This ERISA Seminar is a comprehensive, systematic and advanced problem-oriented interactive learning process for overpayment disputes and commercial claim denials, designed to learn and master the most important federal law, ERISA, which governs and regulates more than 90% of non-Medicare commercial claims and more than 60% of healthcare claim denial reasons for the past 35 years. In July 2009, BCBSA announced $350 million recovery for the year of 2008 alone for the overpayment denials. More than 80% of disputed non-Medicare overpayment claims are with employer sponsored health plans, governed by the Federal law, ERISA, for commercial or managed care medical claims. This two-day ERISA seminar is mainly designed to train skilled ERISA Appeal Staff to fight over new claim crisis, instead of getting paid, providers were forced to pay out more and more every day, and to develop the Special Appeals Department for doctors and hospitals, in conjunction with our optional ERISA Certification Programs for ERISA Claim Appeal Specialist.
ERISA, Employee Retirement Income Security Act of 1974, is a federal law that governs and regulates healthcare claims for estimated more than 170 million Americans who obtained health insurance or benefits from employment in private sector, for both self-insured and fully-insured (through purchase of insurance) health plans. ERISA law completely (100%) preempts, supersedes and invalidates any and all state laws and private managed-care contracts for PPOs and HMOs in any and all dispute over denial of benefits from an ERISA plan. ERISA regulates and governs healthcare claims which include the paid ERISA healthcare claims in more than 50% of $2.4 trillion, 16.6% of GDP, of the national health expenditure in 2008, and also include the denied healthcare claims, legitimately or wrongly for appealable claims, in more than 50% of $5 trillion in the aggregated denied healthcare claims in 2008. More than 60-70% of healthcare claim denials from insurance companies and managed-care third-party payers by employer-sponsored plans are due to ERISA regulated plan or policy coverage, limitations and exclusions rather than traditional billing, coding, medical necessity and managed care contracting or participation dispute. Although in the past 35 years the notices for ERISA rights to appeal were written on almost every EOB (Explanation of Benefits) in the daily practice in doctors' offices and hospitals, the healthcare providers, managed-care third-party payers, and even legal professionals as well as the state regulators rarely understood how to conduct, manage or regulate ERISA claim appeals for ERISA claim denials and disputes.
There have been urgent and popular regulatory needs and market demands for ERISA claim compliance education and training in this $6 trillion healthcare denial management market.
More and more class action lawsuits have been filed recently under ERISA and RICO on behalf of doctors and hospitals for overpayment disputes in order to avoid provider’s financial disasters and bankruptcies. Multi-billion dollars have been reportedly recouped by Payers and managed care TPA’s in private sector, in addition to now popular Medicare RAC overpayment program.
ERISAclaim.com is offering the nation's first systematic, comprehensive and advanced two-day ERISA Seminar specifically in accordance with U.S. Supreme Court rulings in Aetna v. Davila and ERISA claim regulation, with commitment to compliant education for medical claim dispute resolution.
ERISAclaim.com is currently the only company in the country that provides comprehensive, systematic and advanced ERISA healthcare claim education, consulting and publishing primarily for the healthcare providers and industry consultants.
"If ‘ERISA Miranda's Rights’ to appeal for every claim denial is on every denial notice daily in doctors' offices and hospitals for 35 years, and according to U.S. Supreme Court, ERISA is the only correct way to go for denied claims with ERISA plans, regardless of HMO or PPO, and for cost of more than $1.2 trillion in paid ERISA claims each year, and with more than least $3 - 4 trillion in denied ERISA claims, why can't we do what Congress intended, Supreme Court instructed and each daily denial notice explained, "ERISA Miranda's Rights" to appeal?", said Dr. Jin Zhou, the president of ERISAclaim.com.
To resolve daily medical claim dispute and healthcare crisis, Dr. Jin Zhou suggested that the compliant ERISA benefits administration and ERISA appeals by all parties are the best ways to reduce or eliminate unnecessary healthcare wastes, costly and lengthy litigations. This is similar to the traffic accidents. With voluntary traffic law compliance by the drivers and with meaningful enforcement by our government, we all can expect to drive safely. Without traffic law compliance by all drivers, we will have traffic disasters every day. By the same token, without ERISA claim appeal compliance and enforcement by all parties and the government, we cannot expect claim honesty, efficiency and fairness in healthcare delivery system.
ERISAclaim.com, located in northwestern suburb of Chicago, Illinois, is an online publisher, consultant and educator for ERISA claim education, training and consulting as well as claims recovery for ERISA healthcare claims. It also provides ERISA litigation support, research assistance and fraud and abuse prevention as well as PPO auditing defense consulting. In addition to ERISA, ERISAclaim.com also provides consulting and education for Medicare Claim Appeals Specialist, for Medicare RAC overpayment appeals, fraud and abuse prevention.
Dr. Jin Zhou, the president of ERISAclaim.com, developed the nation's first ERISA education and practical appeal system for healthcare providers 10 years ago, He has gained most comprehensive and unique practical experience in training and consulting in ERISA claims for healthcare providers for more than 10 years. Dr. Jin Zhou was sometimes referred to as the "Godfather of ERISA Claims" for healthcare providers by some industry experts.
For more information or to arrange an interview, please visit www.ERISAclaim.com, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237 or ERISAclaim@aol.com.