But we won't let the Congress and American people down. We are celebrating and welcoming the implementation and enforcement of real PPACA
Hanover Park, IL (PRWEB) September 23, 2010
Today, a welcome ceremony from ERISAclaim.com was announced for the date of birth of the new Patient's Bill Of Reimbursement Rights, as a historic landmark overhaul for U.S. healthcare reimbursement in 45-year history, new federal claims and appeals regulations, as a part of new health care reform laws, PPACA, Patient Protection and Affordable Care Act. ERISAclaim.com will offer free Q & A sessions all day today from e-mails and telephone calls on denials and appeals under PPACA, including , but not limited to, new federal EOB standards, new federal internal and external appeal regulations, new federal "Prompt Pay" enforcement and excise tax penalty in $100 per day per patient for any violation of new federal external appeal mandates.
"Today is the most significant day in 45-year U.S. healthcare history when the new Patient's Bill Of Reimbursement Rights, PPACA appeals laws, are finally going into effect for more than 200 million Americans", said Dr. Jin Zhou, president of ERISAclaim.com, the only company in the nation offering comprehensive education on new federal appeals laws for healthcare providers and health plans.
On March 23, 2010, the signing of new Federal Health Reform Bill, PPACA, by President Obama received worldwide media attention and debate. Six months later today, the effective date for the most important part of PPACA, new federal appeals regulations have received little or no attention from healthcare industry and national media, especially healthcare providers. "But we won't let the Congress and American people down. We are celebrating and welcoming the implementation and enforcement of real PPACA", reflecting on the signing of ERISA law 36 years ago by President Gerald Ford on September 2, 1974, without any meaningful enforcement of ERISA claim regulation in the past 36 years. "This is the purpose for our today's PPACA ceremony", expressed by Dr. Zhou.
Dr. Zhou is still excited on what Pres. Obama told the nation on January 9, 2010 in his weekly address to the nation:
"And there will be a new, independent appeals process for anyone who feels they were unfairly denied a claim by their insurance company……In short, once I sign health insurance reform into law, doctors and patients will have more control over their health care decisions, and insurance company bureaucrats will have less. All told, these changes represent the most sweeping reforms and toughest restrictions on insurance companies that this country has ever known."
On July 23, 2010, IRS, DOL and HHS released the new Patient's Bill Of Reimbursement Rights under PPACA:
"Starting from today, as explained by President Obama on January 9, 2010, every doctor and patient can now appeal every denied or delayed claim, with prompt pay enforcement and hefty federal penalties from IRS in $100 per day per patient for any violation of new federal external appeal procedures", explained by Dr. Zhou.
According to Dr. Zhou, very importantly, new federal appeals laws provide a process of two-step "prompt pay" enforcement with hefty federal penalties. First step, a pre-service claim (a claim requires precertification) must be decided in 15 days, and a post-service claim must be decided in 30 days, as prescribed by ERISA claim regulation, the minimum requirements of the new federal claims and appeals regulations. In case of a failure by a plan to strictly comply in making a timely payment or decision, the second step is triggered for external appeals. In six business day, a plan must notify claimant of its decision for external appeals. In absence of strict compliance with ERISA and PPACA, an external appeal decision is binding and final. The plan must make immediate payment or a decision to cover requested services, regardless if a plan will appeal or prevail in a court in the future. A failure to comply with new federal external appeal laws will result in a hefty excise tax penalty in $100 per day per patient. In addition, new federal law prohibits any imposition of precertification or prior authorization for all urgent care claims and guarantees coverage for urgent care claims from both out-of-network and in-network providers. PPACA prohibits any discrimination against any provider regardless of participation in managed care network with respect to reimbursement and appeal rights.
Dr. Zhou further explained that new federal claims and appeals regulations will affect every health care claims outside Medicare, including insurance benefits verification, claim submissions, eligibility for providers, pre-certification, policy coverage and limitation, medical necessity, UCR, bundling and down-coding, overpayment demand and recoupment, urgent care, pre-existing conditions, and any claim payment less than 100% as submitted. PPACA, sec. 2706 of PHS Act, specifically prohibits any discrimination against any health care providers regardless of any network participation.
ERISAclaim.com, said Dr. Zhou, will be interested in co-sponsoring, strategic alliance and networking for more seminars, certification or accreditation programs on PPACA-ERISA Claims & Appeals Regulations with other concerned organizations from billing and coding professionals, health care providers, group health plans, TPA's & IRO's. Please contact Dr. Zhou of ERISAclaim.com for further information.
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/Press_Releases.htm, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.