Tag: No Surprises Act


The State of Claims and Denials in 2023

How do you resolve a repeated and shooting up problem like claims denials? It’s been a fresher subject for revenue cycle management professionals for years that are only experiencing hotter with the growing pressures of staffing shortages, troubles with staff movement and instructing and developing policies and protocols at the government and payer levels. On […]
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Revenue Cycle Will Be The Main Focus Of Advocacy For 2023

Each year the American Hospital Association (AHA) releases an advocacy agenda focusing on key areas in need of “critical support” for hospitals and health systems, and this year, quite a few key areas will be focused on your revenue cycle. “Hospitals and health systems are dealing with unprecedented challenges as they manage the aftershocks and […]
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How The No Surprises Act Law Reshaped Medical Billing

One year ago, the United States marked a turning point for health care cost transparency with a new law aimed at helping Americans avoid unnecessary, unexpected medical debt. As of Jan. 1, 2022, health care providers and insurers are no longer allowed to sideswipe privately insured people with bills for out-of-network services. Experts say the […]
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Uninsured Consumers Also Protected From High Surprise Bills

Most providers understand the “No Surprises” requirements for insured patients. Effective as of Jan. 1, 2022, uninsured (or self-pay) consumers are also protected from unexpected high medical bills. If a consumer doesn’t have health insurance or doesn’t plan to use insurance to pay for health care items or services, they must be given a “good […]
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Unpleasant Surprises Stemming From The No Surprises Act

One facility recently found that failing to get an estimate to a patient in timely fashion created more than a few headaches. This past January, immediately after the good-faith price estimate requirement for hospitals went into effect, one of my clients received a call from a patient late on a Friday to schedule a procedure […]
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No Surprises Act Compliance Debuted as a New Burden

Regulatory burden is on the rise yet again as practices struggle with prior authorizations, No Surprises Act compliance, and the Quality Payment Program, MGMA reports. Prior authorizations are still the top regulatory burden according to executives from group practices, while No Surprises Act compliance has debuted on the list this year as the second most […]
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More Versions to Come: No Surprises Act

Although the Biden Administration claims this is the final regulation, there is evidence more is yet to come. The Biden administration released the final No Surprises Act regulation recently but advised healthcare professionals that this final version is not the final one and promised more to come. The latest final rule was narrowly focused on […]
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Final Surprise Billing Rules QPA

Biden Administration Releases Final Surprise Billing Rules

  The final surprise billing rules downgrade the weight the QPA has on out-of-network payment determinations and establishes documentation requirements for down coding situations. The Biden Administration has released final surprise billing rules implementing the No Surprises Act, a federal law enacted in January 2021 that protects patients from out-of-network medical bills when they seek […]
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Where did all the Medicare Physician Payments Go

The federal government probably won’t be raising Medicare reimbursements next year, and physician organizations are strongly objecting. At its Jan. 13 meeting, the Medicare Payment Advisory Commission (MedPAC), which advises Congress on financial issues pertaining to Medicare, recommended against increasing base payment rates to doctors in 2023. It justified its decision in part by noting […]
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