A Perfect Storm: Agencies Collaborate on Medical Debt, Price Transparency, Charity Care

Kathryn Beard, JDAugust 17, 2023

Almost 40% of Americans recently reported they were deferring medical care due to the cost of treatment.1 This is particularly true for Americans with low incomes, who have reported cancelling treatment for even the most serious conditions due to an inability to pay for necessary services.

 

Financial ...

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Texas Judge Vacates No Surprises IDR Fee Increase, Batching Rule

Kathryn Beard, JDAugust 9, 2023

Disclaimer: This information is for educational purposes only and is current as of August 8, 2023. Not intended to be used as or constitute legal or medical advice.  

 

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Why Prior Authorization Reform Should Garner Provider Support

R1 Regulatory TeamApril 14, 2023

In the United States, prior authorization (“PA”) is a cost-containment tool utilized by payers to reduce payment for medically unnecessary or inappropriate patient care. Despite its laudable policy goals, the use of PA faces

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The Future of Good Faith Estimates Under the No Surprises Act

R1 Regulatory TeamJanuary 18, 2023

The No Surprises Act of the 2021 Consolidated Appropriations Act (“NSA”) established requirements for healthcare providers to deliver Good Faith Estimates (“GFEs”) for scheduled services or upon patient request. 

Key Takeaways: 

  1. Indefinite extension  of co-provider and co-facility enforcement ...

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Hospital Price Transparency: Lessons Learned, Best Practices

R1 Regulatory TeamDecember 19, 2022

Federal price transparency requirements for hospitals from the Centers for Medicare & Medicaid Services (CMS) provide patients with an unprecedented amount of insight into the costs for medical services.1  

 

In theory, more pricing information should ...

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Revenue cycles challenged by mandates of No Surprises Act

Susan MorseDecember 5, 2022

The No Surprises Act has reportedly done its job in preventing an estimated nine million surprise medical bills since going into effect at the start of this year, ...

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HFM: No Surprises Act Regulations Remain Moving Target for Compliance

Nick HutNovember 3, 2022

Amid all the rules stemming from the No Surprises Act, a looming mandate for providers to send cost estimates to health plans looks like the biggest stress inducer.

 

Various regulations under the No Surprises Act have created strain for healthcare finance professionals since the initial rules were published in mid-2021, ...

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Early Insights on Independent Dispute Resolution Under No Surprises Act

R1 Regulatory Affairs & Regulatory Compliance TeamSeptember 23, 2022

On August 19, 2022, the Departments of Health and Human Services (“HHS”), Labor, and the Treasury (“the Departments”) issued a Federal Independent Dispute Resolution Process Status Update.1 In the statement, the Departments reported that between April 15th and August 11th, 2022, providers initiated ...

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No Surprises Act 2022: What Physicians Still Need to Know

Kathryn Beard, JDJuly 7, 2022

On January 1, 2022, the federal No Surprises Act (NSA) went into effect. At its heart, the NSA aims to empower patients to make more informed financial decisions about their care while eliminating unexpected bills which, prior to NSA protections, have sometimes led to financially ...

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Court Vacates No Surprises Act Regulations Favoring Payors in Reimbursement Disputes

Kathryn Beard, JDFebruary 25, 2022

On February 23, 2022, a Texas district court found that portions of the No Surprises Act ...

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