New Federal PPACA Laws on Claims Payment Directly to Out-of-Network Doctors & Hospitals – PPACA Claims Specialists Readying for Full Enforcement of PPACA

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On July 14-15, 2011, YF Corp Completed the 3rd phase of PPACA Claims Specialist Certification Training, Readying For The Full Official Enforcement Of PPACA Claims Regulation After July 1, 2011, Focusing On the New Federal Mandate For Direct Claims Payment To Out-Of-Network Providers.

After July 1, 2011, out-of-network providers with a valid assignment should receive direct claim payments as mandated by PPACA

On July 14-15, 2011, YF Corporation completed the 3rd phase of PPACA-ERISA Claim Specialist Certification Training Program with ERISAclaim.com, in wake of the July 1, 2011, official enforcement date of PPACA Claims Regulation, which went into effect on September 23, 2010. The two-day intensive training focused on new federal PPACA mandates for health plans and insurance companies relating to the disbursement of claim checks directly to out-of-network doctors and hospitals pursuant to: the new PPACA definition of "Claimant", existing federal ERISA claim regulation and recent US Supreme Court rulings. YF Corporation will be the first generation of Certified PPACA - ERISA Claim Specialists by ERISAclaim.com.

With over 20 years of industry experience and 10 years of ERISA practice, YF Corporation officially started its PPACA Claims Specialist Certification training in Jan 2011 and expects to complete the training by the end of the year, becoming the first PPACA & ERISA health care revenue and consulting firm in the nation to be certified as PPACA Claims Specialists.

“73% of insured hard-working Americans pay for out-of-network provider coverage, yet they are hindered in their attempts to visit out-of-network doctors and hospitals when insurance companies will not honor their assignments to out-of-network doctors and hospitals" said Mark Flores, Director, YF Corporation.

“After July 1, 2011, out-of-network providers with a valid assignment should receive direct claim payments as mandated by PPACA” acknowledges Vincent Flores, Vice President of YF Corporation.

“Every health plan must disburse claim checks directly to out-of-network providers with valid designation of authorized representative under new federal law, PPACA,” said Dr. Jin Zhou, president of ERISAclaim.com, a national expert in PPACA and ERISA appeals and compliance.

“PPACA claims regulations are now being officially enforced or implemented since the expiration of the enforcement grace period on July 1, 2011. PPACA claims regulation went into effect September 23, 2010 and adopted ERISA in its entirety as the minimum PPACA internal appeals standards,” explained Dr. Zhou, “for the first time in U.S. healthcare history federal law, PPACA, define a claimant solely based on the patient designation of his/her Authorized Representative, rather than provider’s participation of managed care networks. And more importantly, PPACA outlawed managed care anti-assignment practice for all group health plans outside Medicare and Medicaid programs and individual policies market in all 50 states”.

On July 14-15, 2011, YF Corporation claim experts received PPACA - ERISA Claim Specialist Certification Training with in-depth and detailed coverage on the following topics:

1.    New federal health reform law, Patient Protection and Affordable Care Act, PPACA
2.    Full Implementation and enforcement of PPACA-ERISA claims regulation as of July 1, 2011, except for several new additional PPACA standards;
3.    PPACA adopted federal law ERISA claim regulation in its entirety as the minimum PPACA internal claims standards for disbursement of reimbursement checks and claimant status for any appeals;
4.    PPACA defines claimant to include healthcare providers as authorized representatives;
5.    U.S. Supreme Court rulings on ERISA beneficiaries and disbursement of reimbursement checks;
6.    The importance of, and how to: become an Authorized Representative under ERISA and PPACA, act on behalf of the patients as the claimant, receive reimbursement checks directly and exercise the same rights as patients regardless of network participation;
7.    The importance of, and how to offer indigent discount in compliance with all federal and state laws in order to avoid "no out-of-pocket waiver" fraud allegations and health plan’s audit;
8.    The importance of, and how to properly notify Health Plan of PPACA & ERISA assignment of benefits and demand health plans compliance in disbursement of reimbursement checks directly to providers;
9.    The importance of, and how to secure patient requirements in regards to PPACA and ERISA compliant financial guarantee/collateral agreement

Complete PPACA Regulations and Guidance can be found on DOL website:
http://www.dol.gov/ebsa/healthreform/

PPACA Claims and Appeals Regulations define a healthcare provider with valid designation of authorized representative as a claimant regardless of network participation status:

“(iii) Claimant. Claimant means an individual who makes a claim under this section. For purposes of this section, references to claimant include a claimant’s authorized representative.” [Page 43355]
http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056

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.

Located in Los Angeles, CA, YF Corporation is a leading multi-facet healthcare solution company with dedicated appeals specialists in billing, coding, revenue recovery services, consulting, claims review and compliance. With many physicians and ambulatory surgical centers as clients statewide, YF Corporation has been fighting for the rights of consumers and providers by appealing denials, partial denials and overpayment requests, with ERISA training from ERISAclaim.com since 2001. YF Corporation offers FREE webinars on new Federal Court decisions, PPACA claims regulation enforcement and how these issues directly affect reimbursements.

For more information regarding YF Corporation go to http://www.YFcorporation.com. To schedule a free webinar, please email Mark Flores, Director, at info(at)YFcorporation(dot)com or call 213-355-3900.

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