the more patients you see and the less you get paid, the faster you go broke, as recently reported by CNNMoney and AMA
Hanover Park, IL (PRWEB) January 10, 2012
With forthcoming Supreme Court PPACA hearing in March and an expected decision in June or July, 2012, ERISAclaim.com offers Webinars to discuss what really matters to the doctors and hospitals in their reimbursement rights: “not much as you thought or much more than you thought”, what must doctors and hospitals do NOW for their insurance reimbursements with or without PPACA.
“If every American is insured but without reimbursement rights for doctors and hospitals, the more patients you see and the less you get paid, the faster you go broke, as recently reported by CNNMoney and AMA, ” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
The Webinar will focus on the Supreme Court PPACA development and the real impact on reimbursement rights for doctors and hospitals, rather than pure political and academic marathon debates:
According to the U.S. Supreme Court’s Website, PPACA hearing is scheduled for March 27-28, 2012. A decision is expected as early as June or July 2012. The high Court will decide on whether the PPACA’s individual mandate and Medicaid expansion will be constitutional, and if unconstitutional, whether they are severable from the entire PPACA. The high Court will likely decide (1) to uphold entire PPACA, (2) throw out the entire PPACA or (3) throw out individual mandate and/or Medicare expansion. To follow-up this important Supreme Court activities, please visit Supreme Court website:
The Supreme Court landmark PPACA decision will certainly change U.S. healthcare history politically and economically. However no matter what the Court decides on PPACA, a.k.a. ObamaCare, the specific impact for the reimbursement rights on claim denials for doctors and hospitals will not be as much as the majority expected, because PPACA adopted 36-year-old federal law ERISA in its entirety for internal appeals and endorsed existing NAIC External Appeal Model for PPACA external appeals, and ERISA governs more than 80% of healthcare claims outside Medicare and Medicaid market. Not much realized by the majority, the Supreme Court decision in CIGNA v. Amara on May 16, 2011 has truly and dramatically changed the reimbursement rights for doctors and hospitals with unprecedented remedies, the protections sought for by Patient Bill Of Rights campaign for decades, explained Dr. Zhou.
So, What Will Be the Real Impact on Reimbursement Rights for Doctors and Hospitals?
1. If PPACA Upheld Entirely: ERISA and PPACA Claims Regulations will regulate both ERISA and non-ERISA Group Health Plans, Governmental or Individual Market, AND additional 30 million Americans will be insured under PPACA Exchange & Medicaid Expansion programs;
2. If PPACA Thrown Out Entirely: ERISA Claims Regulation will continue to regulate ERISA claims for 170 -180 million Americans under employer-sponsored health plans, as in the past 36 years;
3. If Only Individual Mandate/or Medicaid Expansion Thrown Out Entirely: ERISA & PPACA Claims Regulations will regulate both ERISA and non-ERISA Group Health Plans, Governmental or Individual Market, AND NO additional 30 million Americans will be insured under PPACA Exchange or Medicaid Expansion programs.
The ERISAclaim.com’s “PPACA & Supreme Court” Webinars will focus on why and what must providers do for their reimbursement rights and will cover the following topics:
1. The U.S. Supreme Court has announced that it will rule on the constitutional challenges on PPACA (Patient Protection & Affordable Care Act) from several appellate cases: National Federation of Independent Business v. Sebelius (No. 11-393), U.S. Department of Health and Human Services v. Florida (No. 11-398) and Florida v. Department of Health and Human Services (No. 11-400). (http://www.supremecourt.gov/orders/courtorders/111411zor.pdf)
2. The U.S. Supreme Court has corrected the errors in remedial laws under ERISA for 36 Years, Cigna Corp. v. Amara, (No. 09–804) on May 16, 2011. (http://www.supremecourt.gov/opinions/10pdf/09-804.pdf)
3. Per DOL, Amara decision has dramatically changed the legal landscape of ERISA and managed care laws. (http://www.dol.gov/sol/media/briefs/kenseth(A)-6-13-2011.htm)
4. PPACA adopts ERISA for more than 180 million Americans for both ERISA and non-ERISA claims. DOL Affordable Care Act Regulations and Guidance: http://www.dol.gov/ebsa/healthreform/
5. On January 5, 2012, CNNMoney Report: "Doctors Going Broke”. (http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3)
6. AMA: “51% of Texas doctors dug into personal funds to keep practices afloat in 2010”. (http://www.ama-assn.org/amednews/2011/03/14/bisc0314.htm)
In particular, U.S. GAO, (GAO-11-268 March 16, 2011): (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……Ohio data indicated that 0.5 percent of claim denials were internally appealed.”
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
Located in a Chicago suburb in Illinois, for over 11 years, 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 numerous pending national ERISA class action 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.