Day -1 ||  PART 1: Balanced Billing Laws: Prevent Avoidable Violations and Penalties

Balanced billing laws are pivotal to safeguard consumers from the unexpected financial burden of out-of-network medical care. Compliance with these laws is essential for healthcare providers to maintain ethical practices and avoid potential legal ramifications. Providers must thoroughly understand the regulations governing balanced billing in their respective states to prevent violations and penalties. Verifying patient insurance coverage before administering care is paramount, allowing providers to inform patients transparently about potential out-of-network costs. Documentation of patient consent and providing estimates and alternative options fosters an environment of informed decision-making. Billing transparency, prompt dispute resolution, and ongoing staff education are crucial to adherence to these laws. Additionally, staying abreast of legislative changes and seeking legal counsel when needed further fortifies compliance efforts, ensuring that healthcare providers navigate the complexities of balanced billing with integrity and accountability.

Highlights of the session:

• Uncover how to write off some balances when billing out-of-network legally.
• Meet billing requirements to avoid criminal prosecution.
• Mitigate routine waiver use and write-offs that raise auditor red flags.
• Pin down the difference between professional courtesy and insurance only.
• Implement policies to monitor write-offs and bad debt.
• Determine when and how it can offer professional courtesy.
• Identify the possible punishment and penalties for improper balance billing.
• Train staff to avoid discount compliance dos and don'ts.
• Avoid violating Stark and Kickback statutes due to balance billing.
• Proven tips to keep billing compliant and legal.

Day -2 || PART 2: Copays: What to Charge, When to Waive & How to Collect More

Determining appropriate copay amounts involves understanding both insurance agreements and fair pricing practices. Healthcare providers must charge copays according to the terms outlined in patients' insurance policies. However, providers may choose to waive copays in certain situations, such as financial hardship or for preventive care services, although this should be done judiciously and in compliance with applicable regulations. To enhance copay collection rates, providers can implement strategies such as streamlining billing processes, offering convenient payment options, and educating patients about their financial responsibilities upfront. Additionally, effective communication with patients regarding copays' purpose and timely payment's importance can encourage compliance. By balancing adherence to insurance guidelines with sensitivity to patient circumstances and employing proactive collection methods, healthcare providers can optimize copay collection while maintaining patient satisfaction and financial fairness.

Highlights of the session:

• Avoid costly violations due to discount, waiver, and write-off policies.
• Offer prompt payment discounts without breaching copay rules.
• Pin down when NEVER to balance uncollected bills.
• Effectively communicate the collection policy to patients to reduce risk.
• Master financial hardship waiver requirements to head off costly errors.
• Uncover how professional discounts can violate Anti-Kickback laws.
• Utilize an Advanced Beneficiary Notice (ABN) to avoid penalties.
• Bulletproof your copay/deductible collections policy to reduce compliance risk.
• Prevent the No Surprises Act from reducing rightful collections.
• Determine what constitutes "routine" when issuing a copay waiver.
• Identify and correct copay/deductible collection policy mistakes.
• Stop fraud allegations related to write-offs and bad debt.
• Tap into payer contract "lowest rate" clauses to minimize liability.
• Implement collection policy training dos and don'ts to protect against fraud.

Day -3 || PART 3: Stop Violating Professional Courtesy & Patient Discount Laws

To avoid violations of professional courtesy and patient discount laws, healthcare providers must prioritize adhering to legal and ethical standards. Professional courtesy, which involves providing discounted or complimentary services to colleagues or their families, should be offered consistently and transparently, without discrimination or favoritism. Similarly, patient discount programs must comply with applicable laws and regulations, ensuring fairness and equal treatment for all patients. Providers should establish clear policies and procedures for professional courtesy and patient discounts, outlining eligibility criteria, documentation requirements, and any limitations or exceptions. Maintaining thorough and accurate records of discounted services and transactions is crucial for compliance and accountability. By upholding professional integrity and respecting legal obligations, healthcare providers can cultivate trust with patients and colleagues while avoiding penalties or legal consequences.

Highlights of the session:

• Identify which providers and family members never offer discounts.
• Pin down the language that must be included in a professional courtesy policy.
• Differentiate the legal requirements of free services from discounted ones.
• Secure the legal definition of "routine" waivers to avoid them.
• Translate the False Claims Act legalese into actionable steps to avoid scrutiny.
• Determine what "professional courtesy" entails in the OIG's eyes.
• Train staff to prevent discount compliance dos and don'ts.
• Define what the AMA means when advising physicians to "use their judgment."
• See how private payers define discounts and if their rules align with Medicare's.
• Identify when to write off copays vs. the entire patient bill.