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No Surprises Act: A Federal and State Overview - Shared screen with speaker view
Lindsay Goldfarb - MHA
Good afternoon, thank you for joining today's webinar "Massachusetts and Federal Surprise Billing: A Status Update." Please note, today's webinar will be recorded and all lines will be in listen-only mode. If you have any questions, please type them in the CHAT box here. We will host a Q&A session near the end of the webinar.
Lindsay Goldfarb - MHA
As a reminder, the slides and recording will be made available after the webinar. If you have any questions, please type them into the CHAT. Thank you!
Karen Granoff
For those of you who are MHA members - MHA sent an advisory earlier this week seeking feedback on the consent and disclosure forms which are due to the feds by August 12, so please take a look and send us your thoughts!
Lindsay Goldfarb - MHA
Yes, the slides will be made available after the webinar. We will send a follow-up email with the slides and webinar recording.
Molly Smith
Will answer a few questions:
Molly Smith
Will the QPA be net of patient liability? The QPA is the total amount and what the patient cost sharing will be keyed off of. So, for example, if the median in-network rate/QPA is $500 TOTAL and the patient has 10% cost-sharing, the cost-sharing would be $50. However, the plan will tell you both the full QPA and the cost-sharing amount.
Molly Smith
Hello- When is the Rule expected to be final? How will the Rule be enforced with regard to the obligations by the Payers and by the Providers?Answer: this is technically a final rule so the Departments are not required under the law to make any changes and issue a "final final." We, of course, are advocating that they make changes and issue another final rule.
Molly Smith
Question: Is there any requirement regarding proportion of in network services? What if a major payor has a high proportion of services that are out of network due to low rates.Answer: there is consideration for what portion of the insurers' business is in-network... in some instances. However, I believe this consideration is only limited to instances where the plan didn't have 2019 rates and wants to use more current year's rates instead.
Molly Smith
To Adam's question around difference in billing... if not pursuing notice/consent to balance bill, then all of this should kick in when you bill the patient's health plan just as you would for any out-of-network coverage. We think this law/regulation rules over any OON benefits the patient may have for the services that are subject this law. However, we are seeking clarification on that point from the Departments.
Lindsay Goldfarb - MHA
We will be hosting a Q&A session soon! Please type any questions in the CHAT box here.
Molly Smith
Adam... is your question with respect to the good faith estimate?
Lindsay Goldfarb - MHA
Thank you to our speakers and thank you all for attending!