Even self-proclaimed “experts” don’t always deliver reliable information about a thorny piece of federal legislation.
Over the last month I have taken in two presentations about the No Surprises Act (NSA), offered by a trade group that I generally consider to be highly reputable.
Each contained significant errors. During the first presentation, a panel of antitrust experts was discussing price transparency. I asked about a recently delayed provision of the No Surprises Act that will ultimately require co-convenors such as a hospital and a surgeon who is performing a surgery at the hospital to coordinate to issue a combined good-faith estimate.
If such a hospital employs surgeons, the sharing of price information means that competitors are sharing price data – which isn’t inherently illegal, but makes it much easier to argue that there are improper agreements regarding price. While I know something about antitrust law, I would not call myself the world’s top antitrust expert, and I was curious if lawyers who analyze such matters full-time might see the issue differently.
To my surprise, they dismissed the premise of the question, arguing that there was no requirement that the physician and the hospital share pricing data. Apparently, these lawyers knew antitrust law, but not the No Surprises Act. They were mistakenly believing that the posting requirements found in the Price Transparency provision apply to the No Surprises Act. In fact, they argued with me rather vociferously, asserting that merely posting prices was sufficient, until another member of the audience echoed the existence of that No Surprises Act requirement.
In the second presentation, last week, someone asked the speaker whether physician practices were required to issue good-faith estimates. The presenter, who claimed to be an expert on the No Surprises Act, indicated that he believed that the law only applied to hospitals.
On the one hand, I am sympathetic to the confusion. The No Surprises Act has various tentacles that can make it difficult to understand. It is true that one portion of the law only applies to services delivered at hospitals, ambulatory surgical centers (ASCs), freestanding emergency departments, and in air ambulances. But there is a second portion of the law that applies to any licensed healthcare entity or professional.
It is true that the government made things confusing by using the term “facilities” to describe both portions of the law, with “facilities” defined once as limited to hospitals/EDs/ASCs/air ambulances, and the second time as all licensed healthcare professionals and entities. It was a terrible error for the government to use different definitions for the same word. But the fact remains that an expert should know that the good-faith estimate requirement is in the portion of the rule applying broadly to all licensed professionals and organizations. Clinics, nursing homes, home health agencies, physical therapists, and the like are all required to offer good-faith estimates. Currently, that requirement is limited to individuals who are not using insurance to pay for their care, but that is slated to change in the future. But back to my main point, which is that you cannot blindly rely on anyone or anything to be a categorically accurate reporter of information. I can’t be too indignant. I make mistakes, at times learning about provisions I did not initially know were there.
George Washington apocryphally said, “I cannot tell a lie.” But even the most honest among us can be wrong. I am not really able to identify a great solution to the problem I am describing. I guess what I am saying is that when there is a disagreement about the interpretation of a legal provision, do not let the pedigree of the speaker or the reputation of the organization, law firm, or consultant prevent you from considering the possibility that they are wrong.
Programming note: Listen to healthcare attorney David Glaser’s “Risky Business” report on Monitor Mondays with Chuck Buck.
EDITOR’S NOTE: This column features spoilers for the current season of The Pitt, and the sentiments reflected therein are the author’s own – not necessarily
A new study from Georgetown University examined the currently publicly available data for the No Surprises Act (NSA) independent dispute resolution (IDR) process during the
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
Have a Medicare regulation question you’d love Dr. Hirsch to answer? Now is your chance! CLICK HERE to learn more→
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
