|
|
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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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Forthcoming Medicare Seminars |
-
Dr. Jin Zhou will be speaking at World
Research Group's
"Summit on Medicare
Advantage Reimbursement for Hospitals"
-
E-mail Your Questions to
ERISAclaim@aol.com
|
|
 |
 |
Summit on Medicare
Advantage Reimbursement for Hospitals
Proven Strategies
to Streamline Front and Back-End Processes to Accurately
Identify Patient Benefits and Capture Complete Reimbursement
from Managed Medicare Plans
|
Winning Strategies to
Navigate the Medicare Advantage Appeal Process: 2008 Maximum
Reimbursement under Medicare Part C (CMS Web Site-Oriented)
Medicare managed care health
plans, which include Medicare Advantage (MA) plans – such as Health
Maintenance Organizations, Preferred Provider Organizations, Medical
Savings Account plans and Private Fee-For-Service plans – Cost Plans
and Health Care Prepayment Plans, must meet the requirements for
grievance and appeals processing under Subpart M of the Medicare
Advantage regulations. If a Medicare health plan decides to deny,
discontinue or reduce services or payments, in whole or in part, the
plan is required to provide the enrollee, and his/her appointed
representative, with a written notice of its determination and right
to appeal in accordance with “Chapter 13 - Medicare Managed Care
Manual”.
Medicare managed care Part C
reimbursement rules for health care providers are more complicated
than and different from Medicare Part A & B reimbursement rules.
Providers must comply with all of the Medicare claim regulations and
managed providers contracting for maximum reimbursement from MA Plans
under Medicare. Failure by a provider to comply with Medicare
reimbursement and contracting regulations will not only deprive the
provider from substantial reimbursement, but also subject the provider
to overpayment recoupment, fraud and abuse investigation and possible
criminal liabilities.
By attending this
workshop, which will be CMS web site-oriented, you learn how to
navigate or master Medicare Part C 2008 appeal processes and maximize
reimbursements, including:
 |
How to navigate the Medicare
web site for Part C appeal process |
|
Medicare Part C
claims-relevant federal statutes, regulations, and Medicare claims
manual |
|
Definition and Basics of
Medicare Part C, Medicare Advantage (MA) Health Plans (CMS FAQ)
|
|
Medicare Part C appeal
basis, scope, definitions, and types of MA Plans (from Federal
Regulation) |
|
Medicare Part C appeal
outlines and process – Managed Care appeals flow chart |
|
MAXIMUS Federal (formerly
MAXIMUS CHDR) – CMS’ Independent Review Entity |
|
Medicare Part C
appeal-winning strategies – To get paid core without financial
risks, civil and criminal violations |
ABOUT YOUR WORKSHOP
LEADER
Dr. Jin Zhou
is a national speaker, consultant, author and publisher of healthcare
Medicare & ERISA claim denials and appeals, regulation education and
compliance. He pioneered, authored and published the nation’s first
ERISA Healthcare Claim Appeal System in a CD book, two Medicare Appeal
Books on CD’s and the nation’s first web site (www.ERISAclaim.com)
in ERISA healthcare claim denials, appeals, claim regulation education
and compliance, in addition, his web site covers extensive information
on new Medicare Appeal regulations for Part A & B, and Part C with
winning strategies for successful appeals.
|
| |
| |
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Register |
Who Should Attend
|
Speakers |
Venue & Pricing
|
|
Conference Overview
|
Why Attend |
Agenda |
Back to Conferences |
| |
2007 Claim
Denial & Overpayment Dispute
ERISA Appeal
Seminar
Class Dates: See Above Chart
8 hours (8 am -12 pm & 1 pm - 5 pm)
$299 - $600
Call: 630-736-2974
For more info:
http://www.erisaclaim.com/seminars.htm
E-mail Your Questions to
ERISAclaim@aol.com
How to Sign up?
Our new 2007 ERISA
Seminars can be enrolled by
1. Calling
630-736-2974
2.
Download,
fax a completed Registration Form to 630-736-1439
3.
Online Secured registration.
Maximizing Healthcare Claim Reimbursement
Problem Oriented
Appeals under ERISA
|
Note: Some group discounts are per
seminar based. |
| Fees |
-
$600 for the first person,
$150 for additional staf
($600 covers tuition + ERISA CD Book,
Retails at $450,
with all Appeal Letters & Forms)
$299/person, $150/additional staff (Already Have ERISA CD Book )
$400/person at the door
(Already Have ERISA CD Book
$700/person at the door with
ERISA CD Book
Lunch will
be on your own
|
| Discounts |
CD-Books:
Discount only for Prepaid Registration |
| Location |
(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 2007, 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 2007, 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 2007 ERISA
Seminars can be enrolled by
-
Calling
630-736-2974
-
Download,
fax a completed Registration Form 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). |
| |
Note: Due to high demand, our seminars in 2007 were booked more often by
in-house sponsors and offered on
other locations or
onsite at providers choice and announced by
other sponsors. If you would like
to book a on-site
seminar for your organization, please contact us directly.
2006
Seminars
(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.
|
| 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
|
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....
|
|
|
|
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). |
| |
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 © 2001-2006
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._________________________________________
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City:________________________________________
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Code:_____________
Tel:
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Fax:
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Registrant Clearly Please.
1) __________________ 2)
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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:__________
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Total
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to: Jin Zhou
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? MASTERCARD ? DISCOVER ? AMEX |
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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 |
|
|
|
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 |
|
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
|
|
|
|
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. |
|
|
 |
|
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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