Since we were asked by a payer to pay back for more than $300,000 as alleged overpayment about 2 years ago, we have spent more than $60,000 to $70,000 on attorney fees in a fight over the overpayment demand, at the same time, the payer has put us on pre-payment reviews for all new claims for more than one year without any payment at all.
Hanover Park, IL (PRWEB) April 19, 2010
New Webinars announced from ERISAcaim.com to resuscitate revenue cycle crisis with right federal law magic. In wake of financial debilitating overpayment demand and recoupment from payers, an increasing number of healthcare providers are also facing bankrupting pre-payment review delays for up to over a year of no-pays and real denials, in an unprecedented U.S. Healthcare Avatar: no payment from insurance companies but pay more back to Insurance Companies by healthcare providers. Once informed by a payer of pre-payment reviews, all state prompt pay laws no longer apply, because no state laws will ever mandate prompt pay for disputed or non-covered claims, and state laws do not govern ERISA plans, both self-insured and fully-insured employment-based health plans. Seemingly healthcare providers are left with no common remedies while hopelessly crying on sinking Pre-payment Review Titanic for inevitable bankruptcy declaration.
New free webinars have been offered from ERISAclaim.com on a weekly and monthly basis to help all involved with very specific and accurate statutory provision reviews and discussions on ERISA and all new Obama health law mandates for claim appeals, especially pre-payment review delays and denials or ERISA deemed denials. The time for each free webinar is 60 minutes, from 11 AM to 12 PM, or 1 PM to 2 PM, Central Standard Time. Registration is free for all. The Webinar Handout is also available and free to download at:
As one of the healthcare providers who attended ERISAclaim.com seminars complained:
"Since we were asked by a payer to pay back for more than $300,000 as alleged overpayment about 2 years ago, we have spent more than $60,000 to $70,000 on attorney fees in a fight over the overpayment demand, at the same time, the payer has put us on pre-payment reviews for all new claims for more than one year without any payment at all."
Federal ERISA pre-empts any and all state laws and managed-care contracts in all money or benefits dispute with ERISA plans, and ERISA provides with most powerful remedies for healthcare providers and insured working Americans: under ERISA §2560.503-1(f)(2)(iii)(B), all post-service claims under pre-payment reviews with or without request for additional information must be decided within 30 with no record request from providers, or within 45 days, including 15 days after receiving the additional records, or the plan must provide claimant with a valid ERISA EOB, Explanation of Benefits, for immediate ERISA full and fair appeals for all deemed denials, according to Dr. Jin Zhou, President of ERISAclaim.com, a national ERISA expert and Compliance consultant.
One of the most popular and costly misconceptions for all providers is turning to the state prompt pay laws and PPO contracts for remedies when the providers were informed by payers of pre-payment reviews and were put on Moon Project schedules. State prompt pay laws are not triggered or no longer applicable as soon as a payer takes an action to review the claim with a timely notice within the time lines as provided by the state prompt pay laws, as common sense will tell you that no state prompt pay laws will ever mandate for a payment for disputed or non-covered services, as noted from Dr. Zhou from speaking to hundreds of healthcare providers.
More importantly, no state prompt pay laws will apply to or govern any ERISA plans, especially self-insured plans, as reiterated by Dr. Zhou.
As further explained by Dr. Zhou, U. S. Supreme Court unanimously and repeatedly ruled that federal law, ERISA, completely pre-empts all state laws in all benefits dispute with an ERISA plan in all pre-payment and post-payment benefits reviews, in Aetna v. Davila in 2004, and ERISA provides no exemptions for plan administrators to act, to make pre-payment and post-payment review decisions, in accordance with ERISA and the relevant plan documents, regardless of SIU's (Special Investigation Unit) and PPO's (participation Provider Organization), in Kennedy v. Plan Administrator for Dupont in 2009.
Health Reform Bill, Patient Protection and Affordable Care Act, PPACA, signed into law on March 23, 2010 by President Obama, incorporates or adopts ERISA regulation in its entirety through §2719 of PPACA to govern all group health plans. PPACA also provides additional protections for providers with payer disclosure of entire claim case files and external ERISA reviews, said Dr. Zhou. Within 6 months after the enactment of PPACA on March 23, 2010, every one must comply with PPACA and ERISA for claim denial and appeals, as pointed by Dr. Zhou.
New Free ERISA Webinars from ERISAclaim.com will review all governing federal laws, ERISA and PPACA, for pre-payment reviews, and claim delays and denials, or ERISA deemed denials without timely decisions under ERISA §2560.503-1(f)(2)(iii)(B). Dr. Zhou will explain most compliant and effective ERISA appeals to bring payers into compliance, for a timely payment that a healthcare provider shall be legally entitled to under ERISA and relevant plan provisions.
In the past 10 years, ERISAclaim.com has been the only ERISA specialized company offering the most practical and comprehensive ERISA education, consulting and publishing services for healthcare providers in administrative ERISA appeals for real problem oriented denials under the most mysterious 35-year-old federal law, ERISA. Dr. Jin Zhou, president ERISAclaim.com has been regarded as the Godfather of ERISA claims for healthcare providers by some in Professional billing and coding industry.
For more information or to arrange an interview, please contact Dr. Jin Zhou, president of ERISAclaim.com at 630-808-723 or visit: http://www.erisaclaim.com/Free_ERISA_Webnars.htm