The best ways to contain healthcare costs and also shield fiduciary liabilities are proactive compliance with all governing laws in making every claim denial and appeal decision under ERISA and PPACA
Hanover Park, IL (PRWEB) January 11, 2013
ERISAclaim.com announced its 2013 PPACA & ERISA Claims Specialist Educational Program for Plan Administrators (PA) and TPAs (PPACA for PA & TPA), as the first of its kind in healthcare industry, in order to comply with 2013 full enforcement of PPACA claims regulation, especially when 82.1% of large health plans (>500) are self-insured. ERISAclaim.com timely offers these programs, because in 2013, failure to substantially comply by plan administrators and TPAs with PPACA and ERISA claims regulations may result in substantial administrative penalties, legal liabilities and court costs. New federal health care reform law PPACA, Patient Protection and Affordable Care Act, went into effect on March 23, 2010, and PPACA claims regulation went into effect on September 23, 2010, PPACA adopts ERISA claim regulation of 37 years in its entirety as PPACA minimum internal appeal standards.
ERISAclaim.com’s 2013 PPACA & ERISA Claims Specialist Educational Program for Plan Administrators (PA) and TPAs was also urged as a result of a recent 5th Circuit court decision on January 4, 2013, affirming a district court ERISA decision against a TPA in awarding $453,000 in attorney fees and $512,000 in medical bills for making claims denial and appeal decisions.
(The court case information: LifeCare Management Services LLC v. Insurance Management Administrators Incorporated, No. 11-10733, Filed on January 4, 2013, United States Court of Appeals, Fifth Circuit.
ERISAclaim.com’s 2013 PPACA & ERISA for PA’s & TPA’s programs are immediately available to the public. These are comprehensive, both basic and advanced private certification programs (as no such known public programs of its kind available yet in 37 years), and educational in nature to assist all plan administrators and TPAs in compliance with PPACA and ERISA mandates in 2013, in order to contain healthcare costs, to protect plan participants and beneficiaries in fulfilling plan fiduciary duties, to improve health care quality and healthcare provider relationship. The basic programs will be for two days, the advanced private certification programs will be for eight days. The pricing for these programs will depend upon the number of attendees in each group session.
“The best ways to contain healthcare costs and also shield fiduciary liabilities are proactive compliance with all governing laws in making every claim denial and appeal decision under ERISA and PPACA,” said Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA and PPACA compliance, who educated healthcare providers in ERISA and PPACA appeals for more than 12 years. http://www.dol.gov/ebsa/healthreform/
“Why now PPACA and ERISA for plan administrators and TPAs? As the common ground for all stakeholders, plan sponsors, patients and healthcare providers, is ERISA and PPACA compliance, and for 37 years, there has been no comprehensive ERISA educational and certification program of this kind for anyone who manages provider or patient ERISA appeals. This is probably partially the reason why a TPA was fined by the court recently as a fiduciary for almost half a million dollars in legal liabilities,” explained Dr. Zhou.
“More importantly, about 82.1% of large health plans (>500 employees) are self-insured at least one plan, according to the HHS and DOL PPACA “Report to the Congress on a Study of the Large Group Market”, and in 2013, PPACA claims regulations are in full implementation and enforcement, after the Extension of Non-Enforcement Period expired,” emphasized Dr. Zhou. http://www.dol.gov/ebsa/newsroom/tr11-01.html
Employer Self-Insurance Decisions and the Implications of the Affordable Care Act (ACA)
Large Group Health Plans Study
“DOL Fiduciary Guidance for all TPAs in “Maintaining the Plan’s Benefits Claims Procedure” states “While many plans hire benefits professionals or insurance companies to process claims, it is important for an employer to understand the requirements before selecting a service provider who can comply with the standards.” commented Mr. Vincent Flores, president and co-founder of AVYM.com, a certified PPACA and ERISA claims specialist. http://www.dol.gov/ebsa/publications/ghpfiduciaryresponsibilities.html
“Every healthcare provider is required to obtain medical license and/or credentialing to perform healthcare services in order to be paid, every TPA or plan fiduciary shall have at least some minimum education, if not ERISA or PPACA license or certificate, to manage all claim denials and appeals from healthcare providers and patients,” noted by Mr. Mark Flores, vice president and co-founder of AVYM.com, a certified PPACA and ERISA claims specialist.
“Our certification programs are only for personal attendance in private studying of the subject materials specified in each individual program for advancing educational knowledge with respect to applicable PPACA and ERISA compliance,” disclaimed by Dr. Zhou.
To find out more services and products from ERISAclaim.com:
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.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.