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Moukawsher & Walsh, LLC
Pension and Employee Benefit Law

Benefitlawyers.com

 
 
 
 
 
 
 
 

U.S. Healthcare Crisis Turnaround?

U.S. A.

Drs. & Hospitals Employers

$1.0 Trillion / Year

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The Only Company with Compliant Solutions for All of You

PPACA Webinars for Hospital CFOs: Most Sweeping Health Reform Revenue Laws & "Overpayment" Crisis

Biweekly, Two-hours/Session, $650/Session

ERISAclaim.com Announced PPACA Webinar For Hospital CFOs: “PPACA - The Most Sweeping Health Reform Revenue Laws & Overpayment Recoupment Crisis,” To Assist Hospitals In Compliance With PPACA, Federal Claims & Appeals Regulations, With Certified PPACA Claim Specialists & PPACA Appeals Department.

 

Click here to register or for more info

New Federal Health Claims & Appeals Laws & Regulations

for 193 Million Americans

Effective 09-23-2010

©2010, Jin Zhou, ERISAclaim.com

Photo of President Gerald R. Ford signing Employee Retirement Income Security Act of 1974

President Obama Signing Health Bill on 03/23/2010

President Gerald R. Ford Signing ERISA on 09/02/1974

New Webinars, Seminars & Certification Classes Announced for New Federal Health Claim Appeals Regulations on July 22, 2010 from HHS, DOL & IRS, Effective On Sept. 23, 2010 for 193 Million Americans

DOL Seal - Link to DOL Home Page

UNITED STATES

DEPARTMENT OF LABOR

(Links to DOL) ©2010, Jin Zhou, ERISAclaim.com

Patient Protection and Affordable Care Act

Statutory Laws [PDF] [PDF]

 

 

Employee Retirement Income Security Act — ERISA

 

 

PPACA Webinars for Hospital CFOs: Most Sweeping Health Reform Revenue Laws & "Overpayment" Crisis

Biweekly, Two-hours/Session, $650/Session

ERISAclaim.com Announced PPACA Webinar For Hospital CFOs: “PPACA - The Most Sweeping Health Reform Revenue Laws & Overpayment Recoupment Crisis,” To Assist Hospitals In Compliance With PPACA, Federal Claims & Appeals Regulations, With Certified PPACA Claim Specialists & PPACA Appeals Department.

 

Click here to register or for more info

 

ERISAclaim.com Free ERISA Webinars


2011 Free Webinars

 

Free Webinars On 2011 New Federal Health Claims Denials & Appeals Laws –

Reimbursement Mandates Under PPACA  - 03-04-2011

ERISAclaim.com Announced New Webinar Schedules For 2011 New Federal Health Claims Denials & Appeals Laws, New PPACA Mandates All Group Health Plan & Individual Market Claims, Effective On 09/23/2010 With A Deadline On July 01, 2011 As Full Enforcement Grace Period. Any Failure To Comply With PPACA By Health Providers Will Result In More Denials And Loss Of Rights To Appeal

2011 New Federal Health Claims Denials & Appeals Laws –

Reimbursement Mandates Under PPACA

 

Register for a session now by clicking a date below:

 

Wed, Mar 23, 2011 1:00 PM - 2:00 PM CDT

 

Wed, Apr 20, 2011 1:00 PM - 2:00 PM CDT

 

Wed, May 18, 2011 1:00 PM - 2:00 PM CDT

 

Wed, Jun 15, 2011 1:00 PM - 2:00 PM CDT

 

Once registered you will receive an email confirming your registration with information you need to join the Webinar.

 

A free PPACA / ERISA Handout can be downloaded here:

http://www.erisaclaim.com/Free_ERISA_PPACA.pdf

 

 

Health Reform Law, PPACA, has been effective since 09/23/2010, with an enforcement grace period until July 1, 2011 for strict and full enforcement, for all group health plans and individual policies as well as all healthcare providers. PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare: ERISA claims and non-ERISA claims as well as all individual policies. PPACA claims regulations adopted ERISA claims regulation in its entirety as PPACA internal appeals process, and adopted NAIC’s external model as PPACA external appeals process. PPACA also provides new patients and providers protections as the most significant reimbursement law changes in 45 years since Medicare was created. It is extremely urgent and important for all hospitals and providers to know and comply with PAPCA for claims reimbursement.  

ERISAclaim.com, a national firm in compliance and reimbursement, offer you this webinar on the most critical health reform law compliance and reimbursement.

 


Topics Covered:

 

  1. A. Brief Review Of DOL Health Reform Law Claims Regulations Website: Http://www.DOL.Gov/EBSA/Healthreform/

  2. B. Understanding That New Federal Health Reform Law And Claims Regulations Are Effective Now, And They Are Federal Mandates, Not Optional, For All Non-Medicare health Care Claims;

  3. C. Understanding of Basic Scope Of New Federal Health Reform Laws And Claims Regulations, PPACA, Patient Protection And Affordable Care Act;

  4. D. Basic Understanding Of New Federal Internal And External Appeals Processes

  5. E. Basic Understanding Of ERISA Claims Regulations;

  6. F. Basic Understanding Of New Federal External Appeals Regulations;

  7. G. Options Available To Master New Federal Claims Regulations and Become PPACA / ERISA Claims Specialist For Maximal Compliant Claims Reimbursement

 

 

            Members: $0.00;  Non-Members: $15.0,                       

   by 2/21/2011      

February 22, 2011

Webinar on Health Reform Law 2011 Mandates for Claims Reimbursement and Appeals
12:00 PM - 1:00 PM PST
FREE for HFMA Members; $15 for Non-Members
Click here to download the event flyer
Add to outlook calendar

 

Webinar on Health Reform Law 2011 Mandates for Claims Reimbursement and Appeals

 

Tuesday, February 22, 2011 to Tuesday, February 22, 2011

Webinar:


Health Reform Law or PPACA, has been effective since September 23, 2010, with an enforcement grace period until July 1, 2011 for strict and full enforcement, for all group health plans and individual policies as well as all healthcare providers. PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare. It is extremely important for all hospitals and providers to know and comply with PPACA.

 

ATTENDEE REGISTRATION

Registration Fees:

Members: $0.00

Non-Members: $15.00

Contact
Geli Argao
office@hfma-nca.org
(925) 828-4532

by 2/21/2011

 

 

 

Objectives of the Webinar:

  • Provide a brief overview of the DOL Health Reform Law claims regulations website: http://www.dol.gov/ebsa/healthreform/

  • Understand that new federal Health Reform Law and claims regulations are effective now, and they are federal mandates, not optional, for all non-Medicare healthcare claims

  • Understand the basic scope of new federal Health Reform Law and claims regulations, PPACA

  • Provide basic understanding of new federal internal and external appeals processes

  • Provide basic understanding of ERISA claims regulations

  • Provide basic understanding of new federal external appeals regulations

  • Present options available to master new federal claims regulations and become PPACA/ERISA Claims Specialist for maximal compliant claims reimbursement
     

About the Speaker:

Dr. Jin Zhou is a national speaker, consultant, author and publisher of healthcare PPACA / ERISA claim denials and appeals, regulation education and compliance. For the past 10 years, Dr. Zhou taught hundreds of free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals, attorneys and commercial companies. He is frequently sought for ERISA litigation support. Dr. Jin Zhou is regarded as the “Godfather of ERISA claims” for healthcare providers. He pioneered, authored and published the nation’s first ERISA Healthcare Claim Appeal System in a CD book, and the nation’s first ERISA / PPACA website: www.ERISAclaim.com, exclusively for ERISA healthcare claim denials, appeals, claim regulation education and compliance. www.ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country.

 

 

ERISAclaim.com Free ERISA Webinars


2010 Free Webinars

 

ERISA Webinar Handout | 10-22-2010

 

 

New Webinars, Seminars & Certification Classes Announced for New Federal Health Claim Appeals Regulations on July 22, 2010 from HHS, DOL & Treasury    08/05/2010, Hanover Park, IL

New Webinars, Seminars & Certification Classes Were Announced by ERISAclaim.com for New Federal Appeals Regulations Issued on July 22, 2010 by HHS, DOL & Treasury for 193 million Americans. Effective 09/23/2010, New Federal Reimbursement Laws Mandate ERISA Internal Appeals and NAIC External Appeals For All Group and Individual plans With Six New & Most Powerful Consumer Protections

ERISA Webinar Handout | 10-22-2010

 

Helping make sense of health care reform (San Francisco Chronicle, August 10, 2010)

"Q: Are most plans going to stay grandfathered?

 

(Borzi ) A: I had the strong sense that most companies, at least initially, would want to stay grandfathered to see what the whole panoply of regulations would look like, and then decide. What I hear is that a lot of the large companies don't want to do the analysis to decide (whether it makes sense to stay grandfathered). They are just going to assume they are not grandfathered."

 

"Borzi is head of the U.S. Department of Labor's Employee Benefits Security Administration,"

Survey Notes Most Health Plans to Lose Grandfathered Status | workforce.com - August 11, 2010  

"Seventy-two percent of employers expect their health care plans to lose their grandfathered status because of design changes. Changing premium subsidy levels, changing insurers and consolidating plans are among other actions employers expect to result in their plans losing grandfathered status."

Register for a session now by clicking a date below: 

 

ERISA Webinar Handout | 10-22-2010

Wed, Aug 18, 2010 1:00 PM - 2:00 PM CDT

 

Wed, Sep 15, 2010 1:00 PM - 2:00 PM CDT

 

Wed, Oct 20, 2010 1:00 PM - 2:00 PM CDT

 

Wed, Nov 17, 2010 1:00 PM - 2:00 PM CST

 

Wed, Dec 15, 2010 1:00 PM - 2:00 PM CST

New Federal Appeals Regulations Promulgated On July 22, 2010, Effective Sept. 23, 2010 For 193 Million Americans

“The new appeals regulations were issued by the Departments of Health and Human Services (HHS), Labor, and the Treasury. Consumers in new health plans in every State will have the right to appeal decisions, including claims denials and rescissions, made by their health plans."

 

The new appeals regulations go into effect on Sept. 23, 2010, for about 193 million Americans, according to DOL.

 

The new appeals regulations are six times better and stronger than previous patchwork for consumers with immediate and powerful protections and remedies if a health plan or insurer fails to strictly adhere to ALL requirements of the new Regulations.

 

The new appeals regulations mandate ERISA internal appeals and NAIC external appeals for all group health plans and individual policies.

 

“On average, about 40 percent of denials are reversed on external appeal” as stated in the preamble of the new Federal Appeals Regulations.

Webinar Topics: (40 min Presentation + 20 min Q &A)

1. Specific and accurate statutory and regulatory provision reviews and discussions on all new Obama Health Law mandates for claims Processing and appeals

2. Basic Information on ERISA Claim Regulations and Current Claims Practice

3. Please download Webinar Handout at http://www.erisaclaim.com/Free_ERISA_Webnars.htm

“After the legislation becomes the law of land for America health care, it is time for everyone who truly cares about reimbursement and compliance to forget about yesterday's legislation enthusiasm, set aside personal emotions and political preferences, to get hands on today’s new reality, statutory and regulatory compliance and reimbursement by learning and mastering new rule of the game for health care reimbursement through compliance”, said Dr. Jin Zhou, president of ERISAclaim.com.

System Requirements
PC-based attendees
Required: Windows® 7,
Vista, XP, 2003 Server or 2000

 

Macintosh®-based attendees
Required: Mac OS® X 10.4.11 (Tiger®) or newer

 

For More ERISA Training Info:

 

ERISAclaim.com: Seminars - 2010 Two-day Basic ERISA Appeal Seminars - Denials and Overpayment Appeals

 

ERISAclaim.com - 2010 ERISA Claim Specialist Certification Programs in Chicago, Illinois

 

ERISAclaim.com:  Create An Appeal Department for Your Hospital or Practice (In-house, onsite ERISA Claim Specialist Certification Programs)

 

 

New Free Webinars Announced to Discuss the Latest Federal Court Overpayment Lawsuit Ruling and New Obama Health Laws for the Skyrocketing $6 Trillion Overpayment Recoupment Market 03-29-2010, Hanover Park, IL

 

The Latest Federal Court Overpayment Lawsuit Ruling and New Obama Health Laws

 

Register for a session now by clicking a date below:

 

Fri, May 7, 2010 1:30 PM - 2:00 PM CDT

 

Fri, Jun 4, 2010 1:30 PM - 2:00 PM CDT

To Discuss The Latest And The First Federal Court Ruling On March 18, 2010 That A PPO Participating Provider’s Lawsuit Against Anthem BCBS, For The Alleged Wrongful Overpayment Recoupment and Even Withholding From Different Patients, Is Completely Governed By Federal Law, ERISA, Rather Than PPO Contracts And State Laws.

New Obama Health Reform Laws That Mandate ERISA Appeals For All Group Health Plans And Health Providers.

“It is extremely important for all health plans, TPA’s, managed care operators and healthcare providers to comply with governing federal laws in resolving and prevailing all overpayment claims disputes and overpayment recoupment and withholding,”

 

Register for a session now by clicking a date below:

 

Fri, Apr 2, 2010 1:30 PM - 2:00 PM CDT

 

Fri, May 7, 2010 1:30 PM - 2:00 PM CDT

 

Fri, Jun 4, 2010 1:30 PM - 2:00 PM CDT

 

  

Once registered you will receive an email confirming your registration
with information you need to join the Webinar.

 

System Requirements
PC-based attendees
Required: Windows® 7, Vista, XP, 2003 Server or 2000

 

Macintosh®-based attendees
Required: Mac OS® X 10.4.11 (Tiger®) or newer

 

 

Embezzlement Recovery Services (ERS)

for  Midsized and Large ERISA Health Plans

        “Anti-fraud initiative is not complete until and unless the recouped overpayment money originated from the plan assets is finally returned to the original self-insured health plans, or the fake anti-fraud crusaders are the real fraud culprit”, said Dr. Jin Zhou, the president of ERISAclaim.com

Free Webinar Registration for Self-insured Health Plans

 

Space is limited and only open to self-insured health plans

Webinar Title: Overpayment Recoupment Embezzlement Recovery

Reserve your free Webinar seat now at

https://www1.gotomeeting.com/register/857663256

Date: Wednesday, December 23, 2009, Time: 12:30 PM - 1:00 PM CST

https://www1.gotomeeting.com/register/177031920

Date: Wednesday, January 27, 2010, Time: 12:30 PM - 1:30 PM CST

https://www1.gotomeeting.com/register/514303152

Date: Monday, February 22, 2010,  Time: 12:30 PM - 1:00 PM CST

Free Overpayment Webinar Announced For Self-insured Health Plans To Get Immediate Relief from New $1 Trillion Overpayment Recoupment Embezzlement Market 11-23-2009, Hanover Park, IL

 

 


2009 Free Webinars

 

 

Register for a session now by clicking a date below:

 

Fri, Dec 4, 2009 1:00 PM - 2:00 PM CST

 

Mon, Dec 14, 2009 1:00 PM - 2:00 PM CST

 

All of Our ERISA Webinars are Free and 60 Minutes for Each Session. All Time Zone Is U.S. Central Standard Time.

 

Free Webinars on New Health Reform

for Healthcare Providers

 

  1. No One Else Has Talked About How Both House and Senate Bills Will Harm or Protect Healthcare Providers for Their Reimbursement Rights, When Every One Is Talking About How The Health Bills Will Be Financed;

  2. Both House and Senate Bills Have Complete Similarities On The Internal and External Appeal Laws For All Health Plans;

  3. How Healthcare Providers Will Be Winning Or Losing Under The New U.S. Healthcare Reform Laws after 2009?

This is the only extensive analysis on both House and Senate Bills (they happened to be same) on Provider's Rights and our Reimbursement Rights after the New Year in the New Obama Health Laws,  when no one else in public has talked about this most important issue for all of us: How do WE, providers, get paid or protected.

New Health Reform

for Healthcare Providers

&

ERISA Basics &  Healthcare Claim Denial and Appeals

 

Register for a session now by clicking a date below:

 

Fri, Dec 4, 2009 1:00 PM - 2:00 PM CST

 

Mon, Dec 14, 2009 1:00 PM - 2:00 PM CST

 

ERISA Basics &  Healthcare Claim Denial and Appeals

Free Webinar Topics To Be Covered

PPT: 20 minutes, Q&A: 10 minutes = 30 minutes total

  1. New U.S. Healthcare Reform Has Made ERISA Claim Regulation as the Claim Regulation for All Health Plans in the Future.

  2. The Latest U.S. Supreme Court Rulings On ERISA And Healthcare:  ERISA Governs Completely (100%) Claim Dispute And Denial For Benefits With All Employer Sponsored Plans, Both Self-Insured And Fully-Insured, And ERISA Pre-Empts Completely (100%) Any And All State Laws And Managed Care Contract For Claim Benefits Dispute.

  3. Federal Law, ERISA Basics, and Your Claims
  4. How To Identify ERISA Plans In 5 Seconds As Soon As Your Patients Completely Registrations;
  5. Statutory ERISA Definition On A "Denial", Any Payment Or Overpayment Refund Less Than 100% Claimed,
  6. How Can A Provider Completely Enjoy Or Be Entitled To The Same ERISA Rights (Verification, Direct Payment Without PPO And Appeal....) As Your Patients Under ERISA?
  7. How To Appeal Commonly Seen Healthcare Claim Denials Or Delays.
  8. Statutory ERISA Definition On A "Denial", Any Payment Or Overpayment Refund Less Than 100% Claimed,
  9. Overpayment Refund Demand = Retrospective Or Retroactive Benefits Denial = Triggers ERISA Appeal Process For Full And Fair Reviews, "Statute Of Limitation" Or Timeline Under Federal Law ERISA For Overpayment Denials, Burden Of Proof And Disclosure Obligations By The Payer;
  10. How To Appeal Overpayment Refund Denials Or Demand.
  11. Latest Nationwide ERISA & RICO Class Action Lawsuits By Providers Against Payers Over Overpayment Refund Dispute

Please send an E-mail to ERISAclaim@aol.com with your name, Co. professional title and contact info as well as the session you would like to attend, we will send you our Free Webinar Log-in Info.

 

The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERISAclaim.com 11-9-2009, Hanover Park, IL

"New Health Care Reform Bill, The Affordable Health Care for American Act, Was Passed by the House Of Representatives Saturday Night, and Is Expected to Be Signed into Law by the President Obama by the End of the Year with Absolute Confidence. ERISAclaim.com Announced the First Claim Specialist Certification Class Specifically for the Compliance with the New Federal Healthcare Law for 96% of Americans"

ERISAclaim.com Is Pleased to Announce Free ERISA Webinars for Healthcare Providers, Coding & Billings Professionals, Payers, TPA's & MCO Professionals, and Healthcare Attorneys.

 

We will have in-depth discussion at our free Webinars on why and how ERISA claim regulation will be incorporated in it entirety into the New Obama Health Plan for All, The Affordable Health Care for American Act, for 96% of Americans.

 

 

##################################

 

ERISA, Employee Retirement Income Security Act of 1974, is a federal law that governs and regulates healthcare claims for estimated more than 170 million Americans who obtained health insurance or benefits from employment in private sector, for both self-insured and fully-insured (through purchase of insurance) health plans. ERISA law completely (100%) preempts, supersedes and invalidates any and all state laws and private managed-care contracts for PPOs and HMOs in any and all dispute over denial of benefits from an ERISA plan. ERISA regulates and governs healthcare claims which include the paid ERISA healthcare claims in more than 50% of $2.4 trillion, 16.6% of GDP, of the national health expenditure in 2008, and also include the denied healthcare claims, legitimately or wrongly for appealable claims, in more than 50% of $5 trillion in the aggregated denied healthcare claims in 2008. More than 60-70% of healthcare claim denials from insurance companies and managed-care third-party payers by employer-sponsored plans are due to ERISA regulated plan or policy coverage, limitations and exclusions rather than traditional billing, coding, medical necessity and managed care contracting or participation dispute. Although in the past 35 years the notices for ERISA rights to appeal were written on almost every EOB (Explanation of Benefits) in the daily practice in doctors' offices and hospitals, the healthcare providers, managed-care third-party payers, and even legal professionals as well as the state regulators rarely understood how to conduct, manage or regulate ERISA claim appeals for ERISA claim denials and disputes.

 

There have been urgent and popular regulatory needs and market demands for ERISA claim compliance education and training in this $6 trillion healthcare denial management market.


 

Related links:

 

ERISAclaim.com: ERISA or non-ERISA Appeal? ERISA Appeal Fact Sheet

 

ERISAclaim.com - ERISA or PPO? Managed Care Slavery or ERISA Superhero

 

ERISAclaim.com - ERISA Appeals or Lawsuit with PPO Contract or Class-Action Settlement

 

ERISAclaim.com: ERISA or non-ERISA Appeal? ERISA Appeal Fact Sheet

 

 

ERISA & Claim Denials

Aetna Video Shows ERISA Patients Mistreated

 

"According to the video, when faced with claims for identical medical problems, Aetna separates the claims where no damages are available - those subject to the federal Employee Retirement Income Security Act, or ERISA - from non-ERISA claims, where consumers can sue.1 2"

 

ERISA & Health Claim
What Is ERISA and How Does It Affect Patient Rights?

 

"ERISA was enacted in 1974 to protect the pension and welfare benefits that employers provide their workers. It currently covers about 2.5 million health plans and 125 million workers, retirees, and dependents."

 

Department of Labor

 
"A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.

Most private sector health plans are covered by the

 Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. Also, those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the law."

 

 

$10,600 ERISA Claim

Recent Federal Court Ruling in a Case with $10,600 medical claim, insurance Co. refused to pay, provider made numerous demand for payment in almost one year, but no appeals filed, the court dismissed the lawsuit because provider failed to exhaust administrative remedy, as required under ERISA, by filing ERISAclaim appeals.  This situation is so popular in health-care community.

 

 

 

 

Agree to terms and conditions

"Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply."

 

CIGNA - Coverage Positions/Criteria
"The terms of a participant's particular benefit plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Positions are based. If these Coverage Positions are inconsistent with the terms of the member's specific benefit plan, then the terms of the member's specific benefit plan always control."

 

UnitedHealthcare Medical Policies

"By clicking "I agree," you agree to be bound by the terms and conditions expressed below, in addition to our Site Use Agreement.

UnitedHealthcare medical policies have been made available to you as a general reference resource. When reading these policies you agree that:

Our Medical Policy is not your patient's Benefit Plan.

Your patient's medical benefits are governed and determined by a benefit document, either a Certificate of Coverage or a Summary Plan Description. You should not rely on the information contained in this Web site section to determine your patient's medical benefits.
 

  1. Federal and state mandates and the patient’s benefit document take precedence over these policies.

  2. The patient’s benefit document lists the specific services that have coverage limits or exclusions.


Our Medical Policy does not address every situation and individuals should always consult their physician before making any decisions on medical care."

 

 

   
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Phone (630) 736-2974 - Fax (630) 736-1439

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