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We Are Seeking New Strategic Partners
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We Are Seeking New Strategic Partners
ERISAclaim.com is seeking for strategic alliance with new business
partners.
With a business market at estimated $600 billion to $700 billion and
U. S. healthcare expenditure at estimated $1.8 trillion for 2004, the
health-care delivery and workers' health insurance business
opportunities and challenges have exploded from not only healthcare
claim reimbursement and denial management but also every American
business survival line due to unsustainable health-care costs.
United States Supreme Court ruled unanimously in Aetna v. Davila on
June 21, 2004 that Paramount and preemptive governing power and law
for U. S. health-care quality and costs dispute and crisis is ERISA,
Employee Retirement Income Security Act of 1974.
ERISAclaim.com is a new company with most comprehensive
and unprecedented services and solutions for U. S. health-care crisis.
We are seeking for new strategic alliance with new business partners
with complimentary prospects and mutually win-win benefits.
we are the only company in the country with
special understanding
and practice of ERISA claim regulation, compliance and implementation
in education, consulting,
claims recovery, publication and
U.S.
health-care crisis ERISA resolutions. we
researched and
dissected
every step of
benefits claim and
managed-care claim denial with
ERISA
diagnosis and compliant resolutions.
Please evaluate our business unique values and market niche, and contact us if you believe our business may compliment each
other with unprecedented win-win benefits. |
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Seminar Alliance
If your business has long history or a broad base of
health-care reimbursement seminars, and but you are facing some
difficulties or less than anticipated results due to reckless
managed-care denials, like everyone else in the country, or you would
like to empower your seminar attendees with ERISA superpower
productions, we would like to work with you to supplement or
compliment you with ERISA claim regulation education for maximal
reimbursement through
compliance.
If your company or plan is seeking compliance
education for third-party claim administrator, benefits consultant,
and in-house benefits management but found ERISA claim regulation to
be confusing and extremely difficult to understand,
we would like to
work with you to supplement or compliment with demystifying ERISA
claim regulations for your claim fiduciaries, benefits managers and
claim processes for maximum compliance and benefits containment.
We promote faithful compliance through fundamental
understanding of ERISA claim regulation and streamlined claim appeal
process for claim fiduciaries.
Please e-mail for more details
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Reimbursement or Benefits Consulting Alliance
Maximal
reimbursement through compliance or benefits appeal management under
ERISA, regardless which segment you are consulting for, fundamental
understanding of new ERISA claim regulation and practical mastering
and implementation of ERISA claim regulation in most versatile
managed-care environment will protect and secure your business bottom
line through compliance, especially after Supreme Court reason ruling
in Aetna v. Davila with possible "make-whole" relief remedies,
health-care fraud and abuse prevention and litigations as well as
escalating health-care costs crisis.
Bottom Line: maximal
reimbursement through ERISA compliance and fraud and abuse
prevention; benefits denial and appeal management with ERISA
compliance to minimize fiduciary
liabilities and losses in benefits costs control.
If your company is consulting for health-care providers or benefits
plans and would like to expand or enhance your services to powerful
and practical ERISA claim regulation compliance and implementation, we
would like to work with you.
we are the only company in the country with
special understanding
and practice of ERISA claim regulation, compliance and implementation
in education, consulting,
claims recovery, publication and
U.S.
health-care crisis ERISA resolutions. we
researched and
dissected
every step of
benefits claim and
managed-care claim denial with
ERISA
diagnosis and compliant resolutions.
Please e-mail for more details
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Claims
Recovery Alliance
As stated above, with our unique expertise and
practical experience, we would like to work with you to compliment or
to supplement you recovery services if you have significant accounts
with hopeless results from ERISA plans or managed care plans.
Please e-mail for more details
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Health-care
Crisis Turnaround Initiatives and Solutions
If you are a plan sponsor or benefits consulting
firm working diligently on practical solutions while health-care
crisis is worsening with plan health benefits costs uncontrollably
out-of-control for years, as entire nation is losing the battle and war in
health-care crisis, we would like to work with you
to find a new way
out, an ERISA solution with unprecedented but compliant results.
We can't accomplish this without your
participation. Our solution is based on fundamental research of
every
segment of health-care claim adjudications, managed-care principle,
benefits design and administration as well as
ERISA claim regulations
and Supreme Court rulings.
Please e-mail for more details
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Please note that we are not offering employment
opportunity in this business alliance, this is a proposal for
strategic alliance and networking.
OIG: Special Advisory Bulletin: Practices of
Business Consultants
[PDF] [http://oig.hhs.gov/fraud/docs/alertsandbulletins/consultants.pdf]
The Office of Inspector General (OIG), Department of Health and Human
Services, June, 2001 |
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Conclusion
or Confusion?
© 2005,
Jin Zhou,
ERISAclaim.com
"Medicare
Appeals Specialist" and
"ERISA
Claims Specialist" will be the crown of US healthcare
reimbursement.
ERISAclaim.com - CMS New
Appeal Rules: "Overhaul of the Medicare Claims Appeals System"
Based on our
comprehensive and diligent study of this new Medicare appeal process,
and our extensive experience in
ERISA
claim procedure practice, and
"in view of the wide span of
applicability of these rules and the complex, intertwined nature of
the affected appeal procedures,"
[page 2 of 511] it is our conclusion that our nation
must recognize and create a new profession, separated from and/or in
addition to traditional Coding and Billing personal:
"Medicare Appeals Specialist"
Guerrilla and
weekend training without systematic and quality education will
definitely fail in Medicare reimbursement because of its broad
requirement and "Authorized Representative" practice with "a waiver of
the assignee's right to collect payment...."
"Medicare
Appeals Specialist" and
"ERISA
Claims Specialist" will be the crown of US healthcare
reimbursement.
ERISAclaim.com: ERISA Certification Programs
for Cost-Saving & Reimbursement by Compliance
This is why
Congress and CMS created QIC
(="Appeal Specialists" with dual and "sufficient
medical, legal, and other expertise", § 405.968 (c) (1) [page 394 of
511]) separated FROM and in addition to Medicare Claim Processors
(Medicare FI's & Carriers),
(Among the major
changes required by the BIPA amendments are--......Requiring the
establishment of a new appeals entity, the qualified independent
contractor (QIC), to conduct
“reconsiderations” of contractors’ initial determinations (including
redeterminations, [page 15-16 0f 511]).
And this is
also why Congress enacted ERISA 30 years ago to require "an
appropriate named fiduciary of the plan",
§ 2560.503-1(h) (1), rather than a claim processor or ASO
(Administrative Services Only) TPA (Third-Party Administrator) to
handle ERISA health claim appeals.
Conclusion or
Confusion? Your choice and decision.
Jin Zhou,
ERISAclaim.com, 03/08/2005 |
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Medicare New Appeal &
Reimbursement Seminars
New Compliance &
Challenges
Toll-Free Numbers and Websites
for
Your
Carrier/Fiscal Intermediary |
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Seminar I 2
days |
Seminar II
2 days |
Seminar III
2 days |
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New Medicare Appeal
Process & Mandates v.
Former Process
Medicare Claims Processing Manual
Chapter 29 - Appeals of Claims Decisions
CMS Transmittal -
R146OTN
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New Medicare Appeal
Strategies for
Reimbursement
Success
&
-
Documentation
-
Fraud And Abuse
-
Medical Review
-
National Correct Coding Initiative
(NCCI)
-
more
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New
Medicare Appeal Laws
Intertwined
with($183
million/y)
ERISA Claims Laws |
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Denials +
Recoupment =
Inflation +
Fraud or
Cost-Sharing?
Rx =
Compliant Denials & Appeals! |
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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
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