2023 ERISA Laws and Regulations – Stop Payer Recoupment to Protect Your Reimbursement

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This one hour 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.

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.

Most 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.

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 Objective:

• 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:

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This is a Live Virtual session.

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