Podcasts about no surprises act

Since the implementation of the No Surprises Act (NSA) in January 2022, out-of-network (OON) reimbursement has become a complex and resource-heavy challenge for hospital and health system revenue cycle leaders. Although designed to shield patients from unexpected medical bills, the legislation has placed continuous financial pressure on physician practices and hospital systems. It has led […] The post No Surprises Act and OON Claims appeared first on Terry Fletcher Consulting, Inc..

GPPR Podcast Editor Mitchell Zupko (MPP'25) chats with Devin Gerzof, the Executive Director of Executive Branch Relations and Federal Relations at the American Hospital Association. They discuss the No Surprises Act, site neutral payments, reimbursements, the 340B Program, and more.

As healthcare regulations continue to evolve, organizations must stay ahead of complex compliance requirements to remain competitive and protect patients. In this episode of Healthcare Insider, Ann Phillips, Senior Director of Regulatory and Standards at PurpleLab, unpacks the current landscape of price transparency rules –including updates to the No Surprises Act and the Transparency in Coverage rule – and what they mean for providers, payers and patients alike. She dives into the latest regulatory guidance, enforcement challenges and how technology and industry collaboration can bridge data gaps and support compliance. Listen to learn how your organization can navigate shifting regulations and leverage data to support compliance, inform strategy and improve decision-making.

*Content warning: infant loss, death, birth trauma, medical trauma and neglect, fraud, scams. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsMarkeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://linktr.ee/momsadvocatingformoms Please sign the survivors petition below to improve midwifery education and regulation in Texas: https://tinyurl.com/SWWS23 *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Balance billing: Independent Dispute Resolutionhttps://www.tdi.texas.gov/medical-billing/index.html#:~:text=Texas%20and%20federal%20laws%20prohibit,with%20a%20surprise%20medical%20bill. CMS, The No Surprises Act's Prohibitions on Balancing Billinghttps://www.cms.gov/files/document/a274577-1a-training-1-balancing-billingfinal508.pdf Do Certified Professional Midwives Need Medical Malpractice Insurance? Understanding the Legal Requirementshttps://www.rcins.com/do-certified-professional-midwives-need-medical-malpractice-insurance-understanding-the-legal-requirements/#:~:text=Texas%3A%20In%20contrast%2C%20Texas%20does,to%20carry%20medical%20malpractice%20insurance. How Expanding the Role of Midwives in U.S. Health Care Could Help Address the Maternal Health Crisishttps://www.commonwealthfund.org/publications/issue-briefs/2023/may/expanding-role-midwives-address-maternal-health-crisis#:~:text=Midwives%20are%20licensed%20health%20care,women%20at%20double%20the%20rate. Implementation of 2015 Sunset Recommendationshttps://www.sunset.texas.gov/public/uploads/files/reports/Implementation%20of%202015%20Sunset%20Recommendations.pdf The Legislative Process in Texashttps://tlc.texas.gov/docs/legref/legislativeprocess.pdf National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Practicing Medicine Without a Licensehttps://www.criminaldefenselawyer.com/resources/practicing-medicine-without-a-license.htm#:~:text=Many%20states%20make%20it%20a,fine%20of%20up%20to%20%2410%2C000. Regulation of Birth Attendants in Texashttps://texashomebirth.com/regulation-2/ Texas Board of Nursing https://www.bon.texas.gov/ Texas Department of Insurance https://www.tdi.texas.gov/ Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ TDLR, Midwives Penalties and Sanctionshttps://www.tdlr.texas.gov/enforcement/midsanctions.htm Texas Health and Human Serviceshttps://www.hhs.texas.gov/ Texas Medical Board (TMB)https://www.tmb.state.tx.us/ State investigating Dallas birth center and midwives, following multiple complaints from patients, by Morgan Young for WFAA (March 29, 2024) https://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef What Do OB/GYN Nurse Practitioners Do?https://nursa.com/specialty-post/what-do-ob-gyn-nurse-practitoners-do#:~:text=OB/GYN%20nurse%20practitioners%20are,not%20licensed%20to%20deliver%20babies. What Is the Texas Medical Malpractice Statute of Limitations?https://www.nolo.com/legal-encyclopedia/what-the-texas-statute-limitations-medical-malpractice-lawsuits.html#:~:text=Like%20a%20lot%20of%20states,and%20Remedies%20Code%20section%2074.251. Which states have the highest maternal mortality rates?https://usafacts.org/articles/which-states-have-the-highest-maternal-mortality-rates/ Why Won't an Attorney Take My Texas Medical Malpractice Case?https://www.hastingsfirm.com/your-case-and-texas-law/#:~:text=Texas%20law%20has%20made%20medical,and%20many%20hours%20of%20deposition. Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Hear more from Emily Wolfe:On Spotify // On Apple Music // https://www.emilywolfemusic.com/ // instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Artificial intelligence may be changing the trajectory of the self-funded industry – but can it negotiate? In this episode of The Phia Group's Empowering Plans podcast, attorneys Brian O'Hara and Jon Jablon break down real-life examples of AI-driven responses in the No Surprises Act's Open Negotiations process that range from nonsensical to outright misleading, where negotiating with AI is like trying to haggle with a toaster. From missing claim numbers to automated counteroffers that make no sense, Brian and Jon discuss whether AI is making negotiations easier, or defeating the purpose of the statutory process to begin with. Tune in for an honest discussion of the pitfalls of AI in No Surprises Act negotiations.

Emergency room costs now make up 6% of total healthcare plan spending—why? In this episode, host Stacey Richter welcomes Al Lewis to break down the data behind rising ER expenses, separating fact from fiction. They discuss whether increased patient acuity or widespread upcoding is driving costs, the impact of the No Surprises Act, and why plan sponsors struggle to negotiate fair ER rates. Plus, Al shares actionable strategies for employers to push back against inflated charges. If you want to understand the hidden forces behind escalating ER bills, this is a must-listen. You can find the charts and links mentioned in the show notes in the link below. === LINKS ===

WEDI Chair Elect Merri-Lee Stine of Aetna CVS Health speaks with Jonathan Blum, Principal Deputy Administrator and Chief Operating Officer with CMS. The two discuss CMS' plans for the rest of the year, success stories during this administration and success stories surrounding the No Surprises Act and the Interoperability and Prior Authorization Rule. 

On this episode of the Empowering Plans Podcast, attorneys Ron Peck and Nick Bonds talk through a recent Florida case addressing judicial review of IDR determinations and highlight some of the key insights and takeaways for any entity subject to the No Surprises Act.

Last time Cora Opsahl was on the show, Michelle Bernabe, RN, KAT, wrote a comment on LinkedIn I thought encapsulated the gist of it all so well. She wrote, “[Cora] first became a mentor/ally through Relentless Health Value episode 372. … It opened a doorway to a whole group of very relentless people.” For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. I want to start there because it's a nice comment, but it's also a call to action. Think about this and think about it not in the context of being a “stakeholder” and not in the context of being an organization but in the context of humans who work at these various organizations who, combined, comprise the bucket of companies that we lumped together using the old stakeholder word. All of these individuals are making choices every day, and all of these choices, they could be made with integrity and with the patient or member in mind … or not. In real life, right now, the overwhelming majority of members/patients in this country get their clinical care and the pleasure of paying for that care or drugs within the current ecosystem we have here in the USA. For any of us, or all of us who work within that traditional ecosystem, it is up to us to choose our own legacy here. It's probably why you listen to this show in the first place, actually. There are so many RHV (Relentless Health Value) listeners who are pushing for patients against the riptide that is the profit motives of the organization that they work for. It's hard. But yeah, it's all about finding our people and supporting each other. Okay, so let's get to the “between a rock and a hard place” portion of this discussion. Hospitals and ASOs (administrative services organizations)/carriers/TPAs (third-party administrators) often enter into or sometimes enter into what amounts to anticompetitive contracts with each other. Listen to episode 395 with Brennan Bilberry for the rundown on that one. But meanwhile, the CAA, the Consolidated Appropriations Act from 2021, holds employer plan sponsors accountable and responsible to ensure that plan assets are spent prudently, that costs paid are reasonable, and that there's no conflict of interest (COI). This is the definition of what a fiduciary is supposed to do, by the way—prudent, reasonable, and no COI. Anticompetitive contracts between a carrier and a hospital are the very definition of COI. And when that COI results in higher, maybe unreasonable, prices and non-prudent spend, well, plan sponsors are put between a rock and a hard place if they stick with their existing vendors. Rosa Novo from Miami-Dade County Public Schools put this really succinctly on a panel at a 32BJ event recently. She said what amounts to, I have no choice but to actually do the right thing here, for many reasons, but one of them is I do not look good in orange. She said, my personal butt is on the line here. And furthermore, who do class action lawsuits make look bad when their company or CEO or CFO are personally sued over conflicted benefits? See the Wells Fargo lawsuit, J&J lawsuit, etc. It sucks that employers or plan sponsors get put into this pickle by their own vendors. And that's what we're talking about today. This is a conversation that starts out talking about rates (ie, prices), edges into rights (ie, plan sponsor rights), and ends up all about power. And by the way, if you're a plan sponsor, especially in New York City, maybe doing the right thing here means hatching a plan to steer and tier in your benefit design, figuring out how to, for reals, help support the efforts of 32BJ to advantage pretty much every patient near and far. The pushback I often hear to doing something like this often involves the perception that plan members are too rich to care about reasonable prices, prudent plan spending, and COI. And yeah, to state the obvious, these same people are also sophisticated enough to smell a fine opportunity for a class action lawsuit; and also, they probably do care, as more and more studies suggest. Sorry if I just stumbled onto a sacred cow. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise ever; employers got a premium holiday and a 3% rate increase for a bunch of years after that; and yeah … this is where we start the conversation today. And yeah, it's a freakin' tangled web we weave; and this tale is a perfect case study of it. It makes me even more invested in remembering my own manifesto (that was episode 400) to ensure that I can feel good about what I personally have accomplished and what I have been a part of and the net impact of my own personal actions, since I, too, very often work in the belly of the beast. Furthermore, you will find links to a template health savings calculator for plan sponsors and also a template contract (again for plan sponsors) that 32BJ has made available. More on that in the show that follows. Also mentioned in this episode are 32BJ Benefit Funds; Michelle Bernabe, RN, KAT; Brennan Bilberry; Rosa Novo; Marilyn Bartlett; Cynthia Fisher; Zack Cooper, PhD; Claire Brockbank; Andreas Mang; Chris Deacon; Elizabeth Mitchell; and Purchaser Business Group on Health.   You can learn more at health.32bjfunds.org and by following Cora on LinkedIn.   Cora Opsahl is the director of the 32BJ Health Fund, a self-insured Taft-Hartley benefit fund that sets comprehensive design parameters to ensure the 200,000 members and families of Service Employees International Union 32BJ have easy and sustained access to affordable, high-quality healthcare. Since becoming director of the Health Fund in 2021, Cora has prioritized a data-driven approach to healthcare, focusing on reducing trend; solving the affordability challenge on behalf of union members; and most important, keeping members at the center of every decision. Under her leadership, the 32BJ Health Fund has saved more than $35 million annually—which it has reinvested in new and better benefits, including the first fertility benefit for members—by removing NewYork-Presbyterian hospitals and physicians from its network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program. Most recently, Cora conducted an innovative medical request for proposal (RFP), stipulating that all finalists must have a signature-ready contract drafted by the Health Fund prior to award. By including the Health Fund–drafted contract in the RFP process, the Fund was able to negotiate an agreement that brought unprecedented visibility and increased accountability to the 32BJ Health Fund benefit. Cora is regarded as an expert in pharmacy benefit management and previously worked at Express Scripts, where she held a variety of roles, ranging from Medicare Part D to operations to strategy and acquisitions. She earned an MBA from Saint Louis University.   06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors? 09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design. 12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design? 14:12 How do these anticompetitive rights have quality implications as well as cost implications? 18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year? 19:46 What did the healthcare savings allow the unions and employers to do? 20:46 Study by Zack Cooper, PhD. 21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend. 24:15 Why 32BJ Health Fund wants to control the contracting process. 26:00 EP419 with Andreas Mang. 27:18 What are 32BJ Health Fund's four non-negotiables? 33:17 Wall Street Journal article on health insurance contract. 35:30 Upcoming episode with Claire Brockbank. 36:14 What is the challenge that exists in our current healthcare environment? 37:43 Cora's advice on how to get high-quality healthcare at an affordable price.   You can learn more at health.32bjfunds.org and by following Cora on LinkedIn.   @CoraOpsahl discusses #fiduciaryresponsibility in #healthcare on our #healthcarepodcast. #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn (EP446)  

In this episode of Glauc Talk, we dive into the chaos of a stressful morning and explore how emotional regulation can make a big difference in managing everyday challenges. I also reflect on some of my biggest social media mistakes and the lessons I learned from those controversies, offering valuable insights for others navigating the online world. The episode touches on the importance of taking a pause before reacting, handling crises calmly, and learning from missteps. Additionally, we discuss the shocking cost of helicopter medical transport and how recent legislation aims to prevent surprise billing in these situations. Tune in for humor, personal stories, and practical lessons on stress management, social media, and navigating healthcare costs. Takeaways: Take a pause before reacting to stressful situations—waiting even a few minutes can help you think more clearly and make better decisions. Learning from social media mistakes can lead to growth, both personally and professionally. Owning your mistakes is key to moving forward. Helicopter medical transport can be extremely expensive, with costs reaching as high as $68,000, though legislation like the No Surprises Act helps regulate billing. Emotional regulation plays a vital role in handling life's unexpected challenges, from stressful mornings to bigger crises. Staying grounded through mindfulness techniques, such as deep breathing, can help manage adrenaline-fueled reactions in high-pressure situations. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you like the scrubs I'm wearing, here's a link and discount code to get some Jaanuu Scrubs link: https://bit.ly/4cAvXbs code: DRG20 for 20% off first-time purchases* *This code works on full-price items only excluding embroidery!  If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link:  Anatomy Warehouse Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit http://www.EyelidCheck.com for more information.  Today's episode is brought to you by the Nuance Dragon Ambient Experience (DAX). It's like having a virtual Jonathan in your pocket. If you would like to learn more about DAX Copilot check out http://nuance.com/discoverDAX and ask your provider for the DAX Copilot experience. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma e Biotech world.Leqembi, a new biotech drug, has been approved in the UK, but reimbursement may not follow due to concerns about the cost to the NHS. The FDA defended its med device chief's tenure after ethics concerns were raised. Employers are expecting higher health costs next year, driven by rising pharmacy spending on drugs like GLP-1 for obesity. BridgeBio has sent rare disease drugs to a new company called GondolaBio, backed by investors including Viking Global Investors and Sequoia Capital. Versant has launched a new startup called Borealis Biosciences with funding from Novartis.New Jersey has announced plans to erase $100 million in medical debt for nearly 50,000 residents, following similar initiatives by other states and federal regulators. Molina Healthcare has extended CEO Joe Zubretsky's contract through 2027, along with a stock grant potentially worth $51 million. Additionally, CMS has received 12,000 complaints of noncompliance with the No Surprises Act, resulting in $1.7 million in restitution.Novartis and Versant have launched Borealis Biosciences with $150 million in funding to develop RNA therapeutics for kidney diseases, following the success of Chinook Therapeutics. Meanwhile, Wuxi Biologics reported a 24% drop in net profit in the first half of 2024 despite signing a record number of new projects. In other news, Biogen and Eisai's Alzheimer's drug Leqvembi has been approved in the UK but deemed too expensive by NICE, while Biomarin has brought on Roche and Amgen alums in an executive restructuring.The text discusses the potential impact of the Democrats' proposed changes to Medicare drug price negotiations on the pharmaceutical industry's research and development (R&D) efforts. Kamala Harris is expected to address these issues during the Democratic National Convention, with the party aiming to lower drug prices by increasing the number of drugs subject to negotiations.TE Connectivity offers sensor solutions for minimally invasive devices, providing precision and safety for procedures such as cardiac mapping and ablation. Their sensor technology can enhance efficacy in heart arrhythmia treatments. The comprehensive sensor solutions guide provides detailed applications, key features, and benefits of their sensors.The text discusses the importance of collecting and using social determinants of health (SDOH) data in health economics and outcomes research (HEOR). It highlights the challenges of collecting SDOH data and provides insights on how to effectively use the data while ensuring privacy and security. The text emphasizes the significance of diverse and inclusive research practices, evaluating data validity and sourcing, and effectively utilizing SDOH data to gain more accurate insights in HEOR.

Since this archive episode aired early in our podcast, organizations have paid off billions of dollars in medical debt, and many hospitals have stopped suing patients for small claims. However, the problem of medical debt is far from over and now is the best moment to do something about medical debt. In this interview, Berneta Haynes, Staff Attorney with the National Consumer Law Center, talks in depth about what medical debt is, who is affected by it, why it's a massive issue in the United States, and how to start solving this problem. In the US, getting sick or suffering an accident can lead to costly bills that trap a patient in a debt and disparity cycle when they lack money, insurance coverage, or live with a chronic condition. The National Consumer Law Center seeks to help communities of color and low-income populations by teaching them to manage their debt, handle collectors, and know their rights. Berneta explains the provisions and protections the Affordable Care Act and the No Surprises Act have to protect consumers from unfair medical bills and aggressive collections while highlighting changes and actions that improve the law, reduce debt, and expand the support umbrella across the country. Tune in to learn more about the issue of medical debt and how to tackle it best! Learn more about your ad choices. Visit megaphone.fm/adchoices

Providers receive a win in the latest appeals court ruling on the No Surprises Act. About 700 rural hospitals are at risk of closing, according to a new report. And a recent survey finds that less than half of Americans trust doctors. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

July 24, 2024 ~ Dr. J. Carter Ralphe, American Heart Association Volunteer, joins Kevin and Tom to discuss how the No Surprises Act is protecting families from surprise medical bills.

Synchronizing provider data between health organizations and insurance companies ensures accurate information and reduces costs. In this episode of the AHIP 2024 series, Eric Demers, CEO of Madaket Health, discusses his company's role in benefitting patients through reducing administrative waste and enhancing efficiencies for providers and payers. By streamlining and automating functions, Madaket Health helps synchronize provider data between health organizations and insurance companies, ensuring accurate information flow and reducing costs. Eric stresses the importance of accurate provider data managed by organizations like insurance companies, which supports initiatives like the No Surprises Act and enhances provider network management, member satisfaction, and quality. He highlights the challenges of misinformation in healthcare and the need for accurate directories, emphasizing that improving provider directories can enhance quality, reduce costs, and increase revenues. He also explains that using platforms like Madaket Health can prevent revenue loss and create business opportunities. Tune in and learn how to navigate the complexities of the healthcare industry and improve your organization's operations! Resources:  Watch the entire interview here.  Connect and follow Eric Demers on LinkedIn. Learn more about Madaket Health on their LinkedIn and website. Listen to Eric's previous episode on our podcast here.

In late 2020 the Congress passed the No Surprises Act largely intended to address patient “surprise,” or out of network bills, typically the result of ER visits. Should settlement between the healthcare provider, e.g., hospital, and insurance company fail, the bill created an arbitration, termed Independent Dispute Resolution (IDR), process. To date the number of disputes going to arbitration have vastly outnumber those expected, the vast majority of provider-initiated disputes have been curiously backed by private equity, arbitration settlements takes take more than twice as long than the statutory limit, providers have been winning 75% plus of arbitrated cases and the median arbitration reimbursement is nearly four times what the Medicare program pays.  With me to discuss the topic is Nathan Martinez, an Arizona-based healthcare claims software developer. During this interview we mention an April 2024 New York Times article that discussed efforts by insurers to reap, or game, greater out of network reimbursement. The article is at: https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

In the insightful Episode 39 of "Closing the Books," Michelle Dove, IC System's Corporate Counsel and Chief Compliance Officer, delves into the intricate realm of healthcare debt collection amidst the backdrop of evolving regulations. Dove highlights the imperative of staying abreast with the latest regulatory changes, such as updates from the Consumer Financial Protection Bureau and the introduction of the No Surprises Act, underscoring the challenges and necessities of compliance for healthcare providers. The conversation further explores how IC System is at the forefront of adapting to these changes, employing strategies like advanced electronic communication and a nuanced understanding of patients' propensity to pay. This approach not only aids in enhancing the effectiveness of debt recovery efforts but also emphasizes IC System's commitment to ethical practices and maintaining respectful patient relationships. Dove's expertise offers valuable insights into navigating the complexities of healthcare debt collection with a focus on compliance, efficiency, and compassion. "It's hard to collect medical debt, but that doesn't mean it's impossible... we've been very successful in doing that. . . it's our job to come up with new strategies and new techniques", says Dove. This episode is a must-listen for healthcare organizations seeking to manage debt collection adeptly within the current legal framework, providing essential strategies and underscoring IC System's role as a proactive, informed partner in the industry.

In this insightful episode of the Leaders in Medical Billing podcast, host Chanie Gluck talks with Matt Riter, Principal at Capital Associates, about key changes in healthcare legislation affecting the revenue cycle management (RCM) industry. They delve into critical provisions of the No Surprises Act and the challenges arising from recent cyberattacks affecting healthcare providers. Key Topics Covered: Change Healthcare Cyberattack (02:15): Matt provides an overview of the Change Healthcare cyberattack, its impact on UnitedHealthcare services, and the challenges faced by providers in accessing payment and data. No Surprises Act Updates (18:45): Discusses the Advanced Explanation of Benefits (AEOB) and Good Faith Estimate (GFE) provisions, emphasizing the importance of preventing surprise medical bills and promoting transparency. Medicare Reimbursement Challenges (32:20): Insights into the complexities of Medicare reimbursement, upcoming payment cuts, and how providers are affected by shifting policies. Legislation & Advocacy (45:30): Matt discusses pending bills in Congress addressing payment issues, virtual credit card fees, and EFT charges to support healthcare providers. FTC Antitrust Investigation (58:10): An analysis of the Federal Trade Commission's investigation into UnitedHealthcare's market dominance and the implications for the healthcare sector.

Introduction:In this episode of "Anesthesia Deconstructed," we delve into the evolving landscape of anesthesia services with two leading figures from NorthStar Anesthesia: Randall Moore, DNP, MBA, CRNA, Chief CRNA, and Jim Roberts, MD, Chief Medical Officer. Together, they shed light on NorthStar's innovative strategies in navigating staffing shortages, private equity involvement, and the complexities of the post-No Surprises Act era.Guest Insights:Randall Moore brings a wealth of experience in anesthesia management and clinical excellence, offering a unique perspective on the role of advanced practice anesthesia professionals in addressing current challenges.Jim Roberts shares his insights from the viewpoint of medical leadership, emphasizing the importance of strategic partnerships and quality care in the face of industry shifts.NorthStar's Journey:A brief overview of NorthStar Anesthesia, detailing its foundation, mission, and evolution into a leading national anesthesia services provider.Key Topics:Addressing Staffing Shortages: Strategies and initiatives employed by NorthStar to combat the ongoing staffing challenges in healthcare, particularly within anesthesia services.Private Equity and Corporate Investment: An examination of the role of private equity in healthcare, specifically in anesthesia services, and how NorthStar navigates these issues.Thriving Post-No Surprises Act: Discussion on the impacts of the No Surprises Act on anesthesia services, with a focus on NorthStar's adaptive strategies to ensure financial stability and patient satisfaction.Blueprint for Success: Insights into NorthStar's operational, clinical, and strategic methodologies that have positioned them for success in a rapidly changing healthcare environment.Why It Matters:This episode offers a glimpse into the operational and strategic mindset of one of the leading anesthesia services providers, highlighting actionable strategies for navigating modern healthcare challenges. It serves as an invaluable resource for anesthesia professionals, healthcare administrators, and anyone interested in the intersections of healthcare policy, management, and clinical excellence.Follow us at:InstagramFacebookTwitter/X

We've been taking a close look on this program at the burdens of medical debt. Back in 2020, Congress passed the so-called “No Surprises Act” to protect patients from unexpected big bills for out-of-network medical care — and turns out, its wider impact on health care spending has yielded mixed results. But first on the show, California’s new $20-an-hour minimum wage for fast food goes into effect today. We’ll unpack reactions.

We've been taking a close look on this program at the burdens of medical debt. Back in 2020, Congress passed the so-called “No Surprises Act” to protect patients from unexpected big bills for out-of-network medical care — and turns out, its wider impact on health care spending has yielded mixed results. But first on the show, California’s new $20-an-hour minimum wage for fast food goes into effect today. We’ll unpack reactions.

Explore the transformative art of storytelling in healthcare, featuring Outcomes Rocket founder Saul Marquez. Uncover the compelling journey from Saul's immigrant family roots to his rise as a healthcare influencer, where optimism and a robust work ethic forge a path that challenges the conventional.  Our discussion brings to life the nuances of personal narratives in healthcare branding, and how these stories bridge the gap between industry professionals and the communities they serve.Join us as Saul describes his voyage in healthcare marketing, from the classical influences of Cicero and Aristotle stirring a passion for the persuasive arts, to the birth of Outcomes Rocket—a platform for celebrating contemporary healthcare innovation. Saul shares his formative experiences at leading med tech companies and delves into the strategic leap to a podcasting venture that elevates the craft of storytelling to inspire change.Tune in for a thought-provoking discussion on the broader impact of storytelling in healthcare, as Saul and I analyze practical strategies for raising awareness on pivotal issues like transparent healthcare costs and the No Surprises Act. We'll reflect on how data-backed, right thinking in storytelling can  foster connection and serve as a catalyst for meaningful progress. Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.

By Adam Turteltaub The No Surprises Act is a significant change to how healthcare coverage is handled and billed. In general, it eliminates balance billing in three typical areas: A patient is brought to an emergency room in an out of network hospital A patient is transported by air ambulance A patient is being cared for at an in-network hospital but, unbeknownst to him or her, a physician or service that is out of network provides care. To understand the Act more fully, we spoke with Brian Stimson, Partner, Arnall Golden Gregory, who will be leading the session The All Surprises Act:  Avoiding Compliance Pitfalls and Responding to Administrative Enforcement Actions under the Surprise Billing Laws at the 2024 HCCA Compliance Institute. As he explains, there is a two-tiered enforcement structure to the law, with both individual states and the federal government involved. Compliance teams looking to ensure their organizations are complying need to pay close attention to patient complaints. These can be a tip off to improper balance billing and a red flag of systemic issues. Be extra alert if a patient comes to them, and it can even be good to check social media for reports of wrongful billing. Listen in to learn more, and then join us in Nashville, April 14-17, for the HCCA Compliance Institute.

In the insightful Episode 39 of "Closing the Books," Michelle Dove, IC System's Corporate Counsel and Chief Compliance Officer, delves into the intricate realm of healthcare debt collection amidst the backdrop of evolving regulations. Dove highlights the imperative of staying abreast with the latest regulatory changes, such as updates from the Consumer Financial Protection Bureau and the introduction of the No Surprises Act, underscoring the challenges and necessities of compliance for healthcare providers. The conversation further explores how IC System is at the forefront of adapting to these changes, employing strategies like advanced electronic communication and a nuanced understanding of patients' propensity to pay. This approach not only aids in enhancing the effectiveness of debt recovery efforts but also emphasizes IC System's commitment to ethical practices and maintaining respectful patient relationships. Dove's expertise offers valuable insights into navigating the complexities of healthcare debt collection with a focus on compliance, efficiency, and compassion. "It's hard to collect medical debt, but that doesn't mean it's impossible... we've been very successful in doing that. . . it's our job to come up with new strategies and new techniques", says Dove. This episode is a must-listen for healthcare organizations seeking to manage debt collection adeptly within the current legal framework, providing essential strategies and underscoring IC System's role as a proactive, informed partner in the industry.

"When consumers understand that they can get the same level of care at half the price, they feel good about making that decision." - Josh Schreiner “We're actually going to collapse that concept entirely. Everyone's in network from your perspective, from the consumer, from the patient perspective." - Michael Mather Continuing from last week's theme of compliance and regulation, Josh Schreiner, Chief Product Officer, and Michael Mather, General Counsel, of HealthEZ joined me for a discussion on the effects of the No Surprises Act on the healthcare industry as a whole, and how it affects consultants as they work with employers. At HealthEZ, Josh and Michael have been looking ahead to the future of healthcare and how the recent regulations have impacted that, including a returned focus to consumer decisions in their own healthcare and an increased focus on employer compliance. For consultants, these are particularly important topics as consultant responsibilities shift in response to the legislation. Join Josh, Michael, and I as we break down the No Surprises Act, offering our insights and hopefully some practical guidance on navigating this crucial piece of healthcare legislation. Chapters: 0:00 - Meet Josh & Michael 1:23 - Empowering Consumer Decisions through Healthcare Transparency 5:44 - Navigating Healthcare Compliance 16:22 - Protecting Patients Through The No Surprises Act 23:19 - The High Volume of Disputes 30:39 - Increasing contract disputes impacting healthcare reimbursement 38:05 - Transparent Healthcare Information 40:50 - The Impact of Transparent Healthcare Pricing 50:30 - Gag Clause Attestation and Compliance Challenges 58:34 - Balancing Guidelines and Innovation in Healthcare 1:04:55 - Leveraging Wearables and Data for Personalized Healthcare Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words: #healthcare #transparency #compliance #innovation #selffunded #medicalcosts #consumerinformation #futureofhealthcare #wearables #datadriven #nosurprisesact #regulation #podcast Healthcare, Transparency, Compliance, Innovation, Self Funded, Medical Costs, Consumer Information, Future Of Healthcare, Wearables, Data Driven, No Surprises Act, Regulation, Podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

Host Ericka Adler is joined by fellow Roetzel Healthcare Attorney Christina Kuta to continue her discussion on the Good Faith Estimate portion of the No Surprises Act. Christina delves into the requirements for providers, including the types of information that must be included in the estimate, such as diagnosis codes, service codes, expected charges, and patient information. She also discusses the different types of providers and their responsibilities under the law, as well as how to ensure compliance with the Good Faith Estimate requirement. Additionally, Christina highlights the investigations conducted by CMS surrounding this law and the potential consequences for non-compliance, including financial penalties and reprimands. Tune in below to stay informed about the Good Faith Estimate requirement and how to protect your practice from potential legal issues. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Dive into the post-No Surprises Act landscape with Martin Cody, Senior Vice President of Sales for Madaket Health! This podcast tackles key challenges for payers, providers, and patients: inaccurate directories, compliance complexities, and optimizing operations. Discover Madaket Health's platform and how they're helping navigate the new normal. Learn what healthcare leaders should prioritize for smooth sailing in the age of surprise billing protection. Don't miss out on insider insights and valuable resources!This episode is sponsored by Madaket Health. To learn more visit, madakethealth.com/roi.

In today's episode, co-host Carrie Nixon talks with VEDA Data Solutions co-founder and CEO Meghan Gaffney about the impact of “peripheral” healthcare innovations, those platforms and technologies which were not initially designed for healthcare.  Listen to discover:How a political entrepreneur and an astrophysicist saw an opportunity for healthcare innovationWhy in-network and out-of-network physician coverage info is so cumbersome to find, use, and update—for all parties involvedWhat spurred the “No Surprises” Act in Congress and how it changed VEDA Data Solutions' businessHow COVID impacted data companies like VEDA DataHow Meghan embraced her Silicon Valley outsider status to attract the right opportunities and employees If you're wondering how your IP can be used in the healthcare sector, if you are a provider or  healthcare plan leader who wants to reduce the time lag of updating in-network data, or if you're a female founder or Silicon-Valley outsider looking for ideas on fundraising and key partnerships, then you won't want to miss this episode!Quotables“These amazing ideas come into the healthcare sector from a completely different industry and have a real role to play” Carrie Nixon on Ep15 of @DecodingHealth1 w/ @NixonGwiltLaw https://sliceofhealthcare.com/category/decoding-healthcare-innovation/ “a high-paced game of telephone between providers & health plans every day…it can take weeks for patients to get updated info on where to seek care.” @meghangaffney Ep15 @DecodingHealth1 @NixonGwiltLaw https://sliceofhealthcare.com/category/decoding-healthcare-innovation/ “Benefits to everyone down the line: patients get the info they need, providers get paid correctly and on time, and health plans are in compliance.” @megangaffney on Ep15 @DecodingHealth1 @NixonGwiltLaw https://sliceofhealthcare.com/category/decoding-healthcare-innovation/ “...the way we care for almost 400M people with quality is to reduce the administrative cost as much as we can, and we can use data to do that.” @megangaffney of @veda_data on Ep15 @DecodingHealth1 @NixonGwiltLaw https://sliceofhealthcare.com/category/decoding-healthcare-innovation/ Fundraising tips for women-led startups: “there is an advantage when the book wasn't written for you, and that is that you don't have to follow the rules because they weren't made for you anyway.”  @megangaffney of @veda_data on Ep15 @DecodingHealth1 @NixonGwiltLaw https://sliceofhealthcare.com/category/decoding-healthcare-innovation/ Recommended ResourcesFind out more about veda hereConnect with Meghan on LinkedIn and follow veda on LinkedInMore on the No Surprises Act, which goes into effect on January 1, 2022

Federal regulators sue to block Novant Health's purchase of two Community Health Systems hospitals in North Carolina. Insurers say that the No Surprises Act prevented 10 million surprise bills for patients in the first nine months of 2023. And, North Carolina says it will no longer pay for popular–and costly–weight loss drugs for state employees. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Congressional lawmakers established a new arbitration process when they passed the No Surprises Act in December 2020. Since April 2022, payers and providers have been able to have a third-party settle payment disputes over out-of-network claims. However, the process has been bogged down by exceedingly high caseloads and legal challenges. On today's episode of Gist Healthcare Daily, Matthew Fiedler, Senior Fellow at the Brookings Institution, joins the podcast to talk more about how the process has fared overall since its launch. Hosted on Acast. See acast.com/privacy for more information.

In this insightful episode, we had the pleasure of speaking with Ken Hogue, a seasoned professional in revenue cycle management. Ken shared his deep-rooted connection to healthcare, influenced by his family's background in the field, and his passion for being a mediator and executive in the space. Ken's journey began with a desire to improve the healthcare system without being directly involved in patient procedures. He has worked with notable organizations like Change Healthcare and Rochester Regional Health and is currently the Senior Director overseeing the entire revenue cycle for both hospital and physician sides. During our conversation, Ken recounted the challenges of implementing Epic EMR during the pandemic and the transition to virtual operations. He emphasized the importance of advancing the organization in growth and proficiency, grooming future leaders, and ensuring financial success. Ken manages a staggering $1.4 billion in revenue, five hospitals, hundreds of physician practices, and leads a team of 540 individuals. He discussed the evolving landscape of healthcare regulations and the need for effective communication and compliance to navigate these changes. We delved into the intricacies of the No Surprises Act and price transparency, exploring how Ken's organization is publishing information online and providing patient estimates to meet compliance and improve patient engagement. Ken also highlighted the role of business intelligence (BI), artificial intelligence (AI), and automation in healthcare. He shared success stories of increased efficiency and the importance of understanding workflows to ensure the effectiveness of automated processes.     [00:02:09] Implementing Epic during the pandemic. [00:04:24] Administrative burdens and communication. [00:08:35] Healthcare regulations and patient education. [00:15:30] BI, AI, automation. [00:18:39] Automation and workflow design. [00:20:17] Success through automation. [00:25:36] Implementing over 100 ideas. [00:29:00] Creating a career ladder. [00:32:30] Advancement and work-life balance. [00:35:37] Career paths and mentorship.

Rob Neuner, general counsel of The Patriot Group, joins the podcast to discuss the aspects of the No Surprises Act that affect OMSs as well as when and how OMSs may balance bill their insured patients. The discussion addresses general disclosure and posting requirements (i.e., in-office, website and verbal), requirements for providing good faith estimates to uninsured and self-pay patients, and how implementation is expected to progress in the near future.

The No Surprises Act: A Much-Needed Shield in the Healthcare Battlefield In the labyrinth of American healthcare, where the Minotaur of unexpected costs lurks around every corner, the No Surprises Act emerges as a beacon of clarity and protection. Enacted in 2022, this legislation represents a crucial step in untangling the Gordian knot of medical billing, a maze that has perplexed and overwhelmed patients for far too long. Unmasking the Menace of Surprise Medical Bills For years, Americans have navigated the perilous waters of healthcare, often finding themselves blindsided by 'surprise bills' - a phenomenon as common as it is financially debilitating. Picture this: You undergo a surgical procedure at an in-network hospital, believing your insurance has you covered, only to receive a staggering bill weeks later because someone on your medical team was out-of-network. It's akin to dining at a restaurant where the menu prices aren't listed, and the final bill is a roll of the dice. The No Surprises Act: A Shield, Not a Sword This Act isn't about attacking the healthcare system; it's about defending patients. It effectively outlaws these surprise bills for emergency services, regardless of where they're provided, and for certain non-emergency services at in-network hospitals. The key here is that patients are only responsible for their in-network cost-sharing amounts, turning a potentially ruinous bill into a manageable expense. Navigating the New Landscape The implications are profound. Now, in emergency situations, the fear of a financial catastrophe won't loom over patients' heads like the Sword of Damocles. Furthermore, for certain services at in-network facilities, the Act requires providers to obtain patient consent if they intend to bill at out-of-network rates. This is a game-changer, introducing a level of transparency previously unseen in the healthcare arena. The Caveats and the Road Ahead As with any monumental legislation, the No Surprises Act isn't a panacea. Issues like ground ambulance services remain unaddressed, and the Act doesn't directly tackle the underlying issue of healthcare costs. However, it's a pivotal first step towards a more equitable system, where patients aren't casualties in a battle between insurance providers and medical facilities. A Moment of Reflection This Act isn't just about bills; it's about the ethos of our healthcare system. It's a statement that healthcare should not be a predatory enterprise but a safe harbor. As we move forward, let's hope this marks the beginning of a journey towards a system that prioritizes care over cost, and patients over paperwork. Your feedback is essential to us! We would love to hear from you. Please consider leaving us a review on your podcast platform or sending us an email at info@maternalresources.org. Your input helps us tailor our content to better serve the needs of our listeners. For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/. You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement: Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources Instagram: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB Thank you for being part of our community, and until next time, let's continue to support, uplift, and celebrate the incredible journey of working moms and parenthood. Together, we can create a more equitable and nurturing world for all.

The CEO of the Medical Association of Georgia, Jeremy Bonfini, engages in a profound dialogue with radiologist Dr. Ashutosh Rao regarding the unintended effects on patients and physicians resulting from the implementation of the “No Surprises Act”.  Make sure to connect with us on social media @MAG1849_ for more videos and updates. 

It is the last podcast of the year, and you know All Too Well that it is Phia's 2023 year-in-review! Sparks Fly as Kendall Jackson and Corey Crigger talk about how Everything in PGC and Provider Relations Has Changed in 2023. If you need to catch up on anything from the No Surprises Act to Gag Clause Attestations, You Need To Calm Down and Stay Stay Stay tuned into this podcast episode. In addition to the big changes in 2023, we look forward to 2024 and ask, are you … Ready For It?  

Elevance Health's proposed $2.5 billion acquisition of Blue Cross and Blue Shield of Louisiana is back in play. CMS reopens the No Surprises Act dispute portal. And, a new poll shows that Americans are growing more dissatisfied with healthcare. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

This episode features Dr. James L Shoemaker, Secretary-Treasurer of the American College of Emergency Physicians (ACEP) Board of Directors, and the Director of Quality for Elite Emergency Physicians, Inc. & John Holstein, Director - Business Development, Zotec Partners. Here, they discuss key insights into their backgrounds & organizations, reimbursement & the No Surprises Act, what they are currently focusing on in their roles, and more.

Host Ericka Adler is joined by fellow Roetzel attorney Christina Kuta for an in-depth discussion on key issues that physicians need to understand within the broad topic of balance billing. Ericka and Christina discuss billing restrictions under the ”No Surprises Act,” steps providers need to take to notify patients of their rights related to balance billing, issues that may come up when working in multiple states, and the repercussions of not complying with balance billing restrictions. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

The Department of Health and Human Services reverses its COVID-era 340B off-site clinic policy. The Biden Administration proposes an overhaul of the No Surprises Act's independent dispute resolution process. And, the federal government will stop covering COVID drugs this week. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

What's the impact of private equity's increasingly large footprint in medicine? The results so far have not been promising.  We dissect: what is private equity, the recent bankruptcy of the largest emergency medicine staffer in the US and how that impacts clinicians, can corporations practice medicine,  the American Academy of Emergency Medicine has jumped into the fray, does profit-driven medicine ever serve patient care, HCA has been accused of naughty deeds, performance metrics versus the one metric that really matters, the No Surprises Act, and  physician unions. 3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates Registration for the Flameproof course is now open The next cohort begins Feb 1, 2024. Learn more here. Love medicine but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine. As medical director at Tennova Healthcare Clarksville and Johnston Health UNC (large rural EDs in Tennessee and North Carolina), Leon led emergency department teams to exceptional patient-centered outcomes. Leon is a graduate of Brown University, the University of North Carolina School of Medicine, the Harvard-Affiliated Emergency Medicine Residency at Beth Israel Deaconess Medical Center, and the University of Tennessee Haslam College of Business. Leon is married to an emergency nurse and has two adorable dogs.   We Discuss:  What does 'venture capital/private equity' in medicine really mean? The largest emergency medicine staffer in the US, Envision, recently went bankrupt. What happens with all of those clinicians and hospitals when the staffing company implodes? A corporation cannot practice medicine in most states in the US (but can in some!). The American Academy of Emergency Medicine is suing Envision and their corporate entity for the illegal corporate practice of medicine Is there a functional difference between the old-school CMG (contract management groups) and modern-day private equity-owning medical groups? Does profit-driven medicine ever serve patient care? HCA has been accused of funneling patients into end-of-life care to improve hospital mortality metrics.  Has private equity made universal healthcare impossible in the US? The group you want to work for sees physicians as the business rather than an expense to minimize Quality of shift is a metric you rarely see on your monthly performance stats, but it should be at the top of the list Would you ever wash your rental car? The downstream of not having ownership in a group The No Surprises Act was set up to protect patients. It's kind of a mess.  Physician unions. Can doctors go on strike? Leon's guess outlook for the emergency medicine job market in the coming years  

What's the impact of private equity's increasingly large footprint in medicine? The results so far have not been promising.  We dissect: what is private equity, the recent bankruptcy of the largest emergency medicine staffer in the US and how that impacts clinicians, can corporations practice medicine,  the American Academy of Emergency Medicine has jumped into the fray, does profit-driven medicine ever serve patient care, HCA has been accused of naughty deeds, performance metrics versus the one metric that really matters, the No Surprises Act, and  physician unions. 3 free resources specifically designed to address pain points in emergency medicine practice Scripting your least favorite conversations The quick and dirty guide to calling consults My 4 favorite documentation templates Registration for the Flameproof course is now open The next cohort begins Feb 1, 2024. Learn more here. Love medicine but the job itself leaves a lot to be desired? I work with many docs in your shoes. To learn more about 1 on 1 coaching, start here   Guest Bio: Leon Adelman, MD, MBA, FACEP, FAAEM is an emergency physician and co-founder of Ivy Clinicians, a software company that simplifies the emergency medicine job search through transparency. Dr. Adelman is the author and publisher of the Emergency Medicine Workforce Newsletter, which explores the business of emergency medicine. As medical director at Tennova Healthcare Clarksville and Johnston Health UNC (large rural EDs in Tennessee and North Carolina), Leon led emergency department teams to exceptional patient-centered outcomes. Leon is a graduate of Brown University, the University of North Carolina School of Medicine, the Harvard-Affiliated Emergency Medicine Residency at Beth Israel Deaconess Medical Center, and the University of Tennessee Haslam College of Business. Leon is married to an emergency nurse and has two adorable dogs.   We Discuss:  What does 'venture capital/private equity' in medicine really mean? The largest emergency medicine staffer in the US, Envision, recently went bankrupt. What happens with all of those clinicians and hospitals when the staffing company implodes? A corporation cannot practice medicine in most states in the US (but can in some!). The American Academy of Emergency Medicine is suing Envision and their corporate entity for the illegal corporate practice of medicine Is there a functional difference between the old-school CMG (contract management groups) and modern-day private equity-owning medical groups? Does profit-driven medicine ever serve patient care? HCA has been accused of funneling patients into end-of-life care to improve hospital mortality metrics.  Has private equity made universal healthcare impossible in the US? The group you want to work for sees physicians as the business rather than an expense to minimize Quality of shift is a metric you rarely see on your monthly performance stats, but it should be at the top of the list Would you ever wash your rental car? The downstream of not having ownership in a group The No Surprises Act was set up to protect patients. It's kind of a mess.  Physician unions. Can doctors go on strike? Leon's guess outlook for the emergency medicine job market in the coming years  

Imagine finding out that your doctor documented a growth in your breast and didn't tell you about it. Imagine that growth being cancer. In this incredible conversation, Jessica and Brandon sit down with  Jessica Baladad, a five-year breast cancer survivor, diagnosed at age 33!  Now that she's done beating cancer's ass, she's an advocate for others navigating the impossible field that is our US healthcare system. From $20k scans to demanding refunds, her experience will give you (chills) and insights on just how you can advocate for yourself and question everything. Jessica's journey, from being dismissed by her practitioner to becoming a staunch advocate for healthcare literacy and financial literacy, is nothing short of inspiring. Learn about the No Surprises Act, how to audit your medical bills, hold insurance companies accountable and so much more. This episode is not just a testament to Jessica's resilience and determination, but a call to action - for everyone to be proactive about their health. Don't forget to do your monthly exam.If you'd like to leave us a question to be answered during future episodes, you can do so at Speakpipe. You can email us at: thesugardaddypodcast@gmail.com Be sure to connect with us on InstagramLearn more about Brandon, and Oak City FinancialSchedule 30 minutes with Brandon Please remember to subscribe, rate, and review.Notes from the show:Follow Feel For Your Life on Instagram Follow Jessica on InstagramFollow Jessica on FacebookConnect with Jessica on LinkedInDownload Feel For Your Life today! Visit the Feel For Your Life Website

The Biden Administration announces it will again send free COVID tests to US households. CMS says parts of the No Surprises Act dispute resolution process can resume. And, the FTC sues US Anesthesia Partners and private equity firm Welsh Carson, alleging they formed a monopoly to drive up prices for services in Texas. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Happy Labor Day Weekend! Please enjoy this Best Of episode. Clark returns Tuesday September 5 The No Surprises Act became law last year to eliminate surprise medical billing, but most people don't know what it is and what their rights are under it. Clark lays it out so you know your new rights when it comes to medical bills. Also - how much, if anything, do you have in your emergency fund? Clark has a way for you to be better prepared for the inevitable rainy day.  The No Surprises Act & Your Rights: Segment 1 Ask Clark: Segment 2 Your Rainy Day Fund: Segment 3 Ask Clark: Segment 4 Mentioned on the show Patients Still Receive Surprise Medical Bills, Including for Medical Laboratory Testing, Despite Enactment of Federal No Surprises Act That Became Law on Jan. 1, 2022 Understand your rights against surprise medical bills - CMS Rocket Mortgage - Physician Loans: Are They A Good Mortgage Option For Doctors? Bankrate's Annual Emergency Fund Report | Bankrate Emergency Fund: Everything You Need to Know Fidelity Investments Review 2022: Pros & Cons Money market funds - Fidelity Investments The Monte Carlo Simulation: Understanding the Basics Clark.com resources Episode transcripts Community.Clark.com Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices

For a year and a half now, the No Surprises Act has protected patients from some of the most outrageous out-of-network medical bills. But Congress left something pretty crucial out of the law — bills from ground ambulances. We look at just how wild ambulance bills can be, with a story about three siblings who took identical ambulance rides — from the same car wreck to the same hospital — and got completely different bills. (Thanks to Bram Sable-Smith who reported the story for the Bill of the Month, a series from NPR and KFF Health News.). And we find out how ambulance bills ended up being so random — a story that takes us back to the 1970's. Plus, what you can do if you get hit with an out-of-network ambulance bill: See if you can negotiate a better dealSee if you might qualify for financial assistance. (Here's some detailed guidance from Jared Walker of Dollar For.)See if you're protected under state law. At least ten states have passed laws protecting some patients from surprise ambulance bills. Check here to see if yours is one of them. Want to share your thoughts on how Congress should deal with out-of-network ambulance bills? A federal advisory committee wants to hear them. You can email them here.Here's a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we'd love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

What to know about Apple's new savings account offer. Plus, a cautionary note about companies promoting high savings rates that only amount to promissory notes because they're NOT insured. Learn what to look out for to protect your hard earned savings. Also today, the wait is over. Finally a new rule on medical debt kicks in that could kick up your credit score.  Apple Savings Offer: Segment 1 Ask Clark: Segment 2 Medical Debt Law Now In Effect: Segment 3 Ask Clark: Segment 4 Mentioned on the show WSJ: Apple Makes the iPhone a Home for Savings Accounts Clark.com: Apple Is Now Offering 4.15% APR Savings Accounts: Is There a Catch? This Start-Up Promises Rates 13 Times Higher Than a Typical Savings Account. One Problem: It Isn't a Bank Deposit Insurance - FDIC / Are Credit Union Deposits Insured Up To $250,000? Fidelity Youth Account frequently asked questions (FAQs) CarMax Review: 5 Things To Know Before You Buy or Sell [The Washington Post] Finally, medical debt under $500 has been removed from credit reports What is a “surprise medical bill” and what should I know about the No Surprises Act? 3 Ways To Get a Free VIN Check Before Buying a Used Car How To Spot a Puppy Scam Online Clark.com resources Episode transcripts Community.Clark.com Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices

The No Surprises Act became law last year to eliminate surprise medical billing, but most people don't know what it is and what their rights are under it. Clark lays it out so you know your new rights when it comes to medical bills. Also - how much if anything, do you have in your emergency fund? Clark has a way for you to be better prepared for the inevitable rainy day.  The No Surprises Act & Your Rights: Segment 1 Ask Clark: Segment 2 Your Rainy Day Fund: Segment 3 Ask Clark: Segment 4 Mentioned on the show Patients Still Receive Surprise Medical Bills, Including for Medical Laboratory Testing, Despite Enactment of Federal No Surprises Act That Became Law on Jan. 1, 2022 Understand your rights against surprise medical bills - CMS Rocket Mortgage - Physician Loans: Are They A Good Mortgage Option For Doctors? Bankrate's Annual Emergency Fund Report | Bankrate Emergency Fund: Everything You Need to Know Fidelity Investments Review 2022: Pros & Cons Money market funds - Fidelity Investments The Monte Carlo Simulation: Understanding the Basics Clark.com resources Episode transcripts Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices

While recent changes to medical debt credit reporting will help, medical debt accounts for half the negative marks on credit reports, due in part to the medical industry's resistance to lawful price disclosure under the No Surprises Act - which unfortunately excludes ambulance service. Clark discusses this glaring omission and the role of non-profits in tackling medical debt for consumers. Also, to solve traffic congestion we're in a never ending quest to widen roads. But in this case, increased supply creates new demand. Clark offers a free market solution.  Medical Debt: Segment 1 Ask Clark: Segment 2 Clark's Traffic Solution: Segment 3 Ask Clark: Segment 4 Mentioned on the show: Half of ambulance rides yield surprise medical bills. What's being done to protect people? How nonprofits help millions tackle their medical debt How Much Does an MRI Cost (With/Without Health Insurance)? Follow Clark Howard's #1 Rule To Travel Cheap How To Plan a Trip: Clark's Best Travel Tips To Save Money Turo: 5 Things To Know About the Cheap Car Rental Service Widening Highways Doesn't Fix Traffic. So Why Do We Keep Doing It? How To Find a Good Moving Company Clark.com - Streaming TV Clark.com resources Episode transcripts Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices