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2023 ERISA Laws and Regulations – Stop Payer Recoupment to Protect Your Reimbursement
Event Date: 09/27/2023
Time: 3 pm ET | 2 pm CT | 1 pm MT | 12 pm PT
Duration of the training: 60 Minutes
Location: Online Webinar
By: DON SELF, CPC, CMCS, CASA

Conference Materials (Password Required)

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
Areas Covered in the Session:
  • Rules and Compliance under ERISA
  • ERISA impact on insurance claims
  • Effective ERISA appeal letter
  • ERISA Appeal letter verbiage
  • Payer Downcoding
  • ERISA appeal timelines
  • Prior-authorization
  • ERISA Letter writing plan and templates
  • Appeal Response
  • Claim Record-keeping
  • Live Q&A session
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.


This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.


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WHAT’S THIS DIFFERENT FORMAT? +
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TESTIMONIALS

“Jim Sheldon-Dean’s insights on privacy and security were very much helpful to our team, it was great to learn from an instructor like him. Appreciate!”
CHRISTINE JACOB MD, CDI SPECIALIST

“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

“The workshop was very insightful and made absolute sense in terms of the regulations and their compliance. I am thankful for having the opportunity to attend.”
BARBARA CAPRIOTTY, REHABILITATION DIRECTOR