Providers are now faced with two choices: continue to debate over the constitutionality of PPACA or become an expert of PPACA and ERISA to get paid today.
Hanover Park, IL (PRWEB) June 29, 2012
After Supreme Court upheld PPACA yesterday, ERISAclaim.com announced its decision to make its 2-year-old Certified PPACA / ERISA Claim Specialist Program permanent, as after the high Court decision, PPACA will be the law of the land for all providers and patients for health claim denials and delays. Now the entire healthcare industry has completely changed from the debating over the constitutionality of PPACA to the total compliance with and profiting from PPACA in the current health claim reimbursement crisis.
Since PPACA claim regulations went into effect on 09/23/2010, ERISAclaim.com has offered the nation’s first and only Certified PPACA / ERISA Claim Specialist Program for doctors and hospitals, after its Certified ERISA Claim Specialists Program for 12 years. PPACA, also known as Patient’s Bill of Rights, as the most significant health care law changes in the past 50 years. PPACA adopts ERISA in its entirety, another federal law of almost 37 years, as the minimum internal appeal standards for both ERISA plans and non-ERISA plans, or the rule of the game for all non-Medicare and Medicaid health plan claims and denials.
“Providers are now faced with two choices: continue to debate over the constitutionality of PPACA or become an expert of PPACA and ERISA to get paid today. It’s certainly one’s constitutional rights to still debate over if Bush or Gore truly won the election 10 years ago, or to quickly act on how to get paid now under PPACA,” says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
In ruling for PPACA constitutionality, Chief Justice Roberts states: “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”
“We at ERISAclaim.com do not consider or debate whether the Congress, President or Supreme Court made sound decisions or policies, we teach only whether and how your claims shall be paid timely and legitimately,” explained Dr. Zhou.
A copy of the Supreme Court PPACA decision can be at Supreme Court website: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf
“PPACA clams regulations are just like Medicare claims regulations, but PPACA governs more money than Medicare in claims for most providers and hospitals, so we must be certified for both PPACA and Medicare claim specialists,” said Vincent Flores, a certified PPACA and ERISA Claim Specialist, VP of YF Corporation in Los Angeles, California.
“The Congress GAO study revealed how little appeals (0.5% in OH) were done and how much you could win (39-59%) if you do file ERISA / PPACA Appeals,” says Mark Flores, a certified PPACA & ERISA Claim Specialist, Director of Healthcare Revenue & Consulting, YF Corporation.
The Congress concluded in U.S. GAO Report, (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.”
The new PPACA training partnership programs will offer important and timely reviews and services to:
1. Provide leadership and organizational guides on the Supreme Court PPACA decision on June 28, 2012;
2. Demystify the Supreme Court final decision on PPACA for healthcare providers with respect to the PPACA Providers’ Bill of Rights in healthcare reimbursement;
3. PPACA Claims Regulations and Guidance from DOL: http://www.dol.gov/ebsa/healthreform/
4. PPACA & ERISA Claims Regulations Assistance and Complaints Webpage from DOL: https://www.askebsa.dol.gov/WebIntake/Home.aspx?submit=Submit+a+Complaint
5. PPACA Claims Regulations and Guidance from HHS: http://www.healthcare.gov/law/features/rights/bill-of-rights/index.html
6. Create partnership networks nationwide to immediately start basic and advanced training on PPACA & ERISA claims regulations for your organization or associations, as you did for Medicare claims regulations, as you will have no choice or excuses after the Supreme Court PPACA decision on June 28, 2012;
7. Create partnership networks nationwide to immediately offer Certified PPACA & ERISA Claim Specialist Programs, as you did for Medicare claims and compliance for 45 years;
8. Create awareness and readiness to develop a national network or association for PPACA & ERISA Claim Specialists.
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm
Located in a Chicago suburb in Illinois, for over 12 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. Dr. Zhou were frequently consulted by and advised numerous providers and healthcare attorneys in ERISA claim appeals and health care provider ERISA class actions in the past 12 years.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.
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