Hot Topics in Healthcare – July 2022 | Burr & Forman

AMA offers a toolkit with no surprises

As most healthcare providers know by now, the No Surprises Act (NSA) prohibits out-of-network healthcare providers from balancing the billing of commercially insured patients under certain circumstances. However, most physicians do not realize that uninsured patients and commercially insured patients who choose not to use their benefits are entitled to a good faith estimate (GFE) of fees from providers before scheduled services are performed. If the actual charges from a particular provider exceed the GFE amount by more than $400, the patient has the right to dispute the charges under an arbitration process.

Further, physicians’ responsibilities for GFE differ depending on whether they serve as a “collecting provider” or a “shared health care provider.” A health care provider (or institution) is the one who receives an initial request for a GFE or who is responsible for assigning the primary service. A shared health care provider (or facility) is one, other than the provider or collection facility, that provides items or services related to the primary service.

To help physicians navigate the NSA, the AMA has published a physician “toolkit” to help them focus on three operational challenges that physicians must address immediately: (1) non-emergency services at in-network facilities , (2) emergency services and post-stabilization care in hospitals and freestanding emergency departments, and (3) bona fide assessments for self-pay and uninsured patients.


Another influential decision from SCOTUS – It’s something other than abortion or gun control

On June 27, 2022, the Supreme Court of the United States (SCOTUS) heard an appeal stemming from a conviction of a physician in Mobile, Alabama and a separate conviction of a physician in Wyoming. The judges specifically examined the sentences of Dr.

In an important precedent-setting decision, SCOTUS ruled that prosecutions under the Controlled Substances Act for overprescribing opioids and other addictive drugs must prove that doctors knew the prescriptions lacked a legitimate medical purpose. Specifically, SCOTUS held that the Justice Department “must prove beyond a reasonable doubt that the defendant-physician knew that he or she was acting in an unauthorized manner, or intended to do so,” so to provide a penalty for improper description. The decision has nationwide implications for criminal and civil cases related to the sale and distribution of prescription narcotics.

The ruling vacated district court opinions upholding the underlying convictions and directed lower courts to take a fresh look at jury instructions given at trial.


HHS Issue Updates – HIPAA Privacy Rule and Information Disclosures Related to Reproductive Health Care

On June 29, 2022, the Office for Civil Rights (OCR) updated its resource material on the HIPAA Privacy Rule and reproductive health care. OCR reiterated its position that the Privacy Rule supports access to health care services by giving individuals confidence that their PHI, including information about abortions and other sexual and reproductive health care, will be kept private. The publication reviews various disclosures required by law and emphasizes that disclosures to law enforcement officials are narrowly tailored to protect an individual’s privacy and access to health services. Specifically, the update discusses and provides examples of (1) disclosures required by law, (2) disclosures for law enforcement purposes, and (3) disclosures to avoid a serious threat to health or safety.


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