PPACA Webinars for Hospital CFOs: Most Sweeping Health Reform Revenue Laws & "Overpayment" Crisis

Share Article

ERISAclaim.com Announced PPACA Webinar For Hospital CFOs: “PPACA - The Most Sweeping Health Reform Revenue Laws & Overpayment Recoupment Crisis,” To Assist Hospitals In Compliance With PPACA, Federal Claims & Appeals Regulations, With Certified PPACA Claim Specialists & PPACA Appeals Department.

A few, if any, out of all 5795 hospitals, have implemented PPACA Claims Regulations with PPACA Claim Specialists or PPACA Appeals Departments.

On April 27, 2011, ERISAclaim.com announced PPACA Webinars for Hospital CFOs: “PPACA - The Most Sweeping Health Reform Revenue Laws, Consumer Protections and Overpayment Crisis.” The Webinars provide hospital CFOs with timely critical understanding and implementation of the new Federal Health Reform Laws and PPACA Claims Regulations governing hospital revenue cycle for all group health plan and individual policy claims, the most sweeping reimbursement law changes since the enactment of Medicare 45 years ago. The CFO Webinars are urged by the Congressional GAO PPACA Appeal Report on March 16, 2011 and prompted by the recent federal court decision on April 21, 2011 against a hospital with million-dollar claims. The webinars are scheduled biweekly, two-hours per session, at $650 per session.

PPACA adopted federal ERISA law as the minimum “PPACA Internal Appeal Standards” for all ERISA and non-ERISA plans. It has been more than six months since PPACA claims regulations went into effect on Sep. 23, 2010. PPACA Claims Regulation compliance is now a federal mandate for all hospitals with unprecedented and the provider protections. (http://www.dol.gov/ebsa/healthreform/)

PPACA Claims Regulations, § 2590.715-2719A, (b) provide all hospitals with unprecedented federal protections for emergency services and out-of-network hospitals.

On March 16, 2011, Congress released the PPACA mandated GAO Report, indicating that only a very small portion of denied claims were actually appealed (0.5% in Ohio), but when appealed, 39 to 59% reversed the initial denials.

“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.” (http://www.gao.gov/products/GAO-11-268)

A few, if any, out of all 5795 hospitals, have implemented PPACA Claims Regulations with PPACA Claim Specialists or PPACA Appeals Departments, while $75.5 billion in unpaid hospital care was reported by AHA for 2009, according to Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

On April 21, 2011, federal appeals court ruled against an in-network Hospital, with claims over $1 million, based on ERISA complete preemption.

According to the Court documents - Montefiore Medical Center v. Teamsters Local 272, Docket No. 10-1451-cv., United States Court of Appeals, Second Circuit, Decided: April 21, 2011:

“This case is yet another act in the all-too-familiar drama involving patients, their health care providers, and their health care benefit plans. The question presented is whether a health care provider's breach of contract and quasi-contract claims against a benefit plan established pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 et seq., are completely preempted by federal law under the two-pronged test for ERISA preemption established in Aetna Health Inc. v. Davila, 542 U.S. 200, 209 (2004). We hold: (1) an "in-network" health care provider may receive a valid assignment of rights from an ERISA plan beneficiary pursuant to ERISA § 502(a)(1)(B),1 the provision setting forth ERISA's civil enforcement scheme; (2) where a provider's claim involves the right to payment and not simply the amount or execution of payment2—that is, where the claim implicates coverage and benefit determinations as set forth by the terms of the ERISA benefit plan, and not simply the contractually correct payment amount or the proper execution of the monetary transfer3—that claim constitutes a colorable claim for benefits pursuant to ERISA § 502(a)(1)(B); and (3) in the instant case, at least some of plaintiff's claims for reimbursement are completely preempted by federal law; furthermore, the remaining state-law claims are properly subject to the District Court's supplemental jurisdiction.”

For a copy of the official court decision: http://ERISAclaim.com/Court_ERISA_Hospitals.pdf

PPACA Webinars for Hospital CFOs will cover the following topics:

1.    Health Reform Law PPACA Claims Regulations, Effective Date Sep. 23, 2010, with only less than 1% requirements extended with enforcement date until 01/01/2012;
2.    PPACA Claims Regulations govern most claims outside Medicare and Medicaid, critically and regulatorily control hospital revenue cycle, more important than Medicare claim regulations;
3.    Unprecedented federal protections for Hospital Emergency Services regardless of network participation, and for non-emergency services by out-of-network hospitals;
4.    PPACA appeals regulations with true prompt pay protections for Internal and External Appeals;
5.    Recent federal appellate court rulings against an in-network Hospital with million-dollar claims brought under PPO contract without ERISA compliance;
6.    Congressional GAO PPACA report on national denial rates and appeal rates with successful reversal of the original denials;
7.    How to cope with the current overpayment recoupment crisis under PPACA and ERISA laws.
8.    The importance of and how to establish hospital PPACA and ERISA Appeals Department, with Certified PPACA and ERISA Claim Specialists.

To register PPACA Webinars for Hospital CFOs: http://www.erisaclaim.com/erisa_for_hospitals.htm

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 any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.


Share article on social media or email:

View article via:

Pdf Print

Contact Author

Jin Zhou
Visit website