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Stop Recoupment to Protect Reimbursement: ERISA Laws and Regulations

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Many physicians, managers and billers mistakenly believe the contract they have with a carrier for a specific timely filing limit or appeal period limit somehow locks them into that for every claim they file to that carrier. They do not realize that more than 80% of the claims they file to that carrier are not subject to that contract, as the federal law ERISA has different mandates. Yes – that 90 days period you think you have with UHC or BCBS or Aetna does not apply on probably 80% of your claims with that carrier. The federal law, that has been upheld by the U.S. Supreme Court many times, says the only thing that applies is what is in the patient’s contract (policy) itself – and that is usually a 180 days or 365 days filing period.

This webinar will teach you what 95% of billers, hospital administrators, office managers, coders, physicians and attorneys do not know about ERISA and medical claims. Too often, even attorneys have no clue how ERISA can stop a carrier from recouping or how ERISA can make a carrier pay when they do not want to. This webinar helps attendees see how to make insurance carriers follow the federal rules regarding claims payments, which most billers and coders have been unaware of. By the end of the webinar, the attendee will know when insurance claim recoupments are illegal, what the true timely filing periods are, what the federal law requires for timely appeals and more. That is only one of the many ways that ERISA will help you. It can stop the carrier from doing their “recoupments” or demands for repayment as well as make the carrier pay on claims you didn’t expect.

Over 80% of your Non-Medicare and Non-Medicaid claims fall under ERISA control. If you master how to write ERISA Appeal Letter and submit correctly, you can overturn denied claims for missed filing deadline rejections, get back reimbursement recoupments, stop payers from downcoding your claims, and so much more. ERISA expert and a renowned healthcare reimbursement consultant, Don Self, CPC, CMCS, CASA, will guide you to write winning ERISA appeal letters that will help you get paid more by non-government payers.

Learning Objectives:
  • Learn how the timely filing limit you think you have is not valid on most of your claims
  • Learn how to make carriers pay when they do not want to
  • Learn how to stop carriers from recouping and why you don’t owe them refunds
  • Learn how to effectively fight improper bundling by carriers
  • Learn why appealing claims to the claims department is a waste of time
  • Learn how the contract your doctor or hospital signed with the carrier does not apply to the majority of claims you file with that carrier
  • Know the Current Federal and State Rules for ERISA
  • Understand Balance Billing Laws
  • Understand Assignment Of Benefits (AOBs) & Release Of Medical & Plan Documents
  • What ERISA protects and how it will help your practice?
  • Which claims are covered by ERISA and which are not?
Areas Covered in the Session:
    • What Is ERISA (Employee Retirement Income Security Act)?
    • ERISA From Provider’s Perspective
    • ERISA From Coder’s Or Biller’s Perspective
    • ERISA Is DOL?
    • Employment Compensation
    • When Is It An ERISA Claim?
    • How Does ERISA Help With Insurance Claims?
    • Provider Agreements With The Carriers
    • Pre-Authorizations
    • Regulating Employee Pension Funds
    • Sets Minimum Standards For Plans
    • Summary Plan Description (SPD)
    • Dealing With Claim Department Or Plan Administrator
    • Recoupment
    • Federal Crime Under Subsection 1141 Of U.S. Code Title 29
    • Federal And State Law For ERISA
    • Service As Excluded Or Investigational
    • How to Reply For Investigational?
    • Balance Billing Laws
    • What About Recouping?
    • Who Can They Recoup From?
    • What Was PCA V BCBSA?
    • Time Limits On ERISA
    • What Is An Adverse Benefit Determination (ABD)?
    • What Can We Do If Already Recouped?
    • Medical Necessity Or Bundling Or Down-Code Reply
    • What About Union Plans?
    • Is AOB Sufficient?
    • Assignment Of Benefits (AOBs) & Release Of Medical & Plan Documents
Suggested Attendees:
  • Healthcare CEOs
  • Healthcare CFOs
  • Healthcare COOs
  • Office Managers
  • Billing Staff and Companies
  • Physicians and Other Providers
  • Healthcare Consultants
  • Compliance Officers
  • Practice Manager
  • In and Out of Network Providers
  • Medical Billing Companies
  • Providers Office Staff
  • Hospitals and Facilities
  • Insurance Companies
  • Healthcare Attorneys
Presenter Biography:

Don Self, CPC, CMCS, CASA,  is the CEO and founder of Don Self & Associates, a consulting firm specializing in medical reimbursements and helping physician practices improve patient outcomes and increase profits while staying compliant with all regulations. Don is also the President of Telecare-USA. Don has taught more than 900 seminars/ webinars over the past 38 years to tens of thousands of physicians, NPPs, coders and billers on coding, revenue, reimbursement and billing. He has helped thousands make sure they are paid properly by Medicare and other payers.


Additional Information:

System Requirement:

  • Internet Speed: Preferably above 1 MBPS
  • Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com


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Frequently Asked Questions:

HOW MUCH TIME DOES IT TAKE TO RECEIVE THE DVDs/ FLASH DRIVE? +

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The system requirements are quite basic: OS: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6 Internet Speed: Preferably above 1 MBPS Headset: Any decent headset and microphone which can be used to talk and hear clearly, in case of live course you can raise questions using a microphone.

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We will also send you the joining link or dial-in number to the registered email address 2-3 days prior to the live training. You can simply click the joining link to join the live training.

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WHAT’S THIS DIFFERENT FORMAT? +
  • Live (One Attendee) – Only 1 person will be able to join the webinar
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WHAT CERTIFICATION DO I GET POST THE TRAINING? +

After successful completion of the training, you will be awarded the course completion certificate (on request). The certifications/ recertifications should be mentioned under the description of every course.

TESTIMONIALS

“This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course.”
Melissa Preston, Health Information Management Staff
“David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN”
Sandie Fowler, Out of Network Billing Staff
“Great presentation. Able to do during the day. Timing was great.”
Tina Duffy, Compliance Officer