Recent Developments in the Area of ERISA: What the Health Plans Don’t Want You to Know

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Recent Trends And Developments In ERISA

Join this session by Thomas Force to utilize ERISA and challenge low payments or no payments by health care insurance companies and plan administrators, along with discussion on pay or recoupment and audits. This session will focus on recent trends and developments in ERISA, highlighting important federal case law. Learn to structure appeal letters and changes that are necessary in view of these new ERISA developments. ERISA has a multitude of requirements and the health care insurance companies just cannot comply with.

Thomas will assist in preparation of appeal letters to health plans and ERISA Demands. He will discuss the internal administrative process to set the health care insurance companies up for litigation and will explain the requirements under ERISA that a health care provider must follow before going to litigation, with the usage of ERISA Demands to create leverage to get their medical claims paid.

We have to hold these health care insurance companies accountable to the requirements of ERISA. They have been trying to hold back money on otherwise covered medical claims and recoup funds on previously paid claims. It is about time we fight back and let them know health care providers will not tolerate this type of behaviour. It is important as a health care provider that you use ERISA and its many attributes to assist your staff in recovering revenue for your practices. However, improper or late appeal letters and failure to have an enforceable AOB can derail litigation attempts.

Session highlights:

  • ERISA requires “full and fair” review – a health care insurance company must provide all documents that the company relied upon to make their determination. Providers are entitled to the plan’s investigative file
  • ERISA requires the insurance company provide the Summary Plan Description, Plan documents and other necessary documents within 30 days of request of the beneficiary. Learn how to use these demands to help get your claims paid
  • Failure to produce documents can be reported to the governing regulatory agency and the health care insurance company may be subjected to a $110 a day penalty for each non-compliant event
  • Recoupment, refund requests and fraud investigations are “adverse benefit determinations” under ERISA. We will discuss the important reasons
  • New case laws will be discussed and analyzed

Who should attend: Anyone who works in the health care industry will benefit from this event; specifically, revenue cycle employees at hospitals, physicians, and billing personnel for healthcare providers.

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About Our Speaker

Thomas Force - Compliance Coding Expert

Thomas J. Force, Esq. is a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries. He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general counsel and...   More Info
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