Hanover Park, IL (PRWEB) November 9, 2009
ERISAclaim.com announced the first Claim Specialist Certification class under new healthcare reform legislation, the Affordable Health Care for America Act, after the House of Representatives passed a sweeping health care bill, H.R. 3962, Saturday night (November 7, 2009) with a tight vote of 220-215, making it the biggest expansion of health care coverage since Medicare was created more than 40 years ago for 96% of Americans.
President Obama said he was "absolutely confident" the Senate will follow suit in passing its version of the bill. "I look forward to signing comprehensive health insurance reform into law by the end of the year," he said.
Although turning the bill into law remains uncertain for many provisions from different Senate Partisan Bills, it is absolutely certain that claims regulation for reimbursement under this new federal law is clear and well settled from the bipartisan Bills and as many as 14 provisions of this new federal legislation will go immediately into effect when signed by the President Obama at the end of the year. It is critically important and urgent for healthcare providers to be educated and trained to be the first certified claim specialists under this most comprehensive and new federal healthcare reimbursement law. We are also offering free webinar to explain the new legislative impact for healthcare providers and everyone under the Act.
Although it is uncertain what will be signed into law as to the antitrust provision of H. R. 3962 and whether the government or insurance companies will collect and manage the mandatory insurance premiums, it is absolutely clear that a new federal claim regulation will be signed into law, as passed by the House of Representatives. ERISA claim regulation, 29 CFR 2560.503-1, will be statutorily incorporated in its entirety into the new law for all qualified health benefit plans (QHBP), as the most important provisions from H. R. 3962 for healthcare providers for reimbursement purposes. The Affordable Health Care for America Act will create a new federal agency, Health Choices Administration, regulating qualified health benefit plans (QHBP), consisting of employment-based health plans, the traditional voluntary ERISA plans, and health insurance exchange plan, the new mandatory ERISA plans. The new legislation, H.R. 3962, is significant with following provisions:
1. Sec. 232 (b) of the Act, Requiring Fair Grievance and Appeals Mechanisms of the Act provides: "(b) INTERNAL CLAIMS AND APPEALS PROCESS.--Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims) set forth at section 2560.503-1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70246) and shall update such process in accordance with any standards that the Commissioner may establish".
2. Sec. 232 (c) of the Act also creates a new federal external review process based on ERISA claim regulation to provide for an impartial, independent, and de novo review of denied claims, and the Health Choices Commissioner's decision shall be binding on the plan and the entity, as the final claim decision in absence of judicial reviews, which is available now for punitive damages for exchange participating health plans.
3. Sec. 233 of the Act, Requiring Information Transparency and Plan Disclosure, enhanced the existing ERISA disclosure obligations for the plan and insurance company, and requires "Accurate and Timely Disclosure", for both exchange participating health benefit plans and employment-based health plans, to both Health Choices Commissioner and the public, doctors, hospitals and the patients, of plan documents, plan terms and conditions, claims payment policies, and practices, periodic financial disclosure, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information.
4. Sec. 233 (5) of the Act, Cost-Sharing Transparency, requires the plan to disclose to the healthcare provider the real fee schedule, plan UCR limit for individual service and supplies at CPT & HCPCS code level.
5. Sec. 235 of the Act, Timely Payment of Claims, provides new federal "Prompt Pay" laws, based on Medicare Part C timeframe, Managed-Care Medicare, to comply with the requirements of section 1857(f) of the Social Security Act.
6. Sec. 238 of the Act, State Prohibitions on Discrimination against Health Care Providers, has adopted "Any Willing Provider Laws" from existing state laws.
7. Sec. 251 of the Act provides new consumer protections, or Obama Patient Bill Of Rights, with state law compensatory and punitive damages as remedies for exchange-participating health plan members, although the new law does not change ERISA preemption of state punitive damage remedies (License to Kill, as some referred to) for employment-based health plans (traditional ERISA plans).
8. Sec. 257 of the Act allows state attorney general to sue for the compensatory and punitive damages on behalf of the private citizen of the state for any violations by the exchange-participating health plans, although traditional ERISA plan is still immune from state government actions from insurance Commissioner or attorney general.
9. Sec. 262 of the Act, Restoring Application of Antitrust Laws to Health Sector Insurers, if signed into law, this will officially provide statutory death penalty for managed care practice model in USA, in conjunction with vigorous enforcement of new federal ERISA claim regulation, complete disclosure of plan information and fee schedules.
The Affordable Health Care for America Act is 1990 page long. For more information and relevant documents, please visit the Website of House Of Representatives:
ERISAclaim.com, located in northwestern suburb of Chicago, Illinois, is an online publisher, consultant and educator for ERISA claim education, training and consulting as well as claims recovery for ERISA healthcare claims. It also provides ERISA litigation support, research assistance and fraud and abuse prevention as well as PPO auditing defense consulting. In addition to ERISA, ERISAclaim.com also provides consulting and education for Medicare Claim Appeals Specialist, for Medicare RAC overpayment appeals, fraud and abuse prevention.
Dr. Jin Zhou, the president of ERISAclaim.com, developed the nation's first ERISA education and practical appeal system for healthcare providers 10 years ago, He has gained most comprehensive and unique practical experience in training and consulting in ERISA claims for healthcare providers for more than 10 years. Dr. Jin Zhou was sometimes referred to as the "Godfather of ERISA Claims" for healthcare providers by some industry experts.
For more information or to arrange an interview, please visit http://www.erisaclaim.com/certification.htm, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.