varied as clinics and AI platforms typically employ these different approaches.

The No Surprises Act will affect patients and providers alike when it goes into effect. While the outcome is still unknown, the hope is that patients will be relieved of surprise medical bills without a change to providers’ revenue.

In split/shared billing, the physician should contribute substantively to taking care of the patient and be permitted to bill for it, even if an NPP participates, too.

Is your clearinghouse a goldmine? In other words, does your clearinghouse provide the tools and the tech to dig into the revenue cycle, accelerate cash and make your business office more efficient? Well, it should. This is a bold statement indeed but in the following series of blogs I will show you why it’s true.

The Centers for Medicare & Medicaid Services (CMS) just updated coverage policies for Rural Health Clinic payments and services. A Rural Health Clinic (RHC) is located in an underserved area with a shortage of primary care providers, personal health services, or both. Medicare pays RHCs for the provision of certain primary care and preventive health services in these underserved rural areas. Make sure your billing staff is aware of these modifications that went into effect Jan. 1, 2022.

Join NHLBI, The Heart Truth®, and organizations around the country on National Wear Red Day®, celebrated each year on the first Friday in February, to bring greater attention to heart disease as a leading cause of death for Americans. Use the poster, stickers, and social media resources below to promote Wear Red Day.