Ironically, all healthcare providers’ associations only focused on the political PPACA talks and ignored any claims reimbursement law PPACA talks,
Hanover Park, IL (Vocus/PRWEB) March 20, 2011
On March 20, 2011, ERISAclaim.com announced its initial Internet Search and Survey results that less than 0.001% PPACA APPEALS LAW education by the providers' Associations (including AMA & AHA) and provider industry to ensure millions of doctors and about 5,815 hospitals in compliance with new federal appeals laws by July 01, 2011 deadline as PPACA full enforcement. This finding is much less than 0.5% of claim denials appealed (OH) reported by Congress on March 16, 2011. New PPACA Health Reform Law Appeals Regulations went into effective on Sep. 23, 2010 with July 01, 2011 deadline as full enforcement, after President Obama singed health reform legislation into law on March 23, 2010. New PPACA Appeals Laws govern almost all non-Medicare and Medicaid healthcare claims. PPACA Appeals Laws are in less than 100 days countdown, while almost all doctors and hospitals are completely unaware of this PPACA Healthcare 911 Call, as Congress GAO revealed on March 16, 2011.
“Healthcare reform and healthcare delivery are not successful and completed until all healthcare claims are paid off legally,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert in PPACA & ERISA Appeals and Compliance.
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)
After reviewing the Congressional GAO Report on 03/16/2011 on “Why GAO Did This Study” under PPACA, ERISAclaim.com conducted its own Initial Internet Search and Survey of the industry and provider organization websites, including national, state, and specialty associations, such as AMA & AHA, as well as billing and coding group website. Surprisingly, entire nation and industry have failed to have any provider education on PPACA Claims Appeals Laws, except for the Northern California Chapter of HFMA, one California Billing and Consulting Co., YF Corp, and one Provider State Association, Ohio State Chiropractic Association (OSCA), completed some types of PPACA Appeals Laws Webinar education and PPACA Claim Specialist Certification Program. Ironically, all healthcare providers’ associations only focused on the political PPACA talks and ignored any claims reimbursement law PPACA talks, when the reimbursement crisis was the main reason for PPACA legislations, according to Dr. Zhou, who conducted this historical PPACA research, after the Congressional GAO Report.
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”.
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):
“Why GAO Did This Study
The large percentage of Americans that rely on private health insurance for health care coverage could expand with enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. Until PPACA is fully implemented, some consumers seeking coverage can have their applications for enrollment denied, and those enrolled may face denials of coverage for specific medical services. PPACA required GAO to study the rates of such application and coverage denials. GAO reviewed the data available on denials of (1) applications for enrollment and (2) coverage for medical services.”
“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
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:
On March 18, 2011, ERISAclaim.com announced slate of new 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, 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 Congress. 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.
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.
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