The No Surprises Act, specifically the Independent Dispute Resolution (IDR) portal portion, has seen a number of legal disputes over the last year. Recently, a federal court of appeals affirmed one of the Texas court's rulings from last year stating that the government’s rules on how to apply the No Suprises Act failed to follow […]
On April 22, 2024, the government issued a Final Rule modifying the HIPAA Privacy Rule to support reproductive health care privacy. The government created additional protections for reproductive health information because it is particularly sensitive and involves highly personal health care decisions. Changes in the legal landscape have nationwide implications, not only because of their […]
Start Time: 1) Pre-OR time is scrutinized by the government because most pre-OR anesthesia services are bundled into the base units. There are only 2 types of pre-OR time that are billable, meaning your billed start time is prior to your in-room time:- Administering sedation (or a regional anesthetic) to the patient or - Transporting […]
While there remain challenges in the Independent Dispute Resolution (IDR) portal, the main one being extensive backlogs, the second half of 2023 proved to be positive for providers. The IDR portal is the arbitration process developed by the government pursuant to the No Surprises Act. The purpose of the portal is to provide a process […]
The No Surprises Act essentially went into effect on January 1, 2022, but portions of it have been delayed and litigated. The Act itself can be broken down into two parts. The first part is the Good Faith Estimates (GFEs), while the second part is the Independent Dispute Resolution (IDR) process. In this article we […]
Anti-Kickback StatuteThis federal criminal statute prohibits the exchange of anything of value to induce the referral of business reimbursable by federal health care programs. Examples of prohibited kickbacks include receiving financial incentives for referrals, free or very low rent for office space, or excessive compensation for medical directorships. In 2022, the Department of Justice’s (DOJ) […]
NO SURPRISES ACT The No Surprises Act is new legislation enacted by CMS. Parts of the Act went into effect January 1, 2022. The purpose of the Act is to protect patients from unknown costs of care and ensure patients have access to information to understand the true costs of healthcare services. The Act consists […]
The Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (the Departments) have released an initial report from the fourth quarter of 2022 covering data from October 1 – December 31, 2022 and a status update on the Federal IDR process for the period from April 15, 2022 […]
Here are three things you should be aware of: 1. If a qualifying payment amount is based on a down coded service code or modifier, a plan or issuer must provide with its initial payment: · A statement that the service code or modifier billed by the provider, or facility was down coded. · An explanation of […]
The No Surprises Act essentially went into effect on January 1, 2022, but portions of it have been delayed and litigated. The Act itself can be broken down into two parts. The first part is the Good Faith Estimates (GFEs), while the second part is the Independent Dispute Resolution (IDR) process. In this article we […]
