Description
This unit explores the No Surprises Act (NSA) and federal price transparency regulations that protect patients from unexpected out-of-network medical bills and promote informed financial decision-making. Learners will examine the intent, scope, and key provisions of NSA, including requirements for good faith estimates, balance billing restrictions, and payer-provider obligations.
By applying legal and ethical principles through case studies, learners gain the ability to integrate transparency and compliance protocols within registration, billing, and patient communication workflows.
Summarize the intent and scope of the No Surprises Act, including its legislative history and consumer protections.
Describe the expectations and legal requirements related to healthcare billing transparency and provider-patient cost communication.
Examine real-world examples of noncompliant balance billing and differentiate between lawful and unlawful practices.
Assess institutional readiness for compliance by reviewing internal workflows, staff training, and policy gaps.
Demonstrate communication techniques for delivering Good Faith Estimates (GFEs) effectively and empathetically to patients.
Develop a practical compliance checklist for billing transparency that healthcare organizations can adopt during implementation or audits.
By the end of this unit, learners will be able to:
Interpret and explain the legal intent and consumer protections established under the No Surprises Act.
Apply transparency rules to patient intake and billing communication workflows.
Identify the obligations of payers, providers, and facilities under NSA and CMS transparency rules.
Evaluate balance billing case studies to ensure proper patient notification and financial disclosure.
Create a step-by-step compliance checklist for operational monitoring and auditing.
Promote patient trust and financial clarity by embedding transparency standards into daily RCM practices.
Completion of prior units (2.1 through 2.4) recommended.
Basic understanding of payer contracts, patient billing processes, and federal compliance terminology.
Compliance and Revenue Integrity Officers
Patient Financial Counselors and Billing Coordinators
Front-End Registration and Authorization Teams
Healthcare Administrators and Legal Advisors
Students and trainees in Health Policy, HIM, or RCM programs
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