39% to 59% denial reversal could be a making or breaking point for most doctors and hospitals to avoid closing down the hospitals and doctor’s medical practice
Hanover Park, IL (Vocus/PRWEB) March 18, 2011
On March 18, 2011, ERISAclaim.com announced new slate of services to ensure millions of doctors and about 5,815 hospitals in compliance with new Federal Claims and Appeals Laws by July 01, 2011 deadline as PPACA full enforcement, since its effective date on Sep. 23, 2010, after President Obama singed health reform legislation into law on March 23, 2010. On March 16, 2011, Congress just reported that 39% to 59% appeals successfully reversed health insurance denials but only a small portion of denials are challenged, “Specifically, for the first quarter of calendar year 2010, Ohio data indicated that 0.5 percent of claim denials were internally appealed”.
ERISAclaim.com announced the new PPACA appeal compliance services to hopefully change that 0.5% appeals rates to at least 50% appeals rates under PAPCA with the same successful rates of 39% to 59% denial reversal as reported by the Congress, and as intended by Congress in new Patient’s Bill of Rights as a practical solution to U.S. healthcare crisis.
ERISAclaim.com is the only firm in the nation, for doctors and hospitals, counting down the actual number of days for PPACA’s full enforcement deadline on July 01, 2011, by offering slate of new services in free Webinars, CD Books, Seminars, Consulting, Claims Recovery, and Litigation Support, in compliance with PPACA and ERISA federal claims and appeals laws. The services complying with PPACA and ERISA included PPACA / ERISA Appeals Seminars, Overpayment Appeals, Corporate Compliance – Fraud & Abuse Preventions, Out-Of-Network Practice & Reimbursement, Pre-Payment Review Denials & Delays, SIU Denials & Delays – ERISA Pre-Emption, and all denials and delays under PPACA and federal law ERISA.
ERISAclaim.com also serves self-insured health plans with Plan Assets Audits & Recovery Programs and Fiduciary Compliance Assistance Educations in PPACA and ERISA Regulations,
On March 16, 2010, Congress released its long waited report by its Government Accountability Office (GAO): Private Health Insurance: Data on Application and Coverage Denials. Nationwide data collected by HHS from insurers indicated that 39% to 59% of appeals reversed original coverage denials. Mr. John E. Dicken, a GAO health care director, noted that only a small portion of denials are challenged, either by providers or consumers.
U.S. GAO, (GAO-11-268 March 16, 2011): Private Health Insurance: Data on Application and Coverage Denials, reports the following in part (http://www.gao.gov/products/GAO-11-268):
“Further, the data GAO reviewed indicated that coverage denials, if appealed, were frequently reversed in the consumer's favor. For example, data from four of the six states on the outcomes of appeals filed with insurers indicated that 39 percent to 59 percent of appeals resulted in the insurer reversing its original coverage denial. Data from a national study conducted by a trade association for insurance companies on the outcomes of appeals filed with states for an independent, external review indicated that coverage denials were reversed about 40 percent of the time.”
“Reversals of coverage denials were limited to denials for which an appeal was initiated. The data we reviewed did not allow for a systematic calculation of an “appeal rate”—the number of coverage denials for which an appeal was initiated—for several reasons, including different data sources or data years for denials and appeals data. Data from Ohio did provide limited information; specifically, for the first quarter of calendar year 2010, Ohio data indicated that 0.5 percent of claim denials were internally appealed.”
A copy of the GAO full report is available at: http://www.gao.gov/new.items/d11268.pdf
A copy of the GAO Highlights Page is available at: http://www.gao.gov/highlights/d11268high.pdf
“39% to 59% denial reversal could be a making or breaking point for most doctors and hospitals to avoid closing down the hospitals and doctor’s medical practice,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert in PPACA & ERISA Appeals and Compliance.
“One of the real healthcare crises is that most doctors and hospitals are not educated on federal appeals laws and their painstaking “appeals” were NOT accepted under the law as appeals, for that 0.5% appeals reported by the Congress,” added Dr. Zhou.
On March 14, 2011, AMA reported that More Texas Doctors Dipping Into Personal Reserves To Keep Practices Alive (http://www.ama-assn.org/amednews/2011/03/14/bisc0314.htm)
“In addition, 69% had cash flow problems because payments from government and private insurers arrived late, below what was billed, or not at all. ……About 51% of physicians whose practices had cash flow problems drew from their own accounts to keep them going in 2010. About 33% said the same in 2008. In addition, 33% took out commercial bank loans in 2010 to stay in business, and 22% did so in 2008.”
PPACA Claims & Appeals Regulations govern all group health plans, ERISA and non-ERISA, and individual market claims.
July 01, 2011 is the deadline for full enforcement on PPACA since its effective date on Sept. 23, 2010. (http://www.dol.gov/ebsa/newsroom/tr10-02.html)
Complete PPACA Claims and Appeals Regulations and Guidance can be found on DOL website:
Located in a Chicago suburb in Illinois, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.
For more info on ERISAclaim.com’s new services: http://erisaclaim.com/products.htm
For a free PPACA Webinar for your Organization or Institution, please contact Dr. Jin Zhou, President of ERISAclaim.com, at 630-808-7237.