The Medical Practice Guide to ERISA: Employee Retirement Income Security Act

The Federal law ERISA (Employee Retirement Income Security Act) helps the majority of medical practices make carriers pay on claims that are now being denied, delayed and recouped. A small percentage of practices understand how ERISA works -- yet with this new book, ERISA could possibly become a practice's best friend! ERISA is complex and most medical practices'Don't know what they don't know when it comes to dealing with ERISA!'Practices are in the dark in understanding how to protect their employer's rights in collecting the monies owed them. All practices have problems with timely filing denials and refund requests, and this book provides simple guidance on how to use ERISA and make it work for the practice's best interest. Insurance carriers, third-party payers, fiduciaries, and health plans are, quite often, not paying the way they should -- or they are not playing fair with providers. Most providers do not understand the laws regarding payment. Do you realize that most of the claims that you file are likely to be ERISA claims? Do you know how to stop carriers from recouping on claims unfairly? Do you understand that many parts of the contracts that your providers have signed are invalid? The authors map out the smart but ingeniously simple tactics that practices can use to force insurance carriers to honor their responsibilities on the policies owned by patients -- and to convince the carriers to adhere to what the policies actually require them to cover. This book describes an overview of the ERISA law, and provides tips, tools and techniques to leverage ERISA for practice advantage. The authors discuss what claims are covered and what does it mean to be covered? They take a close look at real-world ERISA situations, violations and outcomes.This focused book educates physicians, practice leaders, hospital staff, billers and managers on how to use ERISA to force insurance carriers to honor their responsibilities on the policies that are owned by patients. You may think you have all your bases covered, but with ERISA's complex rules and regulations, it is easy to overlook key issues. Authors and experienced consultants Don Self and Steve Verno identify the key areas of ERISA that practices need to understand and they are on a quest to ensure that your claims are paid properly, fairly, and equitable. In demand on the National level in both speaking and writing, the authors offer solutions that have been proven successful in other medical practices. Armed with this roadmap, physicians and executive staff can better put their resources to work-- leveraging ERISA to improve practice profitability. Using this book will allow the reader to not only capture the funds on thousands of dollars that the carriers are now unfairly denying, but will empower the reader to stop the unfair recoupments, illegal timely filing and improper appeal periods that carriers mistakenly quote to physicians and hospital offices. The authors map out the smart but ingeniously simple tactics that practices can start to use immediately. This book allows the physician, manager, and billing staff to take the power back! Noteworthy Features Clear Roadmap - Written in layman's terms so practice leaders can immediately begin to implement a strategy of getting claims paid, how to fight denials, halt recoupment. Very Practical - Includes real world examples and case studies of how medical practices can use the ERISA rules to work for them. Also practical information on how to use the ERISA website and answers to the most frequently asked questions. Templates to Get You Started - Sample letters (describing exact situations and how they can be handled) will get you started and help you take control of the process!