Surprise! The New Federal Surprise Medical Billing Legislation is Here: What You Need to Know
In this presentation, we discuss the issue of out-of-network balance billing, or so-called “surprise medical billing”. The presentation reviews the issue of surprise medical billing and the federal legislation that was passed to address the problem. The federal law, the No Surprises Act, attempts to protect good-faith negotiations between physicians and insurance companies and encourage network contracting. Rulemaking to operationalize the law prompted numerous lawsuits, including one involving the American College of Radiology. Understanding this complex issue, even for radiology practices that are fully in network or never practiced surprise billing, is important given the impact the law has on commercial reimbursement.
Speakers:
Richard Heller, MD
RadPartners
Joshua Hirsch, MD
Mass General Brigham
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Rich Heller is a Chicago-based pediatric radiologist with Radiology Partners, serving as the Associate Chief Medical Officer: Communications and Health Policy, as well as the National Director of Pediatric Radiology. In addition, he is a Clinical Associate at the University of Chicago Medical Center, Comer Children’s Hospital. Rich is an Alpha Omega Alpha graduate of the Feinberg School of Medicine at Northwestern University and has an MBA from Northwestern's Kellogg School of Management. He completed his residency at the Mallinckrodt Institute of Radiology and his fellowship at Boston Children's Hospital. Rich is an active leader with the Society for Pediatric Radiology (SPR) and the American College of Radiology (ACR). Among other duties, he is the co-chair of the ACR’s Commission on Economics- Committee on Pediatric Radiology, vice-chair of the ACR’s MACRA committee, represents Illinois on the ACR’s Contractor Advisory Committee (CAC) Network, and serves on the editorial board of the journal Pediatric Radiology. Rich is also proud to serve on the board of the RSNA. Rich’s academic work focuses on the economics of healthcare and value-based reform, as well as the issue of out-of-network billing legislation.
Joshua Hirsch MD FACR FSIR FSNIS is director of Interventional Neuroradiology, chief of the Interventional Spine Service, vice chair of Interventional Radiology Quality & Safety and associate Departmental Quality Chair at Mass General Brigham. He has extensive experience in diagnosis, management and treatment of cerebrovascular disease, minimally invasive spine surgery and acute stroke treatment. Dr. Hirsch has published over 450 papers, 40 chapters and edited multiple books in the peer-reviewed literature. He is a founding editor of the Journal of NeuroInterventional Surgery and is a past president of both the American Society of Spine Radiology (ASSR) and the Society of NeuroInterventional Surgery (SNIS). He has been elected to the board of the American Society of Interventional Pain Physicians (ASIPP), the Society for Injectable Osteoarticular Biomaterials and the American Society of Neuroradiology (ASNR). He is chair of a committee for academicians at the American College of Radiology.
Dr. Hirsch was named a senior affiliate research fellow of the Neiman Policy Institute. He is an advisor to the RUC, chairs the health policy committee and member of the Niekro Foundation's Medical Advisory Board. Dr. Hirsch co-chairs the Neuro-Psychiatric working group developing episodic cost measures. Dr. Hirsch has received numerous awards including ones for transformational leadership at the ASSR, distinguished service at the ASNR and academic achievement at ASIPP. He has been named one of America's Top Doctors and a Best of Boston physician for multiple consecutive years. He is a member of the Marquis Who's Who and was recently awarded the 100 designation from the MGH's Cancer Center. He has been named an inaugural fellow of the SNIS for his many contributions to the field of NeuroInterventional Surgery.