Joe DeLoach of Practice Compliance Solutions tells us what practice owners need to know about the No Surprises Act.

Date: Wednesday, January 13, 2022


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Jennifer Herring: Because I had the visual impairment nobody ever set real expectations so I’ve always had my own.

Dr.Bethany Fishbein: Hi! I am Bethany Fishbein – The CEO of The Power Practice and Host of the Power Hour Optometry Podcast. And this conversation today is really one that is extraordinarily special and personal for me. I am interviewing Jennifer Herring who is a visually impaired marathoner and all around is an amazing person we’ll get to her for a second, but the reason that it’s so special for me is that when I was growing up when I was in college, I randomly got a summer job working at a camp for blind and visually impaired children. It’s called Camp Marcella and Rockaway, New Jersey. And it’s my experience at that camp that made me realize that I wanted to go into the eye care field and really change the direction of my personal and professional life forever. And Jennifer, or as she was known then by her camp nickname, Pickles, was one of the campers at Camp Marcella. So she and I have known each other for what is it, Jen? Probably 35 years. 


Jennifer Herring: Yes. 


Dr.Bethany Fishbein: And so when I saw you online, posting about your latest running accomplishments, fundraising accomplishments, I knew I wanted to talk and thank you so so so so so much for doing this with me. It’s bringing me all kinds of warm fuzzies already, we haven’t even started yet. 


Jennifer Herring: Thank you for having me on this wonderful podcast!


Dr.Bethany Fishbein: My pleasure, last night, I was like going through the camp pictures to try and find a picture of the two of us. Did you actually end up working at the camp for a year or two? 


Jennifer Herring: Yes, the first time I was asked to work in the kitchen and then for a couple of weeks when one of the other workers was unable to finish up the year, and then I worked a whole summer in the kitchen and then I worked as a counselor for a full summer. 


Dr.Bethany Fishbein: That’s the pictures that I found were from staff training, and it was the two of us out on the blacktop where the basketball nets were and we were learning how to use fire extinguishers. So it might have been the year that you were in the kitchen.  But that was the picture I found that had the two of us in it. I’ll email it to you.


Jennifer Herring: Oh, that’s great. 


Dr.Bethany Fishbein: Anyway, most of the listeners for my podcast are either optometrist eye doctors, optometry students, and people in the eye care industry. So if you don’t mind, would you share a little bit about your eyes, about your diagnosis, and what your vision is like?


Jennifer Herring: Yes, sure. I was born in the mid-70s. So technology has come a long way since then, so early on the eye doctor would do some even right-ups so what they saw on your eyes. I went to an eye and ear in Massachusetts, for them to help diagnose what was going on in my eyes because there is a family history of eye issues, and my family so they knew that there was something wrong. I’d look close, and I also been like near the television and things like that. So I went there. And early on they said I had a form of juvenile macular degeneration so that went on for years I struggled in school and they did give me glasses, but the glasses kind of made everything to focus but I still couldn’t see the blackboard or had issues with seeing far and also I looked very close and so many years went on and then eventually they went to the eye doctor and they looked in and said your macular eyes are fine. It’s your optic nerve. So then it’s white. So they finally diagnosed it as optic nerve atrophy and cone dystrophy and also nearsightedness. So currently that’s what I go by. It’s also been an issue because my eyes outside look very normal. There isn’t really an indication that I do have an eye problem. So going through school that was kind of hard for me because teachers would put your glasses on and they didn’t understand, even though I was a member of the New Jersey Commission for the Blind and Visually Impaired and they tried to help explain to teachers what was going on, but they really weren’t aware of having these issues. There weren’t many children also who had these kinds of issues in their classes. That was also Camp Marcella came in because when I was eight years old, I went there so I would see other children who had eye issues that we helped each other by can see better than you know, it’s there was a totally blind child then we would leave them around and so it was like a beautiful thing to be part of. We did lots of activities. No one ever set limits for us. We did all the activities and you know I met Bethany and all the wonderful people up there. It was happening every summer because she would just be with other kids and wonderful, caring people who wanted to help and so.


Dr.Bethany Fishbein: it’s funny when you said that it makes me realize we work with a lot of visually impaired people in the practice. And sometimes we’re talking to parents of kids with low vision or people with low vision and one of the things that I’ve always talked about, is that a vision problem is not like a mobility issue where somebody has a limp or uses a wheelchair or has always an outward sign of having a disability. And so we talk a lot about people, especially kids, but older people too. Who are losing vision later in life that they’re struggling and there’s no way for people around them in the grocery store or server at a restaurant or anything to know that they’re having trouble which makes vision difficulties a little bit more complex? Nobody’s offering to help because they don’t know that there’s a problem. And I’m realizing as you’re saying it that that’s probably a lesson that I learned from you and your friends talking about it because as you describe it, I’m aware now that that’s almost always how I say it. So that’s something I picked up from you. 


Jennifer Herring: Yeah, it’s a hidden handicap. It’s like I’ve gone through kind of life, You have this burden but I also don’t see it as something positive because I met so many people with compassion other amazing people who are just keep going you know, a lot of my friends I met at Camp Marcella everyone’s still going and so you can still lead a good life. Even if you have a hidden handicap like this.


Dr.Bethany Fishbein: For sure. So tell me we kind of lost touch for a while because I knew when you were a kid at camp and then like most of us at camp we lost touch and it was really when Facebook started to gain popularity that we got back in touch. So talk about what you did after you finished high school. Did you go on in your education? I know you’re working now. What do you do? 


Jennifer Herring: Yes. Well, I’m currently a software engineer. I’ve been working in the computer field now for over 20-25 years. Now. And way back in high school to like told me there wasn’t as much technology and so they were kind of leery about me going to college. I only had a monocular some of the early things. I also had glasses that had a monocular on them, but they didn’t work as well. Like I said they would make it clear but I still couldn’t see everything far away. They weren’t really pushing going to college, but I thought I could I did well through school. So I went to the University of Delaware and I majored in computer science. I got a BS in computer science and I was on the Dean’s List and I did well I think I did better than in high school even because I don’t know if that’s also a part of our skillset. But I’ve always been very structured. I felt like it was always my job in school even though I had to concentrate I had to work harder because I couldn’t see so I always had to ask for extra help a little bit. So I’ve always been pretty structured. So I went to college and so I did well doing that, and I also ran intramural track and five K’s. So I did that. And then I got my first job. I got some help with the New Jersey Commissioner for the Blind and Visually Impaired, offered assistance to help find my first job, and then from there I did well and never had a bad review at any of my jobs but I moved back closer to home a couple of times just to be with my family. And so I’ve been doing that now I worked at Lockheed Martin for a little while, which was very interesting. And now I work for a company that handles the Medicare Medicaid claims for New Jersey. So I do a lot of programming for those systems.


Dr.Bethany Fishbein: And are using any technology or talk about what you’re using to make the computer and stuff like that accessible for you. 


Jennifer Herring: I do the looking close into the screen. I’ve tried some of the other technology they have with the closed-circuit TV and things like that. But now then I’m working at home so when I worked in the office, I would have a lot of people wondering, Why is my face and my screen? and I mean, I’ve been doing it for 25 years. I’m just used to that. It’s just my personal preference, but I know others use the talking technology that you can use in me I have my iPhone and I can look close, and I made the font bigger. So yeah, a lot of the bigger font. I do that on a lot of the applications, it’s on my home laptop. So, fortunately, I looked low so you know they always told you not to do I mean I’ve been doing it for 25-30 years almost. But that’s just my personal preference. 


Dr.Bethany Fishbein: And that’s another piece of education that we’re giving to parents, especially of kids with low vision telling the parents telling the teachers that they were raised saying don’t put your head up in your phone. Don’t get that close to the TV. Don’t get that close to the book. And for somebody who needs that working distance to be able to see it. It is absolutely appropriate and healthy and necessary for them to do that. So we provide that as well. 


Dr.Bethany Fishbein: So you mentioned that you ran in college and really I want to talk about your running but I remember when you were younger, there was awards that we used to give out at the campfire, right so they ended the session we always had a closing campfire and then there were different awards for the kids and you were always kind of almost guaranteed recipients of the Super Girl award for your extraordinary athleticism.


Jennifer Herring: Yeah


Dr.Bethany Fishbein: I don’t think any other girls at Camp stood a chance to win that when you were there in that session. So when did you figure out that you had some ability in specifically running?


Jennifer Herring: Yeah, it’s an innate thing. I think nobody introduced it to me from a young age even like in gym class since you didn’t really have to see well for the gym teacher would say okay, we have to run around the field or inside the gym. I did the Presidential physical fitness test. I love to do all that jumping and running. And so it started just innately, I am blessed that was born with a passion that I love to be active, you know, and I tried to let other people know how to just whatever you can do just walk whatever. Find yourself something that can help you be a good even new track and cross country in high school and the coach helped me because one of the teachers wasn’t nice to me one time with the understanding that I couldn’t see the board. So my coach talked to him because he didn’t want to have his runners upset. So he talked to one of the teachers to explain. I just always loved running and luckily too I wasn’t a superstar. I got my varsity letters all four years and I was captain senior year for track and cross country but luckily I was good enough but not superstar so I didn’t burn out I didn’t get injured. I took care of my body properly. So I mean, what do you got to keep going now? 20-30 years later, 35 years later, so I started to helping people.


Dr.Bethany Fishbein:  Right? Yes, you’ve been running ever since. And not only are you a runner, but you’re also a marathon runner, and not only are you a marathon runner you’re really fast. how many marathons have you done at this point?


Jennifer Herring: 39 marathons 


Dr.Bethany Fishbein: 39 And what spurred this podcast am I reached out to you is you just posted on Facebook that you got back from your 19th Boston Marathon?


Jennifer Herring: Yes. 


Dr.Bethany Fishbein: Amazing. I did one once. And afterward, I said one and done. And I realized about maybe 20 minutes into the first one that this is something that I was never going to experience again. So 39 is extraordinary. How old were you when you did your first one? Do you remember?


Jennifer Herring: Yeah, I was 28 and I did New York. That’s one of the most special ones to do. It’s like you’re a rock star the whole time. There are just people cheering and that’s why to people come from all over the world and get along and just people are cheering there is music and you can’t get lost in your strong woman pretty buddy and I always make friends you know you talk to people and everyone has different reasons that they’re doing the run. So that’s always special and charities if there are people raising money, it’s a really special thing, I always said I do marathons and then I started in that first marathon I qualified for Boston and so that’s how I got involved with starting to run the Boston Marathon.


Dr.Bethany Fishbein: My first and only marathon I finished in six hours and 10 minutes. How did you do in yours?


Jennifer Herring: Ah, that one I was, I did 3:35 for the first year, And I know of course over the years now I’m slowed down but it depends on your training and everything. so sometimes you need to get some more training in but my best was 3:22 there so I run then in New York and then 3:26 in Boston, it’s my elder best one.


Dr.Bethany Fishbein: Do you run them to be fast? Like, are you going for time or you’re going for the experience?


Jennifer Herring: Yeah, it’s always been an experience for me because I was aware of the Boston Marathon and then the qualifying standard and I need to know that I would get that the first time I really wanted to I had read books about it. All the legends and running and eventually, I met Kathrine Switzer, you know, reading all the history of the Boston Marathon and everything. I really wanted to run it, but I didn’t know so yeah, I guess it’s the joy of running. They all talked about the joy of running and I think I have that. Moreover, then even in high school, too, I guess for life because I had a visual impairment nobody ever set real expectations. So I’ve always had my own, at least gone on my own pace through life now, and I hope everyone can do that because that way people set too high expectations or something. And so you should just go along and do it. You can do your six hours. I mean, that’s wonderful to some people never do it. Yeah, those three can be happy with that. It’s just the satisfaction of completing it. And the experience you have.


Dr.Bethany Fishbein: And you mentioned that people out there fundraising and over your running career, you’ve done fundraising or done marathons for I think, some different causes, right?


Jennifer Herring: I’ve done well, one part there’s a lot of unfortunately cancer in my family and then other loved ones and friends that have been touched by cancer. So I’ve done a story with my father in 2007. He was diagnosed with a brain tumor in November of 2007. And so I told them that I was going to run the Boston Marathon for him in 2008. So they tried to do things for him, but it wasn’t working. But he held on till the day I came home and I handed him the Boston Marathon medal that you get when you finish the marathon. And that evening, he passed away. It was just a wonderful thing he did for me because he hung on because I had told him I did that marathon for him. So I do a lot of charities that are related to brain tumor research. I’ve done several in New York, and run a lot of races in Central Park. And then there’s a American Cancer Research. I’m doing a race in Philly. So I’ve done some fundraising for them in Philly, and then there’s Fred’s team. I’ve done the New York Marathon and then of course for the visual impairment I’ve done the Boston Marathon pretty much I guess, I think about 10 to 15 of the Boston Marathon races I’ve raised money for Team with a Vision which raises money for the Massachusetts Association for the Blind and Visually impaired and they support and rehabilitation services for people in society that have visual impairments there. So that’s how I feel it’s the overall good thing for me and for everyone, you know, for helping people.


Dr.Bethany Fishbein: Absolutely! So when you race with Team with a Vision, what’s involved with that? Do you fundraise? Are you running with other visually impaired people? What does that mean, to be part of that?


Jennifer Herring: Yes, it’s a group of blind and visually impaired runners and guides and they start fundraising about six months out they have you set up a web page where you can go to fundraise, which says the Boston Marathon was twice in six months. Now, I did it back in October. So that’s the last one I set up. And then for this one, that was just in April, I donate it and then I informed other people to just go to the main web page that GivenGain, they set up many fundraisers. So Team with Ovation was one of those on there and told them when race week comes along about the Friday before the Monday Boston Marathon, you go up there, they have different activities to get together. So you can meet other people that are blind or visually impaired and then the guide under are solely charity runners to that raise money also, and then they have dinner then you get your bed that you wear for the race. And that’s a wonderful thing too. So when I run in the marathon, people are saying “Go Team with a Vision!” so it’s publicized more. So people wonder what is that now look it up and hopefully they can either join the team to run and raise money or just donate or cheer even is wonderful too. That helps that helped me a lot too. 


Dr.Bethany Fishbein: Just hearing people cheering for you on the course.


Jennifer Herring: Yes


Dr.Bethany Fishbein: Yes, that’s awesome! And you mentioned people go up with their guides, but you don’t usually run with the guide, do you?


Jennifer Herring:  I have a couple of years? You know, Unfortunately, Tom was a racist. There have been some things that have been so you know, in some cases I always go back and forth, whether it’s better if something goes wrong, it’s better to have someone with me because you know like when I’m on the course I feel kind of sheltered because I know where I’m going. There are people all along, you can get help but if there’s something where they say the race is over or something and you’re still out there or something, I would need help to get back or just to make sure nothing goes wrong, but I run with guides and they help because I do have to slow down go into like the water stops and things and they do help to say okay, you’re making a left turn coming up. So instead I go along on my own and just kind of rely on the other runners. Sometimes, it’s better and I’ll always welcome someone to run with me. I’ve always been Ms.Independence. It’s hard for me to always have somebody helping, but they’re wonderful too.


Dr.Bethany Fishbein: And they have to find one who’s fast enough for you like I would offer but.


Jennifer Herring: Yeah, well some friends


Dr.Bethany Fishbein: or you could stroll along with me.


Jennifer Herring: Well, sometimes they have to lie so you can only go up to 11 miles with the person they have this switch off for races and there are all levels to of ability. So there are faster runners, and there’s a guy who runs like 235 marathons and blind, and then there are slower runners that it seems like there’s a whole gamut. So if someone does want to help a guy and there are other associations that they set up, there’s United in Stride, it’s called in America. It’s spread out in different states where you can sign up on the website United in Stride and find if you want to assist a visually impaired runner, and then now I see there’s a team tethered together. And that’s another one that I see is set up. So if there are runners that want to assist, and they have that just even to take a vision curbar out for a run race, which is you know.


Dr.Bethany Fishbein: Cool! I will put those websites in the notes when we put the podcast out. So if somebody’s interested in doing that, maybe they can get matched up with somebody in their area. Were you in Boston at the marathon, the year of the bombing? Was it twenty 2013 Oh my god. 


Jennifer Herring: Yes. Well, I have the associated story with being going to visually impaired because I finished about 15 minutes before the bombs went off. And I was around the corner about 600 feet around the corner. I guess from there, we had a family meeting area where the team was the Vision Group would meet after the race, and there happened to be a seeing-eye dog there waiting for his person to come. And so of course, since he wasn’t working, I wasn’t petting, but I just kind of kneeled down, Just this was my 10th Boston Marathon. So, of course, I love dogs and I was talking to the dog and I felt, I finished my 10th Boston Marathon and it was a beautiful day, that day too and finally because usually, it’s very cold and windy in that area. So yeah, I just usually want to get going and then all of a sudden I heard a noise and an echo sound like a backfire and I was like, okay? and the dogs heard it too. And then it was a little bit of time and then it happened again. And the dog started shaking. So we’re only what is that noise and Josh Warren who had introduced me to Team with a Vision. He had asked me to join the team couple of years back, He said, I don’t know that doesn’t sound good. So my mom was in the hotel in the Prudential Center there I always told her to stay put because I didn’t want her ever wandering around. She called and she said there was a bomb something was going on at the finish line and to get back to the room. So I got up from there and you know me while the dog was shaking, and so he knew the dog knew something was bad. And I had to get back to the hotel. And luckily, I got back then before they started shutting the doors you couldn’t go in, it’s just horrible there. And then actually, a beautiful thing that just happened is that this was a second Boston Marathon they had the Power Elite Athletes Division and one of the women participating in it. Adrianne Haslet – She was affected by the Boston Marathon bombing. She was a ballroom dancer, she lost her leg and she decided she wanted to run the Boston Marathon again after she had done it in 678 hours I think a couple of years ago. So she participated in this past last week, the Boston Marathon and she was just ready. I mean, it was beautiful to see she was so happy because she trained with Shalane Flanagan. She had won the New York Marathon. She’s a professional runner, and she had her as her support. I saw her at the starting area. I could feel the smile, I couldn’t see but I thought we were on the running scene and what was going on and just to know how happy she was and she finished in I think a little over five hours. So it was like a three-hour improvement. And she posted and has been so happy since joy. Yeah, I was even though you’re part of a horrible thing, but she’s turned it into something beautiful in her life. So that was very nice to see firsthand. I always miss out on things. So it was kind of like right there. I was fortunate to just be in the presence of that.


Dr.Bethany Fishbein: I really I think that message or theme has come through and a bunch of different stories that you’ve shared today about your experience of taking something that maybe people would consider a negative and finding the positive side or finding the beautiful things in a situation. So that’s a very positive message for today. You know, I think for anybody who’s listening if they are inspired to do something positive, I will share the links to Tethered Together to United in Stride for somebody who’s looking to give us their time for somebody who may be looking for a wonderful place to give their money. I’ll share links for the Team with a Vision and also for Camp Marcella, which although it’s a little bit different now is still helping blind and visually impaired kids in New Jersey and is still a special place to me, and Jen I know for you too. And I’m really grateful that your running career and my vision career have put us back in touch and given us the opportunity to reconnect all these years later. Thank you so so so so so so much for talking. It was great to have this conversation with you.


Jennifer Herring: Thank you Bethany and you are wonderful too, I’m honored to talk with you.


Dr.Bethany Fishbein: I am the one who is honored here and for everybody out there, Thank you so much for listening.



Read the Transcription

Joe DeLoach: AOA has confirmed and I’m sitting here looking at the letter that we are covered under the No Surprise Act in part two related to the good faith estimate.


Dr.Bethany Fishbein: Welcome to the Power Hour Optometry Podcast. I’m Bethany Fishbein, the CEO of Power Practice and Host of the Power Hour. At Power Practice, we are helping our clients surf the waves of the ever-changing healthcare industry. And one of the waves that people are talking about now is the Introduction of the No Surprises Act, which took effect at the start of this year. There’s been a lot of discussion on email lists and social media sites among Optometrists to figure out whether this has any effect on Optometry and the general consensus I’ve read so far has been that this act does not apply to us as private practice Optometrists. However, my guest today feels that there are absolutely applications to Optometry. And considering that his career is entirely focused on compliance, I think that we all need to hear what he has to say. So I’m happy to welcome Joe DeLoach, who is the President of Practice Compliance Solutions. He’s a noted National Authority and lecture on many aspects of practice, including medical billing and coding, documentation and medical records, HIPAA compliance, and ocular disease management. He served in numerous capacities with his state association where he was recognized as one of the few recipients of the Distinguished Service Award. Joe also continues to serve as an advisor to Medicare. So welcome, Joe, and thank you for taking the time to be here today.


Joe DeLoach: My pleasure, Bethany!


Dr.Bethany Fishbein: So let’s start at the beginning for anybody who’s been hanging out under a rock and hasn’t heard of this, what is “The No Surprises Act?


Joe DeLoach: Okay, so, The No Surprises Act: It’s actually almost two years old now. So it’s not really anything particularly new. It’s just the part that we’ll get into talking about whether Optometry is involved is new, but the act actually went into effect in 2020. It’s all based on a desire to increase transparency of pricing in healthcare, so that patients don’t receive crazy bills. They weren’t aware of our charges that they didn’t feel they were aware of. And the general consensus is that they should be aware of these charges before they agreed to accept the care involved with those charges. So that was the basis behind The No Surprise Act.


Dr.Bethany Fishbein: So is that like, they think someone’s in network and they’re not or they have a deductible? And they don’t know like, what’s the big example cases? I guess that this needs to address.


Joe DeLoach: Yeah, so whereas we can derive an example from two different settings, we’ll talk first about a like a hospital situation which, honestly was the driving force behind The No Surprises Act as people will go to the hospital. And check out they have these massive bills for things they weren’t aware of at all, or didn’t feel like they were explained properly. And this would involve fees that they’re responsible for their insurance didn’t pay for, or they don’t have insurance. So that’s where the whole concern started. But later, it drills down to even practitioner care like in practice, where, let’s say a patient came in for an exam, and we’ll use Optometry is that as a specific example, we determine based on the examination that there are Glaucoma suspects, and we want them to return for another evaluation and testing related to that, that now has been incorporated into this the patient should be totally aware of what those fees will be before they agreed to the care. So there’s no again surprise at checkout.


Dr.Bethany Fishbein: So, What the fees are in general like what we’re charging or is it what they are going to have to pay? If someone has a $10 copay, and we’re in-network do they need to know that we’re charging $360 for that service?


Joe DeLoach: No, So The No Surprise Act predominantly focuses on people that do not have insurance, so it really doesn’t have anything to do with what is my copay or what is my deductible? Unless Well, it just doesn’t. It has to do with only two categories. People who have no insurance, or people who elect to receive care and not utilize their insurance. So the no surprises act totally applies to people that are going to pay out of pocket.


Dr.Bethany Fishbein: So no insurance, they’re electing not to use their insurance. Does that include somebody who elects to see a doctor who’s out of network?


Joe DeLoach: Yes, because in that case, they are not a recipient of that insurance.


Dr.Bethany Fishbein: Okay. So somebody that falls into one of these categories, what information do they need to have?


Joe DeLoach: So, back to the original act itself? The main part of Part one of The No Surprises Act totally had to do with hospitals’, ASCs and ambulance services. So that is a very complex situation and how you have to disclose those fees. And we don’t need to talk about it because it has nothing to do with private practitioners at all. What came, how we got involved was in part two of The No Surprises Act, which was an amendment called the “Transparency in Coverage”. And this is where they brought the same concept of a patient understanding what they’re gonna get charged for services down to a private practice level. And what they asked practitioners to do or require us to do is to provide what they call a good faith estimate. And it’s really important to understand what a good faith estimate is, so what do we have to tell them? We have to provide them an estimate keyword of what services will cost them before they receive those services, again, only if they’re uninsured, or are electing not to use their insurance. So in our cases, we would need to tell them, Our fee and this is individual for each practitioner. Our fee for visual field is x. And so that’s what you’re going to be required to pay estimate is a very important concept of this because obviously we never know exactly, you know, we don’t know what offices level is going to be involved until we actually see the patient see the reason for the visit and see how involved it is based on the medical decision making. So we can only say in most cases, the fee would be between x and x. And that’s totally allowed in the good-faith test. So it’s an estimate of what the patient is going to have to pay for those services.


Dr.Bethany Fishbein: And that needs to be given when they make the appointment or before the services start. What’s the rule on that?


Joe DeLoach: Yeah, the rule is before the services are delivered. Now there’s all kinds of crazy opinions and not much guidance on what if a patient just calls up and says what is my office is it gonna cost? Because HHS Real Health and Human Services realize that that’s an almost impossible answer to give because again, we don’t know how involved the care is going to be until we deliver it. So again, that’s where the estimate comes in. So the general guidance is that if they call on the phone and say, How much is this gonna cost? We are obligated to give them that but then they turn right around and say that we have three days to give it to them. So it seems to be conflicting. You know, they call and we should answer but we can answer three days later. So, you know, as most legislation goes, this thing is gonna have guidance that plays out over time. And I will make a statement that this bill, especially Part Two is very poorly constructed very poorly worded and leaves a lot of questions that will be answered over time.


Dr.Bethany Fishbein: On that estimate, is there a margin of error like do they tell you how far off you can be?


Joe DeLoach: Absolutely! Good question. So another part of the Transparency and Care Act, there’s two parts, there’s actually three parts of it. One part is not enacted and won’t be for several years, so we don’t need to worry about that. The second part is the Good Faith Estimate. And the third part is Patient Arbitration. So there you have to be able to if the patient disagrees with what they ultimately were charged versus what the estimate was. There’s an arbitration process you go to resolve the disagreement. Now, the arbitration does not kick in unless the estimate differs. From the alternate fees by $400. So in my opinion, that’s going to be incredibly uncommon, if not, never in routine Optometric Medical Care, that we would be off that much. So, I really don’t think it’s going to be a big issue.


Dr.Bethany Fishbein: So when you explain this, it feels pretty clear, right? If someone doesn’t have insurance, they’re not using their insurance. This says that they have a right to know before the service is provided what the service is going to cost or at least to have an estimate of that.


Joe DeLoach: Excellent summary!


Dr.Bethany Fishbein: But when you go on the Facebook side to the list and where everyone else is talking, everyone says this doesn’t apply to Optometry. What’s the other side? How are they interpreting it to say this doesn’t apply to us?


Joe DeLoach: Yeah. So when the Act was first introduced, all the focus was on part one, and part one, from the beginning did not have anything to do with private practitioners. The second interim guidance that dealt with the “Good Faith Estimate and the Patient Arbitration” did not come out until the fall of this year. And what I think happened is everyone focused on the most Surprise Act as it was introduced and went, well, this doesn’t apply to private practitioners so we don’t have to worry about it. And it all just kind of fell by the wayside. Then we know it does at this point, and I’ll tell you why. Because after you said all the discussion and disagreement, we spent a good amount of time with our legal counsel and with the AOA and just the other day and a lot of that information came because the AOA sent out a frequently asked question post that said we’re not involved. The problem was that was related to part one, and they never updated it when Part Two came out. So AOA has confirmed and I’m sitting here looking at the letter that we are covered under “The No Surprise Act in part two related to the Good Faith Estimate”. I can even tell you this quote from Health and Human Services on December 27, “We received clarification from Health and Human Service which addresses AOA’s question regarding Provision of Good Faith Estimates” and they have indicated that “no specific specialties, facility type sites of service or providers are exempt from this requirement” so there’s no confusion anymore. It is definitely an AOA is working very quickly to try to update their information and I will add that AOA is working very hard to try to get us and all private practitioners removed from this requirement, but the AOA has actually been working on that for about six months now and they’ve been unsuccessful. So the question is no longer a question. It is absolutely that we are under the act.


Dr.Bethany Fishbein: Aside from it being kind of a pain to have to figure this out. What’s the logic to wanting us to be removed? It seems like a pretty reasonable thing to provide to patients.


Joe DeLoach: Yeah, I would say there are probably three answers to that. Very good question. Number one, everybody’s tired of regulations in general. Number two, I don’t think and I agree. I do not think we’re going to have to deal with this. All that much. When you drill it down to only uninsured or people that elect to not receive care. And it only applies to medical care not to vision care, that gene pool of people that are going to be asking for a Good Faith Estimate, I think is going to be extremely small. So I agree, it’s not going to be a big deal. I think the biggest deal, as you and I have already discussed is going to be kind of the Patient Relations side of this. We absolutely know that media and look what social media did, you know In the past two months in total misunderstanding of this thing. What do you think’s gonna get drilled down to the patient level? So I think we’re going to have patients coming into our offices with significant misinformation about what their rights are under this Act. And I think that is probably the biggest thing that practitioners are gonna have to worry about is how do I deal with these people that say, I need a written good faith estimate of what my contact lenses are going to cost? Has nothing to do with the act. I have insurance but I want a written estimate. I need a good faith estimate of what your charges are, doesn’t apply. So we’re gonna all have to be extremely good and have good scripts at answering these questions. I think that’s the biggest hassle of this act.


Dr.Bethany Fishbein: Yeah, I agree with you because even before the clarification when this first came out, and it really looked like it didn’t apply to us at all before the part two and all of that, that was my first thought is whether it applies or not. If the news coverage or the information that gets to patients is there’s this act so that you shouldn’t have to be responsible for anything you’re not covered for. And that’s not what it is, but that’s very likely how people will interpret that. Then all of a sudden, no matter what the bill says it applies to everyone because they think it applies to them. They’re asking for it. And so we can either spend our day arguing with people about how it doesn’t apply to them, or like you said, we can create better scripts and have good answers to that question, or really be able to provide the information that patients are asking for which is largely not a secret. We just don’t have an effective, efficient way to provide it. So, What’s your advice right now to a practice owner?


Joe DeLoach: I’ll have one piece of advice from my stance as a compliance expert. And I will readily admit that I’m not a practice management expert. So the first one will be legal opinion. The second one will be Joe’s opinion. So number one, you’ve got to comply with this. And just like any other law, there’s going to be ramifications. If you don’t add, I would add that I think because of the issue we just discussed with the patients are going to get this wrong. The kind of practice management ramifications may be far worse than anything the government is gonna do to you. From a practice management standpoint, you know, I think there’s going to be three answers to that. Number one, argue your face off. I just don’t think that’s a pure really good way to deal with this number two comply with the letter of the law, which means when they come in and have the misinformation we try to educate them on what the law really says and all that.


Dr.Bethany Fishbein: We kind of sounds like arguing your face off.


Joe DeLoach: And I would agree which is why number three comes up. Number three is this really that hard? Is it unreasonable? And it certainly interestingly enough, we kind of under Medicare have an obligation to obtain informed consent from our patients for services before we deliver them. It’s kind of like this has already been the case already. The only real difference is that now it says it needs to be in writing, as opposed to just walk in and say I need to run a visual field on you. You don’t have insurance cost X amount of dollars. Do you want the visual field run which is our obligation already because patients get to decide what care they want and don’t want. All this really does is say now used to be in writing. So point three would be if and this is probably outside my wheelhouse but if a system that is still going to be a little bit of a hassle but is some point efficient can be developed or this just kind of becomes part of your routine way of practicing. I’m disclosing transparency in my fees. That seems like they may be a little bit more work. But I think from a patient relations standpoint is going to be the best answer but again, that would totally my opinion.


Dr.Bethany Fishbein: It’s a valid opinion. It’s goes with looking to provide what patients are asking for and if that’s the case, and you can figure out a system that doesn’t stress the practice too much and just be able to provide that. That feels to me also like the best, if not necessarily the easiest solution, but certainly more fun than arguing your face off all day.


Joe DeLoach: There’s one other thing too and I said I’m not really into practice management, but I have spent a lot of time investigating all this generational difference stuff. You know, which when I first started looking at it, I kind of went people are people, this is stupid, it’s not stupid, that there truly are significant differences in millennials and baby boomers and y gen and from the baby boomers, on there is an increasing drive for those individuals to want transparency from their doctor. So I think we’re gonna see the desire from that our patients increasing significantly. So like you said, I mean we can argue or do we figure out a way to make it work. Where the patients are happy, even if we have to do a little bit more work? I don’t know, seems to me like the best answer.


Dr.Bethany Fishbein: Yeah, we’re definitely seeing that interest in transparency not only from doctors but from all companies. I feel like when I’m researching things, it is not uncommon these days to have a tab on the website that says our fees, not necessarily for a doctor’s office, but for a company doing anything else. And you click on it and it tells you how much it’s going to cost and you can make your next steps based on that. Which is a contrast now to what we’re we were accustomed to, which is for more information, click here. You can schedule a conversation. We can talk about the fees after you’ve heard everything else. And it’s very different. So I think that’s good insight.


Joe DeLoach: There’s one other thing I would very much discourage. There’s been a lot of talk about encouraging or directing the AOA to get Optometry removed from this and I would say, I think that is a very bad decision. If they remove all private practice physicians. That would be fine, but a drive to just remove us and I think it’s very deadly. Because now the patient comes in and we say we don’t have to do this. Why? Because we’re Optometrists. Oh, really? So what do you have to hide? So why don’t you have to act like all the rest of the doctors? I think that is very, very bad advice to AOA and I don’t think I always going to try to do it that way. But I don’t know that I hope so.


Dr.Bethany Fishbein: It’ll be interesting to see what everyone else starts to do because the expectation changes also based on what other providers are doing when the whole meaningful use thing was going on. And then all of a sudden people started getting invites to the portals for all their other doctors and where’s my invite to the portal? or, you know, online appointment scheduling once people start, then the expectation for everybody else increases. So, I meant to ask before, but I’ll I’ll go back to it. Is there a specific form or sheet that this needs to be on or you can put this on a letterhead? Does it need to be signed?


Joe DeLoach: Okay, so, two answers there. First of all, we skipped over this, but this is important. You can’t hide from this. Because the law says that you must post on your website that you are in compliance with The No Surprise Act basically, and you have to post a notice in your office so it’s like we can’t hide from this and those two things will generate these patient questions as well. So that’s just more things we have to do but in indirect relation to your question about is there a form we need to use for the Good Faith Estimate? So CMS has a standard form that you can utilize, and that’s fine. It definitely says that you do not have to use that specific form that you can develop your own form, as long as the spirit and content you know, doesn’t dramatically change. So, you know, in our compliance program, we’ve already written one that kind of looks more like Optometry, but it’d be easy for anyone to do but the easy answer to your question is, you can develop your own form and probably want to want to look at the CMS standard form you’re gonna not want to use it.


Dr.Bethany Fishbein: Fair enough. And does the patient have to sign to acknowledge that they received it? Can it just be posted? Like, I’m thinking about the some of the other regulatory forms we’ve had? 


Joe DeLoach: Yeah. So interesting question. One of those things they didn’t think about when they wrote the law. So nowhere does it state the patient has to sign the estimate. So in situations like that, I always say let’s try to apply some degree of common sense. As you said, we make them sign everything else and it’s pretty much always that you know, not signed – not done, not written down – not done. So I think, you know, having them sign it is good advice, although I will say it’s not written into the law.


Dr.Bethany Fishbein: And you said that new clarifications are coming in already there’s been amendments and addendums and all of that this is getting like shades of PPP here. What are the rules going to keep changing?


Joe DeLoach: Short answer? Yes. They’ve never I mean, just look at HIPAA. Look at OSHA, look at all these other come look at billing and coding in general. This is not static. These things are going to change. And as I said, from the beginning, a pretty poorly constructed piece of law. And so I think we’re gonna see a lot of clarifications on this as time goes by. And HHS is even aware of that. So they put in the Part Two guidance that because of, basically, this is going to be a moving target. They are going to apply what we call discretionary enforcement of The No Surprise Act through December of 2022. Now, I would encourage everyone to not take that to mean they are not going to enforce it. But I think what they’re saying is, if you’re trying to comply at some level, we’re probably not going to slap you. If you perform what we always calling “compliance reckless indifference”, which is I don’t want to do this. I’m not gonna do this. I do believe that, you know, they have every right to go after you, but because there’s a lot of  I think you’re no one’s gonna get in trouble because your form wasn’t right or the patient didn’t or did sign it or things like that. I think if we make a reasonable attempt that everyone’s going to be just fine, until they give us more answers.


Dr.Bethany Fishbein: If you do get in trouble. Do you know what the penalty is? Is there no surprise jail or something?


Joe DeLoach: To be developed, interestingly enough, so No, they have not stated specific binds related to this.


Dr.Bethany Fishbein: Aside from the desire to comply with the law and do the right thing for your patients. Is there any upside is there? Do we get anything for doing this?


Joe DeLoach: No. You know, I think the upside is what you said. The upside is happy patients. And in the bottom in the final analysis, that is what we want is happy patients being cared for in a very competent way. But other than that, no it’s not like when some of the meaningful use came out. We got $1 here or $10 here for complying or, you know, we get a buck for telling some insurance company a patient has diabetes. Now there’s none of that’s going to be happening. This is purely like HIPAA and OSHA and all this you don’t do it, you’re gonna get in trouble. You do make a reasonable attempt to comply, you’re going to be fine.


Dr.Bethany Fishbein: Gotcha. And where do people look for further information? If this changes, how do we know?


Joe DeLoach: Yeah, that’s why things like Power Hour exist. It’s why things like Practice Compliance Solutions exist. That’s why things like AOA exist. You know my recommendation, always go to a reputable source for the correct information and certainly, the last few months have played that point out. There are people out there that for some insane, crazy reason keep up with all this stuff. And so you can rely on help from those people. And you know, just like you right now you have reached out to Practice Compliance Solutions for assistance. So people involved in groups will I think, well, good groups are going to have access to the correct information. The problem and exactly what we’ve seen over the last few months is, you know, getting on social media sites and the misinformation just becomes viral. So try to find a reputable source for information before we start posting inaccuracies.


Dr.Bethany Fishbein: Yeah, We certainly see that in practice management as well somebody posts on a site asking for advice. And you have no idea who’s giving that advice back. So, it’s hard to know what’s worth following, and always good to have an expert on your side.


Joe DeLoach: Well, and certainly they’re no, no Darkthrone on this one. This is one of the more complicated compliance laws that we’ve had to deal with in the past decade. I mean, just the interim guidance on part two was almost 500 pages long. So you have to go see patients you can’t sit down and read 500 Page guidances where the actual factual information is so you have to rely on somebody to help you with this.


Dr.Bethany Fishbein: I’m grateful that you did and grateful that you were here to share that. Any final words, any additional thoughts? Anything we missed?


Joe DeLoach: Yeah, the biggest thing, two things the number one, this act is in play, it went into effect January 1, it is a law right now. So we’re kind of behind the eight ball, a little bit. You can catch up pretty quick. Number two, this is definitely a moving target. So this is the only thing that I think will change in the Good Faith Estimate, part of this is are we in or are we out? The law as written “We are clearly in and always we’re” so it’s simply a matter of whether the AOA, the AMA the Podiatry Association everybody else can get private practitioners taken out of part two of The No Surprise Act. If they don’t do that. I don’t see a whole lot changing here. We’ll probably see a little bit of change in how the arbitration process works. We won’t see anything in part one that relates to us because it never related us to begin with. So obviously, I think it’ll be a moving target. I just don’t think it’s going to be massive. You know change in thing the massive change will be our the association successful and getting private practitioners removed.


Dr.Bethany Fishbein: And Joe if someone wants to get in touch with you for more information how do they reach you?


Joe DeLoach: Well, my email is I’m just one of any they can contact but I’d be happy to take any questions on this or anything else.


Dr.Bethany Fishbein: Alright, Thank you so much again for your time for clearing this up for making 500 pages plus sound fairly simplistic, and laying out what private practice owners need to do. I appreciate it. 


Joe DeLoach: Well, that’s what we try to do. And thanks for having us, Bethany.


Dr.Bethany Fishbein: My pleasure. I also want to thank Joel North who is our awesome podcast editor and Kevin Dau for our music. And to learn more about Power Practice or becoming a client. You can email or sign up on our website for a free mini-consultation. You can bring us the greatest challenge you’re having in your practice, and we’ll see if we can help you or refer you to someone else who’s a better fit. But either way, if you bring us a problem, we’ll see to it that you walk away with the solution.


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