Federal No Surprises Act – The IDR Process, Good Faith Estimates, and What Providers Need to Know

November 04, 2021
60 Mins
Thomas J. Force, Esq.

Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period

The Departments of Health and Human Services, Labor, and of the Treasury issued an interim final rule (the “IFR”) concerning the federal No Surprises Act on September 30, 2021.  Although the hope was that the IFR would provide clarity as the requirements and dispute resolution programs under the No Surprises Act, it left many questions unanswered and revealed a considerable hindrance to out-of-network providers securing fair and reasonable reimbursement.  

In particular, the presumption that the qualifying payment amount (the “QPA”), defined as the plan’s median in-network rate for the applicable geographic area, serves as the primary obstacle to overcome before fair and reasonable reimbursement will be securable.  Notably, this position as set forth in the IFR, contradicts Congressional intent, as explained in the recent letter from the U.S. House of Representative’s Committee on Ways and Means.  Accordingly, prior to delving into how the QPA can be differentiated and, thus, bypassed, this webinar discusses how and why the healthcare industry must unite as one to combat the inequitable guidelines specified in the IFR.  In particular, a call to join together to issue unified comment to the aforementioned Departments is issued.

Join this must-attend Live webinar with healthcare attorney Thomas J. Force. Esq. where he discusses various factors helpful in bypassing the QPA, with explanation as to how these factors can be supported by credible evidence to demonstrate that the QPA is materially different from fair and reasonable out-of-network reimbursements (a requirement set out in the IFR for circumventing the QPA).

Finally, Thomas will discuss, in detail, the requirement to issue good faith estimates to uninsured (or self-pay patients), the questions that remain as related to this process, and the logistics of compliance with the same (a task that will, at least initially, result in a considerable administrative burden, especially in light of the uncertainty as to how the dispute resolution process will play out, as a whole).

Webinar Objectives

This power-packed session seeks to address the unfair nature of many of the IFRs guidelines, how the healthcare industry can fight back against this inequity, and how out-of-network providers (namely who provide services at in-network facilities and are subject to the Act’s regulations) can promote the likelihood of securing fair and reasonable compensation.

In addition, this session seeks to flesh out the logistics of the provider-plan independent dispute resolution process (“IDR” or the “IDR process”), as failure to properly satisfy the steps therein can prevent full and fair compensation from being secured.

Finally, this webinar will advise providers/facilities as to how they can ensure compliance with the good faith estimate requirements for uninsured and self-pay patients.

Webinar Agenda
  • General Information and Perceived Bias in Favor of Plans & Carriers
  • The IDR Process – A Refresher on Timeframes
  • The IDR Process – Open Negotiation
  • The IDR Process – Initiation of IDR
  • The IDR Process – IDRE selection
  • The IDR Process – Submission of Offers
  • The IDR Process – Determinations and Factors
  • The IDR Process – Getting Around the QPA
  • Good Faith Estimates (Generally)
  • Good Faith Estimates – Who is an Uninsured/Self-Pay Patient?
  • Good Faith Estimates – Steps & Requirements
  • Good Faith Estimates – Who’s Responsible?
  • Good Faith Estimates – Deferral to State Law (Open Questions)
  • Topics Not Discussed and Unanswered Questions
  • Key Takeaways
Webinar Highlights
  • How the Departments have apparently favored the plans/carriers
  • The logistics of the IDR process
  • Factors that can be used to your advantage in the IDR process
  • How to circumvent the QPA
  • How the healthcare industry can fight back (actions that can be taken) 
  • How to satisfy the good faith estimate requirements
  • How the IFR left many unanswered questions / areas where further guidance will still be necessary
Who Should Attend

Out-of-network healthcare providers and facility (ambulatory surgery centers, for example) owners and managers.

Thomas J. Force, Esq.

Thomas J. Force, Esq.

As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance Officer propelled the founding of The Patriot Group. The Patriot Group is a full service revenue recovery company that provides billing, collections, and follow-up services as well as assistance with managed care appeals, managed care contracting, credentialing and compliance. Mr. Force is nationally recognized as an expert in revenue collection...
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