|
|
|
About Us
ERISAclaim.com is a new provider of services
concentrating uniquely on
solving U.S. health care crisis,
improving healthcare ERISA claim
administration with regard to claim denials and appeals through ERISA
compliance and education. We, with the principal and founder, Dr. Jin Zhou,
are committed to providing
unique and practical solutions to our nation's
health care crisis, in case the Congress and the President of the United
States
fail to stop our
health-care
crisis and
probable health care crash.
As nation's only ERISA concentrated claim denial and
appeal compliance solution firm, we provide and deliver demystified and
practical ERISA solutions where entire nation has failed in the past 34
years and when this nation is facing the worst healthcare crisis!
We will provide
educational and consulting
solutions to
healthcare providers, clinics
and hospitals for maximum reimbursement or crisis
turnaround only through
compliance of ERISA.
We will provide educational and consulting solutions to
employers/plan sponsors,
insurers and TPA's with
compliance assistance
to minimize administrative costs and risks
through compliance of ERISA.
We will
provide educational and consulting solutions to the nation to
establish or restore the hope,
faith and
the Law
&
Order for
our health-care system through
education and
compliance of ERISA, the federal law designed to regulate about 80% of the health-care claims and 60% of the U.S.
health-care expenditure,
ERISA is the only "nuclear power" capable of
stopping our escalating health-care costs. Compliance is the
only common
ground for everyone, and it is the only way
that we can bail out of
our worst health-care crisis since World War II.
We are located in northwestern suburb of Chicago, IL. We
provide unconventional but practical solutions to our nation's health-care
crisis. We work with health-care providers, employers, insurers, TPA's and
regulators on the
common ground of compliance of the ERISA. We believe
existing ERISA is the only "nuclear power" that is capable of stopping our
escalating health-care costs and uncontrollable health-care premium, the
compliance of ERISA is only
common ground for everyone in our economy and
labor force as well as health-care industry. We are available for
consulting, seminar, and executive brainstorming under the principle of
compliance and solutions.
 |
|
About Dr. Jin Zhou
Dr. Jin Zhou is a
national speaker, consultant, author and publisher of
health-care ERISA claim denials & appeals, regulation education
and compliance. He pioneered, authored and published the
nation's first ERISA Health-care Claim Appeal System in a CD
book, and the nation's first website (www.ERISAclaim.com) in ERISA healthcare claim
denials, appeals, claim regulation education and compliance, “ERISAclaim.com”. |
| He
has taught ERISA seminars across the country in past 8 years to
health-care providers, hospitals, billing and coding
professionals, and managed-care organizations. Dr. Zhou’s
articles and expert advice were quoted and appeared on numerous
industry professional magazines, web sites and organizations.
Dr. Jin Zhou was an orthopedic surgeon with Air Force General
Hospital in China prior coming to
United States in 1988. He is a licensed chiropractic physician
in Illinois since 1991. In addition to his ERISA compliance and
educational practice, he maintains an active clinical practice
in Chicago suburb in Illinois. Dr. Zhou has been actively
participating in teaching and
innovative clinical research in
medical science
(www.SleepApneaUSA.net). |
| |
e-mail us
for more information
Legal Disclaimer
The publication or information
on this Website is designed to provide accurate and authoritative
information in regard to the subject matter covered. It is presented and
published with the understanding that the author and publisher are not
engaged in rendering legal, accounting or other professional service or
advice. If legal advice or other expert assistance is required, the services
of a competent professional person should be sought.
We're not employees
of, or in affiliation with any governmental or regulatory agencies.
ERISAclaim.com
is not a law firm. We do not practice law. If legal action or advice is
required to successfully resolve a claim or a claim/business decision, we
will refer out our client to an outside legal counsel chosen by our client.
We do not
teach, advise or participate in coding & billing of your health care claims and
practice. We advocate appeals of your already denied claims
through compliance and compliant claim processing for savings in accordance
with ERISA claim regulations and applicable federal and state laws.
Although
ERISAclaim.com often works in conjunction with, but completely
independent from, different law firms or seminar sponsors whose practice is
focused on the representation of or advising clients in health care ERISA
claims dispute or compliance, those law firms or companies
advertising on ERISAclaim.com are not
affiliated with or employed by or with ERISAclaim.com. ERISAclaim.com
disclaims any and all responsibility or liability for the accuracy, content,
completeness, legality, reliability, or operability or availability of
information or material displayed or
advertised
on the
ERISAclaim.com.
ERISAclaim.com disclaims any
responsibility for any harm resulting from downloading or accessing any
information or material on the Internet linked to or through the
ERISAclaim.com.
Except for otherwise specifically stated, our educational and training for
certification programs are not affiliated with any governmental or
educational institute for the purpose of accreditations or degrees.
Our certifications are only for attendance in studying subject materials
specified in each individual programs for advancing educational knowledge
with respect to applicable business and compliance.
|
|
|
Happy or Sad 30th Birthday To ERISA?
(Copyright
© 2004
by
Jin Zhou, ERISAclaim.com)
Sept. 2, 2004
On Sept. 2, 1974, exactly 30
years ago today, ERISA, The Employee Retirement Income Security Act,
was signed into law by President Gerald R. Ford. The congressional intent in enacting ERISA was to protect employees in pension and
welfare plans, to provide uniform federal protections in response to
the failure of the Studebaker Co. in December 1963, with thousands
of long-service employees cheated out off their promised pensions,
and to preempt any state laws when the employees pension and welfare
benefits were threatened. 30 years later, ERISA Failure in its
compliance and enforcement left thousands of retirees without
medical benefits, and resulted in a skyrocketing national healthcare expenditure explosion with 45 million uninsured and a possible national pension bailout.
ERISA Failure Syndrome
U.S. Healthcare Crisis
Trilogy
Jin Zhou Identifies "ERISA Failure" That Killed
U.S. Healthcare
"Failure of Imagination"
Again?
|
|
ERISA Celebrates 30th Anniversary As Trouble Brews For the Pension
Insurance Program (Spencer Benefits Reports)
Excerpt: "The seed for ERISA
was planted with the failure of the Studebaker Company in December
1963, leaving thousands of long-service employees without their
promised pensions."
|
|
Denials +
Recoupment =
Inflation +
Fraud or
Cost-Sharing?
Rx =
Compliant Denial & Appeals! |
|
Forbes.com: "Roughly one in seven Americans has
no health insurance. That hurts HCA Inc. (nyse:
HCA -
news
-
people), the largest U.S. hospital chain, which
last year wrote off $2.21 billion
of revenue because patients couldn't pay their
bills."
The American Hospital Association (AHA): "Hospitals today are faced with the challenge of managing their
limited resources, while continuing to deliver the highest standard of care.
According to health care experts, the cost of clinical
denials to individual healthcare organizations averages
$3.3 million
annually. However, many hospitals do not have the resources or the
expertise needed to avoid unpaid days at the end of admissions and lead the
denial-appeals processes."
Payments Go Under a Microscope (washingtonpost.com)
"MAMSI and CareFirst recoup overpayments to doctors by making
deductions from future reimbursements.
Doctors can appeal insurers' decisions.
But, in the end, they usually pay up, doctors and insurers agree."
Hospital Pricing and the Uninsured,
Glenn Melnick, Ph.D.,
"Price
Gouging"
(Subcommittee on Health
Hearing on the Uninsured,
U.S.
FILES COMPLAINT AGAINST NATIONAL ACCOUNTING FIRM UNDER FALSE CLAIMS ACT
(DOJ
Press Release) "January 5, 2004
- PHILADELPHIA –
United States Attorney Patrick L. Meehan announced today the filing of the
Government's
complaint against national accounting firm Ernst & Young.
According to the complaint, nine hospitals paid Ernst & Young for billing
advice – advice which later caused the submission of false claims to the
Medicare program."
USATODAY.com - Hospitals Sock Uninsured with Much Bigger Bills
GM to Report $60B in Future Health-Care Obligations
|
|
A New Diagnosis & Prescription for
Our Nation's Health-care Crisis
Contrary to the popular belief, our nation's health-care crisis
has been truly and mainly caused by the
lack of understanding and
failing in compliance with
ERISA, the federal law regulating about
80% of
health-care claims or
60% of
health expenditures in the U. S. by both
insurance/benefits
industry and health-care providers for 28 years, through reckless
and fraudulent as well as
revengeful, inflationary spiral
billings and
claim denials that
destroyed
or foreclosed the hope,
faith and
the Law
&
Order for our nation in health-care quality and
cost control, and the lack of meaningful and practical federal
administrative enforcement of ERISA claim regulations, because this
inflationary spiral skyrocketing increases in
managed
care claim and denial war behind
ERISA
shield between
health
insurers/ERISA plans and healthcare providers
have
overwhelmingly outnumbered increases in cost of living and national
gross domestic products, causing
annual
double-digit increases in
health
insurance premiums and
skyrocket health-care costs
($1.55
trillion
in 2002, 14.9% of the U.S GDP)
after
every managed care strategy and
model
failed to
contain or control health-care costs in long run
despite short-term savings, while entire country has devoted
more
and more money in
litigation,
legislation
and
noncompliant managed care campaign, which practically have
solved little or no problem.
In order to
resuscitate U.S. Healthcare/managed care from such a
critical
condition, the strategy and solution must to be a
common ground
acceptable to all parties involved, instead of hostile and contradictory
debate of punitive
damage therapy vs.
the uninsured coverage in
Congress. This
common ground for our national health-care crisis is the
ERISA
Claim Regulations, applicable and existing laws and regulations on
the book, originally designed by Congress in 1974 to
regulate
health-care claim dispute and to avoid fiduciary breach and failures
we are facing today.
A new practical and effective solution to
saving our
nation's health-care system is to implement
ERISA as
Congress intended by creating a new
occupation or profession, ERISA claim specialists and departments,
the bridge the gap FROM
medical billers and coders &
insurance claim processors TO lawyers for both health-care providers and
insurance companies/ERISA plans, and to educate everyone in
health-care and employee benefits system,
health-care
provider,
health insurance, employee benefits TPA's
and legislators as well as
regulators to truly understand ERISA, and comply with
existing
ERISA's
claim procedures and benefits administration rules, to make practical
sense for health insurance delivered as
employee welfare benefits under
ERISA,
protecting participants and beneficiaries and safeguarding plan
assets through compliance of
ERISA
laws and regulations by everyone.
How do
we know this is the right diagnosis and prescription?
Plain and simple, imagine what
would happen if U.S. healthcare superhighway transported
$1.55 trillion for 280 million Americans each year without
understanding, complying and
enforcing
laws and
regulations governing those
80% of
the
healthcare claims,
60% of the
healthcare expenditures and
163 million Americans under
ERISA?
The latest Harvard & RAND study for Congress and state legislative debate on Patients'
Bills of Rights, conducted by David Studdert and Carole Roan Gresenz,
study authors from the Harvard School of Public Health and RAND, funded
by federal government, Department Of Labor, and Agency for Health Care
Research and Quality, revealed that
"little is publicly known about such appeals system", and concluded
that "A
majority of preservice appeals disputed choice of
provider or contractual coverage issues, rather than medical necessity.
Medical necessity disputes proliferate not around life-saving treatments
but in areas of societal uncertainty about the legitimate boundaries of
insurance coverage. Greater transparency about the coverage status of
specific services, through more precise
contractual language and consumer education about benefits limitations,
may help to avoid a large proportion of disputes in managed care."
This valuable study has pointed out the direction but failed to provide
a turnkey practical solution.
ERISAclaim.com has provided this nation with a turnkey operational
solution with ERISA compliance, educate everyone on coverage and claim
procedures, to ensure Bill Of Rights for Patients, Providers, Plan
Sponsors and Insurers.
|
|
|
|
Department of Labor
|
|
|
 |
|
|
Opinion: Cutting Costs in Half Through Better Management is
Fantasy But Health Care Debate Is Real (The Hartford
Courant)
Excerpt: "If a
talk on economics can have a $650 billion throwaway line,
Treasury Secretary Paul O'Neill delivered it.... [Treasury
Secretary Paul] O'Neill was already the designated
shoot-from-the-lip dreamer of the Bush administration, and this
ridiculously unreachable goal ... only adds to his lore. Still,
America's finance minister has a point if he meant to prod deep
health care savings."
"O'Neill
insists the problem is not with people, but systems - systems
that invite medical errors, systems that penalize health care
professionals for making honest mistakes, systems that create
the mind-numbing complexity of reimbursement for providers,
systems that reward too much treatment and punish efficiency." |
|
|
|
|
|
