No Surprises Acts (NSA): Observations from the Front Lines

Effective on Jan 1, 2022, the NSA was created to Protect patients from Surprise Medical Bills from Out-of-Network (OON) Providers, making it illegal for Providers to “Balance Bill” Patients.
However, lawmakers anticipating a significant impact on Providers’ revenue, established a Federal Independent Dispute Resolution (IDR) process to help Providers pursue reimbursement for these Out-of-Network services from Payors/Insurers.
Presenters Chris Myers and Guy Barber have had the opportunity to engage this process from its inception and collaborate with impacted stakeholders across the process. This includes providers, CMS, payors, and IDRE Mediators.
In this presentation- we will share an overview of the process, real world case studies of HEMS programs who have engaged and achieved favorable results, and trends/predictions for the future direction of the NSA.
Participants will learn how to assess their program's financial health as it relates to reimbursement. A simplified approach towards understanding their financial data, and its implications, as well as an actionable tool kit for developing a comprehensive payor strategy plan.

Session Outline:
I. Introduction, Overview, History of No Surprises Act, how did we get here, and who are the Stakeholders? 10min
2. Why is the No Surprises Act so important- Understanding short term revenue impact and long term rates/payor strategy impact 5min
3. Case Studies- Specific case studies outlining diverse HEMS programs and how they engaged the NSA process. Include non-HEMS case studies to illustrate the similarities and differences between the HEMS experience vs peers in other sectors of Healthcare 10 min
4. Q&A / Recommended actions and data every Program should be fluent in as it relates to patient billing strategies 5min