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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.
-
Federal and state mandates and the patient’s
benefit document take precedence over these policies.
-
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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Press Release:
ERISAclaim.com Announced
2010 ERISA Seminars for Healthcare Overpayment and Claim Denial Appeals for
the $6 Trillion Healthcare Denial Management Market.
10-14-2009, Hanover Park, IL
2009 - 2010 Claim
Denial & Overpayment Dispute
Two-day ERISA Appeal
Seminars
Recent ERISA
& RICO Class Actions on Overpayment
Class Dates: Oct. 29-30, 2009
Class Dates: Jan. 12-13, 2010
Class Dates: Feb. 16-17, 2010
8 hours (8 am -12 pm & 1 pm - 5 pm)
$700/first person;
$350/additional
Call: 630-808-7237
For more info:
http://www.erisaclaim.com/seminars.htm
E-mail Your Questions or
Wish List for Future Seminar Dates & Locations to
ERISAclaim@aol.com
How to Sign up?
Our
new 2009 ERISA
Seminars can be enrolled by
1. Calling
630-808-7237
2. Download,
fax a completed Registration Form to 630-736-1439 (coming soon)
3.
Online Secured registration.
Maximizing Healthcare Claim Reimbursement
Problem Oriented
Appeals under ERISA
Seminar Goals:
- To Understand Basic
Definitions Of ERISA Claim Regulation And Appeal Practice;
- To Understand Relevant
Provisions Of ERISA Claim Regulation, CFR ERISA §2560.503-1;
- To Understand DOL
Guidelines Of ERISA Claim Regulation And Appeal, DOL ERISA FAQ;
- To Understand Relevant
Provisions Of ERISA Summary Plan Description (SPD) Regulation;
- To Understand Basic
Application Of The ERISA Claim And SPD Regulations In Healthcare
Claim Appeals;
- To Understand Most
Significant U.S. Supreme Court And Federal Court Rulings, Case
Laws, For ERISA Claim Litigation And Appeals;
- To Understand How To
Quickly Identify ERISA Plans;
- To Understand How To
Identify Plan Administrator From the ERISA Plans;
- To Understand How To Read
Insurance Denial Notification/EOB From ERISA Standpoint;
- To Understand Relevant
State Laws And Managed Care Regulations In Support Of ERISA
Appeals;
- To Understand General
Principle And Practical Applications Of Denial Fact Findings,
Laws And Regulations And Appeal Strategies;
- To Understand How To Appeal
Commonly Seen Denials Under ERISA In Healthcare Claims, Policy
Exclusion And Limitation, Medical Necessity, UCR,
Precertification/Prior Authorization, Pre-Existing Condition
Exclusion, Subrogation, Coordination Of Benefits/EOB, Lack Of
Documentation, Lack Of Authorization To Appeal, And More……;
- To Understand How To Appeal
Claim Denials And Delays With Very Specific Allegations of ERISA
Violations From Payers, Beyond and Above Coding, Billing and PPO/HMO
Contracting Arguments;
- To Understand How To Appeal
Overpayment Recoupment Demand And Withholding/Embezzlement;
- To Understand Basic
Principles And Procedures For Healthcare Provider In Fraud And
Abuse Prevention;
- To Understand Federal Law
And Regulations On Indigency Policy, Discount Programs In
Compliance With Federal Laws, A New Risk That Unkown to
Providers In Overpayment And Fraud Disputes;
- To Understand How To
Communicate With Attorneys Retained By ERISA Plans And Plan
Administrators Of Self-Insured Health Plans For Speedy
Settlement;
- To Understand How To
Quickly Identify And Correctly Use The Sample Letters From ERISA
Appeal CD Book From Jin Zhou Of ERISAclaim.com;
- Based On The Individual
Practice, To Identify and Make Recommendations And Changes
For Medical Practice Forms, Such As Legal Assignment Of
Benefits, Medical Necessity, Financial Discount/Corporate
Indigency Policy;
- Will Answer Any Specific
Questions From The Real Claim Denials On Ongoing Basis During
The Seminar.
|
Note: Some group discounts are per
seminar based. |
| Fees |
-
$700 for the first person,
$350 for additional staff
from the same office/Co.
-
50% discount off all CD Books
at the seminar
Lunch will
be on your own
|
| Discounts |
CD-Books: 50%
Discount at the seminar |
| Location |
Chicago (Hotel To Be Determined) |
| Dates |
See Above, 8hrs (8 am -12 pm
& 1 pm - 5 pm) |
|
|
"Maximizing Healthcare Claim Reimbursement
- Problem Oriented Appeals under
ERISA"
Did you know that ERISA completely
controls or regulates all of your claim denials and delays from
employer-sponsored plans, as long as your dispute is reimbursement:
"denial of benefits", and if you were very and really frustrated?
(Unanimous US Supreme Court Decision on June 21, 2004) Did you also
know that most employer-sponsored plans in USA, not only
self-funded/insured but also fully-insured (through purchase of
insurance), are ERISA plans, and most of your reimbursement claims
for patients under age of 65 are ERISA claims?
|
Aetna Health Inc. v. Davila
06/21/04
Opinion of the
US Supreme Court
"Held:
Respondents’ state causes of action fall
within ERISA§502(a)(1)(B), and are therefore completely
pre-empted by ERISA §502 and removable to federal court.
Pp. 4–20."
"We hold that
respondents’ causes of action, brought
to remedy only the denial of benefits under
ERISA-regulated benefit
plans, fall within the scope of, and are completely pre-empted
by, ERISA §502(a)(1)(B),......" |
-
What is
the law protecting patients against managed care problems for
claims with employer sponsored health plans?
-
Why did a
US Supreme Court unanimously rule on June 21, 2004 that ERISA
governs all of your claim denials or money problems from an
employer sponsored health plan and ERISA supersedes all of your
state laws for your "denial of benefits" (money problems) in your
managed care troubles?
-
Federal
ERISA claim regulation protects patients from all of your managed
care troubles, such as claim delays, coverage denials,
"over-payment" money back hassles, choice of network and
providers, prior-authorizations, policy "limit", silent PPO's,
"Mad HMO's", down-coding and bundling to pay only a fraction
of your claims, medical necessity problems, and all of your
managed care problems;
-
How to
best use federal ERISA and state laws in utilization review
(UR/medical necessity review) and external reviews to get your
claim paid timely and reasonably?
-
ERISA
claims compliance and anti-fraud and abuse prevention.
ERISA, the federal law, requires every
ERISA plan to disclose every relevant information for each denied
claim, and provides most powerful full and fair reviews to protect
patients and providers, but ERISA was never fully understood and
taught to health-care providers and the billing industry nationwide.
New Denial
Crisis Demanding for New Solutions
for Your
Reimbursement Problems
In 2009, healthcare
providers are facing unprecedented reimbursement crisis for healthcare
claim denials, delays and "overpayment" recoupment as well as managed
care PPO audits.
Several years ago, most
health care providers were seeing class actions against insurance
companies and managed care entities by 950,000 physicians across USA
after terribly failed political actions of "Patient's Bill of Rights"
campaign for eight years, and desperately hoping to see some positive
changes. In last several year those class actions were either settled
or dismissed by federal court.
Do you see any major
positive changes for your reimbursement?
No!
Now in
2009, the game is
totally different. More and more healthcare providers are the target
of healthcare fraud lawsuits and investigations, PPO fraud and abuse
audits, and more detrimentally harmful to financial bottom line for
many healthcare providers and facilities. We have been experiencing
more and more Volcano type of PPO audits and tornado type of
overpayment recoupment crisis from payers withholding subsequent claim
payments for millions of dollars, while no federal or state agency
seemed to have jurisdictions for healthcare provider’s Katrina crying
for justice, and while state government declined to intervene because
of ERISA preemption and federal government refused to investigate
because of alleged provider network contract agreement dispute, but
healthcare providers on behalf of your patients received no payments
or little payments for already approved claims as a result of
"overpayment" recoupment by the payers.
Most Comprehensive Research and
Analysis from US Supreme Court Rulings
US supreme court
unanimously ruled on June 21, 2004 that ERISA, a federal law, controls
and governs your problems in managed care crisis if you want any money
from the employer sponsored health plans.
Most Comprehensive, Advanced And
Practical Appeal Letters For “Overpayment Recoupment” Due To PPO
Audits And Medical Necessity As Well As Poor Documentation For Both
Self-Funded ERISA Plan And Fully-Insured ERISA Plan
Our new
2007 major
updates provide you with most powerful protections and advanced appeal
letters based on all of US Supreme Court recent rulings on managed
care reimbursement, ERISA state law and PPO preemption, state law
medical review preemption, and every type of practical arguments used
by payers in withholding and recouping benefits payment from
healthcare providers for those already approved benefits claims.
Latest Federal Court Ruling on
Disallowing Health Plan Recovery or Recoupment against Healthcare
Providers
Two new federal court
rulings on overpayment and state law prompted pay preemption relied
upon most recent US Supreme Court rulings, in addition to our 2006
updates in this area.
Latest Federal Court Ruling on
Definitive ERISA Preemption of State Prompt Pay Law.
For years, federal and
state regulators, legal and health care experts, health care providers
and insurance companies are not certain if federal law ERISA preempts
state Prompt Pay Laws, now federal court has ruled clearly that ERISA
definitely preempts state prompt pay laws based on analysis of Supreme
Court recent rulings.
97.96% Claims of United
Healthcare Lawsuit in These Case Were ERISA Claims
You will be also
surprised to learn that in this provider lawsuit against United
healthcare for wrongful denial of benefits claims
"Plaintiffs
lawsuit centers around 295 claims for services rendered by Schoedinger
to patients covered by United healthcare plans. 289 of these claims
qualify as Employee Welfare Benefit Plans under ERISA, and 6 involve
non-ERISA plans.5 268 of the ERISA claims surround self-funded or
self-insured health plans, in which the employers are financially
liable for any benefits due and United serves only as the plan
administrator and claims processor. 21 of the ERISA claims and all of
the non-ERISA claims involve health plans that are fully insured by
United. For these 27 claims, United is financially responsible for the
benefits due to plan participants and serves as the plan administrator
and claims processor."
No PPO Participation, No Checks
to Non-PPO Providers, but ERISA Laws Protect You
Because certain major payers are no longer sending reimbursement
checks to healthcare providers who were not participating in the
network, we have thoroughly researched federal law, ERISA, and
developed a most powerful but straightforward action plan package
based on specific federal ERISA regulation and requirements for
healthcare providers to receive reimbursement checks directly from the insurance payers.
New Federal Government Guidelines
on Filing Benefits Claims and Appeals
Our
2007 major updates
also include latest federal government, DOL, guidance on filing
healthcare claims and appeals
New Federal Government Guidelines
on Pre-Existing Condition Denials and Protections
Our
2007 major updates
also include latest federal government, DOL, guidance on filing
healthcare claims, appeals for pre-existing condition protections.
Our U.S. employment
market in modern society, divorce, relocation and adoption as well as
newborn babies have caused countless mysterious claim denials and
delays due to mysterious “additional information requesting” by payers
from patients and health care providers, but healthcare providers can
never find out what exactly addition information the payers are
looking for. These confidential information is not about privacy
compliance but pre-existing condition investigation, also governed by
HIPAA, money part of HIPAA regulation.
HIPAA pre-existing
condition regulation was never fully understood by healthcare
providers, as HIPAA is part of ERISA regulation.
If you want to get paid
quickly and accurately for 90% of your non-Medicare claims from
patients obtained health insurance from employment in private sectors,
you must understand and follow published federal government
guidelines.
How to Sign up?
Our new
2009 ERISA
Seminars can be enrolled by
-
Calling
630-808-7237
-
Download,
fax a completed Registration Form (coming soon) to:
630-736-1439
-
Online Secured registration.
|
 |
|
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 5 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). |
| |
| |
|
|
NBC 10 Breaking News:
Overpayment - FBI - Class
Action
"Biggest Fraud in US
History"
NBC10 Video |
Blue Cross sues doctor over payments
NARRAGANSETT, R.I. -- Just two
days after a Narragansett doctor leveled strong accusations
against Blue Cross & Blue Shield of Rhode Island, he learned he
was being sued. Blue Cross filed a $100,000 lawsuit against Dr.
Jay Korsen for damages caused by his going public with his
complaints. - turnto10.com -
Jun 19, 2009
Doctor claims Blue Cross withheld payments
A local chiropractor says he
was strong armed by Blue Cross & Blue Shield of Rhode Island. The
Narrangansett doctor says Blue Cross withheld money from him and
he charges them with intimidation. -
turnto10.com -
Jun 17, 2009
Pomerantz Files Class Action Against Blue
Cross Blue Shield Association
Sept. 10, 2009
"Pomerantz filed a class
action lawsuit against the Blue Cross Blue Shield Association ("BCBSA")
and 22 leading BCBS insurers across the country on behalf of a
putative nationwide class of health care providers, as well as the
Pennsylvania Chiropractic Association ("PCA"), the New York
Chiropractic Council (the "Council"), and the Association of New
Jersey Chiropractors ("ANJC"). The suit challenges the Defendants'
abusive practices in using post-payment audits and reviews, and
improper repayment demands, to pressure providers to repay
substantial sums that have previously properly been paid as health
insurance benefits for services provided to BCBS subscribers."
For a copy
of the BCBSA Complaint, click here
|
read
|
Pomerantz Files Class Action Against
Blue Cross Blue Shield Association ("BCBSA") and Related BCBSA
Entities
Reuters, Thu Sep 10, 2009 6:11pm EDT
CHICAGO--(Business Wire)--
"Pomerantz Haudek Grossman & Gross LLP today
announced that it and co-counsel Buttaci & Leardi, LLC filed a
class action lawsuit against the Blue Cross Blue Shield
Association ("BCBSA") and 22 leading BCBS insurers across the
country on behalf of a putative nationwide class of health care
providers, as well as the Pennsylvania Chiropractic Association ("PCA"),
the New York Chiropractic Council (the "Council"), and the
Association of New Jersey Chiropractors ("ANJC"). The suit
challenges the Defendants` abusive practices in using post-payment
audits and reviews, and improper repayment demands, to pressure
providers to repay substantial sums that have previously properly
been paid as health insurance benefits for services provided to
BCBS subscribers.
......In making the appointment, the Court
stressed the significant role Pomerantz had played in a $249
million settlement of its UCR class action against Health Net,
stating that the Court had "similarly appointed Pomerantz to be
Plaintiffs` spokesman to the Court in the Health Net litigation
because the Court found D. Brian Hufford, Esq. to be the attorney
most capable of presenting Plaintiffs` position in a clear and
concise manner." In re Aetna UCR Litig., 2009 Dist. LEXIS 66853,
*8 n.4 (D.N.J. July 31, 2009)."
For a copy
of the BCBSA Complaint, click here
Pomerantz Files Class Action
Against Aetna (News
from Pomerantz)
For
a Copy of the Official Complaint, click here
Pomerantz
Files Class Action Suit Against Aetna On Behalf of Healthcare
Providers to Challenge Abusive Post-Payment Audit Practices
(GlobeNewsWire,
press release)
"NEWARK, N.J., July
29, 2009 (GLOBE NEWSWIRE) -- Pomerantz Haudek Grossman & Gross LLP
today announced that it and co-counsel Buttaci & Leardi, LLC, have
filed a class action lawsuit against Aetna, Inc., and its various
health insurance subsidiaries on behalf of a putative nationwide
class of health care providers, the Association of New Jersey
Chiropractors ("ANJC") and the New York Chiropractic Council ("NYCC").
The suit challenges Aetna's abusive practices in using post-payment
audits, with false allegations of fraud, to pressure providers to
repay substantial sums that have previously properly been paid for
providing services to Aetna subscribers.
The action alleges that Aetna's post-payment audit process violates
the Employee Retirement Income Security Act of 1974 ("ERISA"),
in that its repayment demands are retroactive determinations that
particular services are not covered under the terms of Aetna's
health care plans, but without any of the appeal or other
protections otherwise available under ERISA for both
self-funded and fully insured health care plans offered through
private employers. The complaint further alleges that both the
post-payment audit process and the pre-payment claim review process
employed by Aetna to strong-arm chiropractors into unfavorable
settlements violate the Racketeer Influenced and Corrupt
Organizations Act ("RICO"). In addition to challenging the
process by which Aetna pursues and applies its audits, the complaint
also challenges numerous clinical policy bulletins of Aetna, which
are used to deny services retroactively without adequate basis or
clinical support."
ERISAclaim.com - "Overpayment" Refund Request
Response & Appeals
BCBSA News,
June 30, 2009
Blue Cross And Blue Shield Companies'
Anti-Fraud Efforts Recover
$350 Million In 2008
"WASHINGTON
– Blue Cross and Blue Shield companies' anti-fraud
investigations resulted in overall savings and recoveries of
nearly $350 million in
2008, an increase of
43 percent from
2007, according to data released today by the Blue Cross and Blue
Shield Association (BCBSA) National Anti-fraud Department (NAFD).
From 2007 to 2008, the number of cases opened increased
nearly 34 percent,
and the closed cases increased about
43 percent."
AMNews: July 6, 2009. Tennessee Medical Assn.
sues collections firm
Health Research Insights has contacted
physicians in several states this year trying to collect alleged
overpayments.
For A Copy of TMA v. HRI
Lawsuit, click here
AMNews: May 18, 2009. State medical societies
strategize against collector
Legal action is one option against Health
Research Insights.
AMNews: May 11, 2009. Company stops tapping
physicians for 'overpayments'
Doctors protested self-insured
Georgia-Pacific's attempt to collect refunds of suspected claims
upcoding.
AMNews: April 13, 2009. Self-insured companies
going after doctors to recover 'overpaid' claims
There is no clear time limit on how far
back ERISA-protected companies can go to
recoup money. One company is turning that into a business.
Overpayment
Demand Letter from HRI:
"Dear Health Care
Professional,
......You must take action
as outlined in items (1) or (2) above, in order to ensure compliance
with the Employee Retirement Income Security Act of 1974
(ERISA). ERISA is the federal law that,
among other things, governs health benefit plans in private
industry. Investigation of potential ERISA
violations is given to the United States Secretary of Labor pursuant
to sections 504 and 506 as amended by the Comprehensive
Crime Control Act of 1984 and enforced
by the US Department of Labor.
In the event HRI is not
contacted by you or your designee, a Complaint
may be filed with the Employee Benefits Security Administration
(EBSA). You may view additional
information at
(www.dol.gov/ebsa)."
Physicians Strike Back At Employers'
Collection Firms ( BNET Healthcare Blog | BNET)
"In the most
recent clash,
the Tennessee Medical
Association has sued
Health Research Insights (HRI), a Franklin,
TN-based firm that has sent collection letters to physicians in
Georgia, Kentucky, Tennessee and Texas.
Other defendants in the
suit include the Metropolitan Government of Nashville
and Davidson County, TN, and Nashville’s
Board of Education, which runs a self-insured
plan for school employees. Blue Cross and Blue Shield of
Tennessee, the plan’s administrator, is also named
in the suit, although the insurer disavows any relationship with
the collection firm.
The suit, which alleges
fraud, says that HRI keeps 40 percent of whatever it collects.
The TMA wants a court to enjoin HRI from making any further
efforts to collect from physicians. An earlier protest by the
Georgia Medical Society against HRI’s work on
behalf of Georgia Pacific led to a suspension of
those activities."
Employment-Based Health Coverage and
Health Reform: Selected Legal Considerations (PDF)
(U.S. Congressional Research Service)
"It is estimated that
nearly 170 million individuals have employer-based health
coverage. As part of a comprehensive health care reform
effort, there has been support (including from the Obama
Administration) in enacting comprehensive health insurance reform
that retains the employerbased system. This report presents
selected legal considerations inherent in amending two of the
primary federal laws governing employer-sponsored health care:
the Employee Retirement
Income Security Act (ERISA) and the Internal Revenue Code
(IRC)."
ERISAclaim.com - "Overpayment" Refund Request
Response & Appeals
|
|
Past
Seminars 2006 - 2008
(for
Reference only)
|
2006 Reimbursement Seminars
Problem Oriented
ERISA & Medicare Claims
&
New IL WC Laws
|
|
"Problem Oriented"
=???
Bring your actual
denied claims with EOB's and failed appeals as well as your
frustrations,
We will show you
the most applicable & powerful laws & regulations to guide your
successful appeals!
|
Finally a Reimbursement
Seminar with Information that is Really "KRYPTONITE"
Sponsored
by The
New York Chiropractic Council & Chirocode Institute
Thursday
September 14th, 2006, 8am - 2pm
Crown Plaza Hotel,
LaGuardia Airport
104-04 Ditmars Airport,
East Elmhurst, NY 11369
Click Here to
download Flyer:
Erisa Doc
Chirocode Sponsored
Monthly National Seminars by Dr. Jin Zhou of ERISAclaim.com
Dr. Jin
Zhou will speak at "11th
Annual Medical Billing National Conference" on
May 10th, 2006 sponsored by Synergy Medical Information Systems
and Electronic Network Systems on:
"Maximizing Healthcare Claim Reimbursement - Problem Oriented
Appeals under ERISA"
"Mastering the 2006 Medicare Appeal Process"
For More
Information
CALL: 1-630-736-2974
E-mail Your Questions to
ERISAclaim@aol.com
|
Note: Some group discounts are per
seminar based. |
| Fees |
ERISA: $350 |
Medicare: $350 |
IL WC: 350 |
| Discounts |
$50
off each if paid 30 days in advance, and another $50 off total if
taking more than one seminar.
$100 off each seminar if taken
any of our seminar of the same topic before (not including different
topics).
CD-Books: 20% off on all
CD-Books at Seminars. |
| Location |
Oakbrook, IL |
Oakbrook, IL |
Oakbrook, IL |
| Dates |
Topics: ERISA, Medicare &
IL WC |
|
Topics I
9AM - 5PM
FOR ALL DATES
March 30, 2006
April 20, 2006
June 08, 2006
July 20, 2006
Aug. 17, 2006
Sept. 21, 2006
Oct. 19, 2006
Nov. 16, 2006
Dec. 21, 2006
|
"Maximizing Healthcare Claim Reimbursement
- Problem Oriented Appeals under
ERISA"
Did you know that ERISA completely
controls or regulates all of your claim denials and delays from
employer-sponsored plans, as long as your dispute is reimbursement:
"denial of benefits", and if you were very and really frustrated?
(Unanimous US Supreme Court Decision on June 21, 2004) Did you also
know that most employer-sponsored plans in USA, not only
self-funded/insured but also fully-insured (through purchase of
insurance), are ERISA plans, and most of your reimbursement claims
for patients under age of 65 are ERISA claims?
|
Aetna Health Inc. v. Davila
06/21/04
Opinion of the
US Supreme Court
"Held:
Respondents’ state causes of action fall
within ERISA§502(a)(1)(B), and are therefore completely
pre-empted by ERISA §502 and removable to federal court.
Pp. 4–20."
"We hold that
respondents’ causes of action, brought
to remedy only the denial of benefits under
ERISA-regulated benefit
plans, fall within the scope of, and are completely pre-empted
by, ERISA §502(a)(1)(B),......" |
-
What is
the law protecting patients against managed care problems for
claims with employer sponsored health plans?
-
Why did a
US Supreme Court unanimously rule on June 21, 2004 that ERISA
governs all of your claim denials or money problems from an
employer sponsored health plan and ERISA supersedes all of your
state laws for your "denial of benefits" (money problems) in your
managed care troubles?
-
Federal
ERISA claim regulation protects patients from all of your managed
care troubles, such as claim delays, coverage denials,
"over-payment" money back hassles, choice of network and
providers, prior-authorizations, policy "limit", silent PPO's,
"Mad HMO's", down-coding and bundling to pay only a fraction
of your claims, medical necessity problems, and all of your
managed care problems;
-
How to
best use federal ERISA and state laws in utilization review
(UR/medical necessity review) and external reviews to get your
claim paid timely and reasonably?
-
ERISA
claims compliance and anti-fraud and abuse prevention.
ERISA, the federal law, requires every
ERISA plan to disclose every relevant information for each denied
claim, and provides most powerful full and fair reviews to protect
patients and providers, but ERISA was never fully understood and
taught to health-care providers and the billing industry nationwide.
Dr. Jin Zhou, Founder & President of ERISAclaim.Com, the pioneer
of ERISA appeal system for providers will show you what US Supreme
Court ruled on nation's managed-care disputes and how ERISA can
really maximize your reimbursement practice through compliance. |
| Topics II
9AM - 5PM
FOR ALL DATES
March 31, 2006
April 21, 2006
June 09, 2006
July 21, 2006
Aug. 18, 2006
Sept. 22, 2006
Oct. 20, 2006
Nov. 17, 2006
Dec. 22, 2006
|
Medicare New Appeal Rules for All Claims
Effective 01/01/2006
"Mastering the 2006 Medicare Appeal
Process"
Starting on January
1, 2006, the NEW Medicare Appeal Process went into effect for all
Medicare claims in the USA. According to CMS, this is the most
significant overhaul in Medicare history for claim denials and
appeals. You may have noticed these changes from your local
Medicare carrier or in frustration after your Medicare claims have
been denied recently.
If you want to get
paid by Medicare, you have no choice but to comply with the NEW
Medicare Appeal Process. Since this is the most significant
Medicare claim appeal overhaul in history and new to everyone, we
must get very serious at learning and mastering this new Medicare
Appeal (reimbursement) Process and practice for your survival and
compliance. Learn how to master the new Medicare Appeal Process
during this very important session.
-
New Medicare appeal laws for all claims, effective 01-01-2006;
-
Most significant overhaul in Medicare history;
-
Comparison between old rules and new rules;
-
Is new law better than old law?
-
Who is the new Medicare contractor for your level two appeals?
-
How to file appeals for fast payment under new Medicare Appeal
rules?
-
and more
at
http://www.erisaclaim.com/CMS_New_Appeal_Rules.htm
One of the
main goals for
ERISAclaim.com is
to assist Medicare’s 1.2 million physicians and other
providers with the
information they need from CMS and our unique but practical guidance
with compliant strategy to
correctly appeal Medicare denied or delayed claims in
accordance with
Medicare rules and
regulations, as
intended by Congress, to
receive reimbursements more quickly, and spend less time dealing with
paperwork ultimately.
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| Topics III
9AM - 5PM
FOR ALL DATES
Feb.
27, 2006
March 20, 2006
April 24, 2006
June 19, 2006
July 03, 2006
Aug. 21, 2006
Sept. 25, 2006
Oct. 30, 2006
Nov. 20, 2006
Dec. 11, 2006
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New Illinois Workers' Compensation Laws
for Healthcare Providers
- New workers’ compensation law in Illinois
- Illinois Supreme Court opinions on causation
- Medical Necessity and Utilization Review
- Utilization Review v Case Management
- Utilization Review v "Work-related injuries"-Causation
- Utilization Review v. "disability" impairment rating
- Medical Necessity Appeal Strategies
New Appeal Forms and Letters to Comply with HB 2137 for Prompt
Payment under New Illinois Workers' Compensation Laws
No Patient Balance Billing, No UCR's, URAC Appeals, and Reminders as
Well as When to Bill Health Plan for WC Claims
How to find WC Carrier and verify WC benefits under new
Illinois WC Laws;
Penalties, Late pay Interest Rate and more....
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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 5 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). |
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For More
Information
CALL: 1-630-736-2974
E-mail Your Questions to
ERISAclaim@aol.com
For Fax Registration
Click here to Download PDF/Fax verion of Registration Form
For Online Registration or Order
Click here to enter our secured online registration page
Please Specify the Date of Your Seminar on
Registration Form
Tape or any forms of digital recording of seminar are not allowed
Copyright © 2001-2009
We now
offer post-seminar teleconference
for staff training at $190/hour.
Fax To:
(630) 736-1439
A confirmation will be given by fax
CALL: 1-630-736-2974
E-mail Your Questions to
ERISAclaim@aol.com
Driving Directions
 |
For Fax Registration
Click here to Download PDF/Fax verion of Registration Form
|
2006 Reimbursement
Seminars
Problem Oriented ERISA & Medicare Claims
&
New IL Workers’ Compensation Laws
www.ERISAclaim.com
Focusing
on Problem Oriented Denials & Delays
Powered
by
US
Supreme Court Opinions & Federal Regulations
New
Medicare Appeal Rules
Name:
______________________________________
Co._________________________________________
Address:_____________________________________
City:________________________________________
State:____________ Zip/Postal
Code:_____________
Tel:
________________________________________
Fax:
________________________________________
Email:
______________________________________
List Each
Registrant Clearly Please.
1) __________________ 2)
___________________
3) __________________ 4)
___________________ |
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REGISTRATION FORM & PAYMENT |
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Seminar
Fee
including
lunch only, dinner & Hotel are not included |
30 Days
in Advance
$300 per
seminar |
Regular
Fee
$350 per
seminar |
Previous
Attendee
$250 per
seminar |
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Seminar
Topic: _______________________Dates:__________
Seminar
Topic: _______________________Dates:__________
Seminar
Topic: _______________________Dates:__________
Total
Attendees & Fees: No. of people ( ) $___________
? CHECK ENCLOSED
Please Make All Checks Payable
to: Jin Zhou
? VISA
? MASTERCARD ? DISCOVER ? AMEX |
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___________________________________________________
Credit Card
Number Exp. Date
___________________________________________________
Cardholder’s
Name (Please Print)
___________________________________________________
Cardholder’s
Signature (Required)
___________________________________________________
Cardholders
Zip Code |
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(Note: All
credit card receipt are processed under the Name of |
“Century
Chiropractic and Acupuncture Clinic” |
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9 a.m. to 5
p.m. for all seminars dates
2425 W. 22nd
St, 2nd Fl Conference Room
Oak Brook,
IL
On-line
Registration at
http://www.ERISAclaim.com/seminars.htm
By Fax
Fax the
Form Completed to 630-736-1439
By Mail
Mail
This Form Completed to:
Jin Zhou
ERISAclaim.com
1260 Bamberg
Court
Hanover Park,
IL 60133 |
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Seminar
registration will be at 8:30 A.M.
The Seminar
will begin at 9 a.m. and wrap up at 5 p.m.. Lunch will be
provided 12:30 p.m. to 1:30 p.m.. Morning and afternoon refreshment breaks would also be provided.
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REGISTRATION CANCELLATION |
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ERISAclaim.Com will accept cancellation requests for refund made
in writing at least 10 days prior to seminar dates. Otherwise
no refund will be issued, but registration fee can be used for
any future seminar. ERISAclaim.com will refund registration fee
if the seminar is canceled.
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The Seminar
site is not associated with any hotels, therefore you need to
make your hotel arrangement accordingly with your travel plans.
Some reference travel web sites are listed on ERISAclaim.com
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Call or
E-Mail Jin Zhou at ERISAclaim.com
Tel: (630)
736-2974 (office);
Mobile: (630)
523-2190 (Seminar day contact only)
E-Mail:
ERISAclaim@aol.com |
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For Fax Registration
Click here to Download PDF/Fax verion of Registration Form
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Codified in Title 29 of the
Code of Federal Regulations:
Regulations
Selected links:
2520.102-3 Contents of summary plan description.
2560.503-1 Claims procedure. |
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ERISA Laws/Rules
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ERISA in US CODE
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ERISA &
Health Claim |
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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." |
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ERISA v State Laws |
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$10,600 ERISA Claim
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| 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.
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$37,350 ERISA Claim
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| Health-care provider alleged medical claims
submitted to Aetna for reimbursement, Aetna asserted no receipt
of medical claims, no written denials. Health-care
provider failed to present proof of claim submission, claim
denial and ERISA claim appeals. This case was dismissed. ERISA
health-care claims are handled in federal court, state law is
generally not applicable.
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Former uninsured patients alleged predatory collections
Chicagobusiness.com
Fraud Recovery and Prevention Efforts Net Over $7.5 Million
FAQ/Glossary, Member Services, Preferred Health Network, PHN Online,(
CareFirst BlueChoice, Inc.)
DOL ERISA Talking Points
(BCBSCNY)
BCBS 2004
Edu Programs (pdf)
BCBS2003 Edu Programs (pdf)
Washington Post Examines Health Plans' Increased Scrutiny of
Healthcare Providers' Claims (KaiserNetwork.org)
ABCNEWS.com : Huge Medical Insurance Scam Alleged
"Rarely does the FBI discuss an ongoing investigation. But the
agency made an exception because this scam is so big. Insurance
companies have already been hit with half a billion dollars in
claims."
CNN.com -Transcripts:
A New Plan to Fight Terrorism? A look at Healthcare Fraud
Rent a Patient - Fraud Scheme
(BCBSAL)
KSAT.com - Health - 'Rent-A-Patient' Fraud Under Investigation
"UnitedHealth Group alone said it's told the FBI about 300
allegedly fraudulent Southern California centers."
State of Wisconsin - DOJ News Release
Lautenschlager Announces Public Alert on "Rent a Patient"
Insurance Scams Victimizing Wisconsin Citizens and Businesses
Outpatient surgery centers probed for fraud
(San Jose Mercury News, CA)
'Rent-A-Patient' Fraud Under Investigation
(NBC4.TV, CA)
New Boston podiatrists accused of insurance fraud (AP Wire |
03/11/2004)
TWO ACCUSED IN NEW BOSTON MEDICAL SCAM
(Tyler Morning Telegraph)
USDOJ: Deputy Attorney General: Publications and Documents - -
Health Care Fraud Report Fiscal Year 1998
Payments Go Under a Microscope (washingtonpost.com)
CMS: Comprehensive Error Rate Testing (CERT) Program
(January 15 , 2004)
RECOVERY room
(MLive.com)
USATODAY.com - Hospitals sock uninsured with much bigger bills
A Booster Shot for Uninsured
"Illinois hospitals are hammering out a plan to provide
free or discounted care to the uninsured"
Hospital group examines plan for free care ( Chicagobusiness.com)
""Aggressive collection tactics with uninsured
patients cost a non-profit hospital in Urbana its tax-exempt
status last month. Illinois Attorney General Lisa Madigan is
investigating hospitals’ dealings with the uninsured, and a
Chicago alderman is talking about revoking tax breaks for
hospitals that limit charity care."
Doctor 'scorecards' are proposed (The Wall Street
Journal)
Table of Contents - Health Care Fraud: Enforcement and Compliance -
LawCatalog.com
PROSECUTING AND DEFENDING HEALTH CARE FRAUD CASES, WITH 2003
CUMULATIVE SUPPLEMENT (Author(s):
Michael K. Loucks and
Carol C. Lam)
HEALTH CARE FRAUD AND ABUSE: PRACTICAL PERSPECTIVES, WITH 2003
SUPPLEMENT
Staying Out of
Jail Under ERISA's Bulked-Up Criminal Law Penalites
(Attorneys Russell D. Shurtz and Craig R. Pett) |
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FDA > CDRH >
Database Super Search
"Device Listing Database
Proprietary Device Name:
MASSAGER ( THERAPUTIC, ELECTRIC,
WATER
Common/Generic Device Name:
ASOOTHE/AQUAMED
Classification Name:
MASSAGER, THERAPEUTIC, ELECTRIC
Device
Class:
1
Product Code:
ISA
Regulation Number:
890.5660
Medical Specialty:
Physical Medicine"
Categorization of
Investigational Devices
"... all FDA-approved IDE's
into either Category A (experimental
/ investigational) or
Category
B (nonexperimental/
investigational). An
experimental /
investigational ..."
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