Hanover Park, IL (PRWEB) January 01, 2013
On Jan 01, 2013, ERISAclaim.com announced its 2013 HSA & PPACA Claim Specialist Programs to train both in-network and out-of-network healthcare providers on: (1) 2013 new federal PPACA SBC (aka “Insurance Verification”) laws, (2) PPACA internal and external appeal laws, (3) the latest health claim overpayment ERISA laws and (4) how to get paid with $14 billion in patient HSA (Health Saving Account) in 2013.
The two-day basic PPACA HSA Claim Specialist Program was designed to get paid even with high deductibles from most High Deductible Health Plans (HDHP), with HSA grown to $14.1 billion by June in 2012. The one-day basic PPACA SBC Claim Specialist program was designed to comply with new federal SBC laws in 2013 for every health plan to disclose health plan coverage information, commonly practiced as “insurance verification” procedure by every provider, as one of the federal health reform law’s milestone changes of standards for all healthcare claims. The eight-day advanced Certified PPACA & ERISA Claim Specialist programs were designed to comply with 2013 full implementation of PPACA Claims regulations for both internal and external appeals for all claims denials, and especially for sky-rocketing payer overpayment claims and newly approved claim withholding or offsetting denials, in accordance with the latest Court rulings and DOL legal guidance on the increasing overpayment or repayment disputes.
“Beginning in January 2013, new federal SBC law will mandate every health plan or insurance company to timely disclose patient insurance coverage information in a federally standardized form with Uniform Glossary of Coverage and Medical Terms, or willful failure to comply with SBC laws will be subject to a fine of $1,000 for each such failure,” said Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
“In 2013, most providers will be shocked by the unprecedented high prevalence of the high deductible health plans for both in-network and out-of-network patients, while Health Savings Accounts Grow to $14.1 Billion in June in 2012,” according to Dr. Zhou. http://www.devenir.com/2012/devenirmidyearhsasurvey
“On Oct 12, 2012 and Nov. 30, 2012, in connection with the increasing national provider overpayment ERISA class actions, the federal court and DOL, for the first time, finally made some new decisions and legal guidance on the No. 1 nightmare for all providers – overpayment demand and recoupment: a payer must comply with ERISA regulations in all overpayment demand due to the coverage dispute,” according to Dr. Zhou, who provided ERISA compliance assistance to th class rep. providers and litigation support to the leading class action law firms in seeking compliance guidance in all overpayment disputes.
According to DOL Overpayment Amicus Brief on Nov. 30, 2012 in support of the plaintiff providers:
“The crux of the question at issue here is not whether the plaintiff or the defendant is correct in their views of the plan terms, but whether Aetna must comply with the procedures mandated by ERISA section 503 and its accompanying regulations in rendering a determination based on a plan interpretation that is adverse to the plan participants and beneficiaries.”
According To Houston Chronicle, November 7, 2012: “Federal Court Rules against BCBS in Overpayment ERISA Class Action: Providers Entitled to ERISA Appeal Rights”
“What really made these PPACA, ERISA, SBC and HSA programs timely important is that PPACA Claims Regulations are now in full implementation for all provisions of the health reform laws for all ERISA and non-ERISA health plans,” explained Dr. Zhou.
The followings are 2013 ERISAclaim.com New Year’s Resolution to Reimbursement by Compliance:
1. DOL Affordable Care Act Regulations and Guidance: Internal Claims and Appeals and External Review: http://www.dol.gov/ebsa/healthreform/
2. SBC Laws: Final Regulations
3. SBC Laws: Summary of Benefits and Coverage and Uniform Glossary--Templates,Instructions, and Related Materials; and Guidance for Compliance
4. Sample Completed SBC: http://www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf
5. The IRS publication about HSAs, Pub 969 Health Savings Accounts and Other Tax-Favored Health Plans: http://www.irs.gov/pub/irs-pdf/p969.pdf
6. PCA v. BCBSA et. al.: http://ww1.prweb.com/prfiles/2012/10/18/10028942/PCA%20v%20BCBSA.pdf
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.