Most provider attempts through the state legislations to cure prompt pay crisis have failed in the past 2 decades mainly due to the federal law ERISA preemption of state laws.
Hanover Park, IL (PRWEB) January 12, 2012
In response to the new demands, ERISAclaim.com offers 2012 Advanced PPACA & ERISA Claim Specialist Programs on “2012 Healthcare Prompt Pay Laws”. The new healthcare reform law, PPACA, will be fully enforced in 2012 to remedy the epidemic health claim prompt pay violations in the wake of the failures from the state legislative patches due to ERISA preemption. The Advanced PPACA & ERISA Claim Specialist Programs will cover: (1) The 2012 PPACA & ERISA Prompt Pay Laws under full enforcement of PPACA Claims Regulation for all 50 states; (2) the potential impact of the imminent U.S. Supreme Court decision on the PPACA prompt pay laws; (3) PPACA and ERISA prompt pay appeals and federal enforcement; (4) federal laws, PPACA & ERISA, pre-empt and supersede any and all conflicting or inconsistent state prompt pay laws.
The first program of “2012 Healthcare Prompt Pay Laws” will be held on January 17 & 18, 2012 in Los Angeles, California.
“Federal PPACA & ERISA prompt pay laws are more powerful than any state laws, and take a different approach. The state prompt pay laws provide for timely pay for clean claims with an interest penalty as remedies, while the federal prompt pay laws mandate for timely benefit determination, with appeal rights for an adverse benefits determination without timely actual pay,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
According to an AMA report in March 2011, more than 51% of doctors in Texas are going broke, mainly due to the insurance claim payment delays and denials. Prompt pay crisis is epidemic and similar for all 50 states, explained Dr. Zhou, as to the high demand from the providers. (http://www.ama-assn.org/amednews/2011/03/14/bisc0314.htm)
“Most provider attempts through the state legislations to cure prompt pay crisis have failed in the past 2 decades mainly due to the federal law ERISA preemption of state laws,” added Dr. Zhou.
“PPACA full enforcement in 2012 mandates full compliance with PPACA and ERISA, especially if a healthcare provider wanted to get paid timely, regardless from any state,” said Vincent Flores, a certified PPACA and ERISA Claim Specialist, VP of YF Corporation in Los Angeles, California.
This Advanced PPACA & ERISA Claim Specialist Programs will discuss specific potential impact from the imminent U.S. Supreme Court decision on the enforceability of PPACA and federal prompt pay laws: (http://www.supremecourt.gov/orders/courtorders/111411zor.pdf) & (http://www.supremecourt.gov/docket/PDFs/120811zr.pdf)
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.
ERISA claim.com “2012 Healthcare Prompt Pay Laws” will cover the following specific topics:
1. PPACA claims regulation, effective September 23, 2010, being fully enforced in 2012 (http://www.dol.gov/ebsa/healthreform/)
2. PPACA Claims Regulations regulate ERISA and non-ERISA claims, even individual policy claims, under group health plans and health insurance coverage in the group and individual markets, for most of health claims outside Medicare Medicaid. B http://webapps.dol.gov/FederalRegister/HtmlDisplay.aspx?DocId=24056&AgencyId=8&DocumentType=2)
3. PPACA [29 CFR § 2590.715-2719 (b)(2)(i)] has adopted all ERISA timelines for benefits determination [§2560.503-1(f)(g)(h)] and defines a prompt pay violation, “failure to provide or make payment that is based on a determination”, as an "adverse benefits determination" under §2560.503-1(m)(4). (http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=5a02ffcbdc3b299526312c6fe4f889f8&rgn=div8&view=text&node=29:126.96.36.199.188.8.131.52&idno=29)
4. ERISAclaim.com ERISA prompt pay timelines: http://www.erisaclaim.com/prompt_pay_crisis.htm
5. New PPACA federal prompt pay violation enforcement: DOL PPACA & ERISA violation complaint website for providers and patients: https://www.askebsa.dol.gov/WebIntake/Home.aspx?submit=Submit+a+Complaint.
6. ERISA timelines from prompt pay benefits determination: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=e46da7169dc9db98a57461c30d1115bf&rgn=div5&view=text&node=29:184.108.40.206.6&idno=29#29:220.127.116.11.18.104.22.168
7. Federal PPACA and ERISA Prompt Pay Laws Are Enforceable in 2012: EBSA News Release: US Department of Labor’s EBSA creates new consumer assistance Web page [11/10/2011] http://www.dol.gov/opa/media/press/ebsa/EBSA20111627.htm
8. PPACA & ERISA preemption of any and all conflicting or inconsistent state prompt pay laws.
9. Advanced appeal practice and strategies for prompt pay violations
To find out more about the Total 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.