Webinars for New Federal Appeals Laws on New EOB's For Claims Denials, Internal And External Appeals Released on August 24, 2010 from IRS, DOL and HHS

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Without understanding this new federal EOB law, the final money statement for all billing and coding, no provider could get paid properly, even with correct ICD and CPT/HCPCS codes

Hanover Park, IL (PRWEB) August 26, 2010 -

On August 24, 2010, IRS, DOL and HHS released new federal external appeals procedures with a detailed Technical Release and new EOB requirements (Model Notice) for Claims Denials, Internal Final Appeal And External Appeals, as a part of final implementation for PPACA, Patient Protection and Affordable Care Act, to be effective on Sept. 23, 2010. ERISAclaim.com announced the nation's first series of new Webinars, Seminars & Certification Classes for healthcare providers and health plans to comply with these new Federal EOB and External Appeals Regulations.

"With these federal EOB rules, PPACA will revamp entire U.S. healthcare reimbursement practice after Sept. 23, 2010, going beyond the Patients Bills of Rights as attempted by President Bill Clinton," said Dr. Jin Zhou, President of ERISAclaim.com, the only company in the country providing complete education and consulting on ERISA and PPACA reimbursement laws for healthcare providers in the past 10 years.

"ICD Codes + CPT/HCPCS Codes = EOB = money?, new federal EOB law controls and finalizes all ICD + CPT/HCPCS codes for every provider's coding, billing and reimbursement practice," explained by Dr. Zhou, "Without understanding this new federal EOB law, the final money statement for all billing and coding, no provider could get paid properly, even with correct ICD and CPT/HCPCS codes".

"After teaching reimbursements centered around CPT & ICD9 for 23 years, with these changes by the federal government, I will be required to start teaching EOB and Adverse Benefit Determinations", said Don Self, of Don Self & Associates, Inc (Donself.com), a nationally renowned expert on coding, billing and reimbursement.

The most important new rules are Interim Procedures for Federal External Review, released with a Technical Release 2010-01 and Model Notice of Final External Review Decision. Together, these federal regulations and guidance provide the nation, for the first time in history, with federal external reviews to make independent and binding final decisions for the plan final denials, unless appealed to federal court, especially for those self-insured employer sponsored plans not subject to any state laws, according to Dr. Zhou.

Among other protections, new federal external laws require a health plan to make preliminary review decision within five business days and notify its decision within six business days after receiving such request for standard external reviews. Then the health plan must refer the case to a contracted external Independent Review Organization (IRO) accredited by URAC or a similar body. If the health plan fails to timely provide the documents and information, the IRO can make a decision to reverse the plan denial, and the health plan must pay or appeal to the federal court, as discussed by Dr. Zhou.

Interestingly, as noted by Dr. Zhou, under the new federal rules, the assigned IRO will have to utilize PPACA - ERISA legal experts to make ERISA plan coverage determination on external reviews, in addition to medical determinations. Currently, URAC or similar bodies, only accredits IRO for UR (utilization review, or medical necessity review) or external review on medical necessity. There is NO accreditation from any one in U.S. on PPACA or ERISA claims and appeals procedures as legal experts, as required by this federal rule for external PPACA - ERISA reviews. Dr. Zhou indicated that his company will continue to educate providers, health plans and IRO's on PPACA and ERISA claims and appeals procedures, and willing to work with URAC or any similar bodies to offer accreditations for PPACA - ERISA experts.

Another set of historical landmark federal rules are new federal standards for EOB's (Explanation of Benefits) for all health plans, said Dr. Zhou. This will be the first time in the history for our nation with an annual healthcare expenditure of $2.6 trillion to have a single set or model of federally standardized Form for claim initial denials, plan internal final appeals and independent external appeals, as we have had for Medicare for 45 years.

The new EOB's standardized Model Notices combined all ERISA claims regulations, § 2560.503-1 (g) and (j) for initial denials and reviews (appeals), with PPACA EOB requirements and PPACA Appeals Regulations released on July 23, 2010 by IRS, DOL and HHS. Most importantly, as reiterated by Dr. Zhou, all three new EOB Model Notices have one full page with "Important Information about Your Appeal Rights", with detailed information and instructions for ERISA and PPACA Internal Appeals rights, External Appeal Rights and Consumer Assistance Resource.

These new federal claims and appeals regulations and guidance can be found at DOL web site:
http://www.dol.gov/ebsa/healthreform/

Interim Procedures for Federal External Review
http://www.dol.gov/ebsa/pdf/1210-AB45.pdf

Technical Release
http://www.dol.gov/ebsa/pdf/ACATechnicalRelease2010-01.pdf

Model Notice of Adverse Benefit Determination
http://www.dol.gov/ebsa/IABDModelNotice2.doc

Model Notice of Final Internal Adverse Benefit Determination
<http://www.dol.gov/ebsa/IABDModelNotice1.doc>;

Model Notice of Final External Review Decision
http://www.dol.gov/ebsa/IABDModelNotice3.doc

ERISAclaim.com has been offering these educational Webinars, Seminars and Certifications Classes on ERISA for 10 years and on new Health Reform Laws since the Health Bill was signed into law by President Obama on 03/23/2010. These ongoing Webinars, Seminars and Certification Classes were scheduled on bi-weekly, monthly and customer request basis to teach basic, practical and expert level of appeals practice strictly in accordance with new and existing Federal Appeals Regulations for all types of claim denials and delays.

For more information, please visit http://www.erisaclaim.com/Free_ERISA_Webnars.htm, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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