Generate Revenue for your Practice with ERISA

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Expert Reimbursement Guidelines on ERISA Governed Payments for Denied & Ignored Medical Claims

In 2013, more than 60% of Health Plans are “self-funded,” and/or Employer Sponsored Health Plans, meaning they are governed by ERISA. And, every practitioner has a major number of medical claims and appeals which get wrongfully denied by the insurers. ERISA is a federal statute that the various payers cannot ignore. There are provisions in this federal law which can be used to compel payment. 

Learn how to hold the payers accountable to federal law with the knowledge of federal ERISA regulations in this presentation with our expert Thomas J. Force. This expert session will focus on winning strategies to achieve positive results on medical claims submissions and appeals of denied medical claims. The focus will be on valuable techniques to compel accountability from the insurers.

Here are few additional topics covered in the session:   

  • ERISA is your friend. The provisions within this valuable federal statute can help get your claims paid.
  • Learn what documents you must obtain from your patients. Is your AOB document ERISA-ready?
  • Learn how claims get denied for lack of medical necessity or is experimental paid? Learn ERISA requirements for such denials.
  • Does ERISA afford an opportunity to sue a plan administrator and sponsor? Learn how.
  • Know what happens if the Court finds that plan administrator acted in an “arbitrary and capricious” manner in making their adverse benefit determination.
  • What additional challenges does an OON provider have in getting its claims and appeal paid?
  • Discover what prevents insurance companies from retaliating against my patients and my practice.
  • And, tips & strategies on how to get the appropriate response from insurance companies
  • Understand the basics of Claim
  • Know all the rules and regulations of ERISA plans while responding to claims and appeals
  • Find out the timing of benefit determination (Response to claim)
  • Find out the timing of notification of benefit determination ?(Response to appeal)
  • Know all about standard of care for Judicial review
  • Learn when a court will conduct a “De Novo”
  • Find out the exhaustive administrative remedies
  • Why it’s important to include ERISA demands with your appeal letters
  • What to do when ERISA demands are ignored?

Who should attend? Out of network and in-network medical practices, Practice managers, Billing and Claims personnels, administrators, compliance officers, other health practitioners who deal with revenue recovery, medical claims and medical appeals.

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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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