Ever wonder why payers don’t share information about how ERISA protects your practice from wrongful denials and chargebacks? The answer is simple: Because they don’t want you to know how much money you can retain by protecting your practice with proven ERISA strategies.
Insurers make money every time you simply accept a denial. When they don’t have to pay you — or when they can ask for their money back — they make thousands, and you suffer. But it doesn’t have to be that way.
During this upcoming 3-Part online training series, three ERISA experts will share the specific strategies you must know if you want to sharpen your claims processing and appeal strategies and hang on to every penny you deserve.
Don’t wait: Sign up today to master the insider techniques that will help you bring in cash by using ERISA to your advantage.
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PART 1: Boost ERISA Claim Payments with Simple Intake Process Changes
Order the On-Demand Recording to Watch at Your Convenience.
You’re doing everything you can to get paid by insurance companies. You verify benefits, get preauthorizations, and your electronic recordkeeping is pristine. Not to mention that your patients sign page after page of documents entitling you to payment for the care you provide. But you’re still getting the runaround…
Sound familiar?
If so, your patient intake process is most likely the culprit. Most of your privately insured patients have health plans governed by a federal law called ERISA. ERISA is in place to protect plan participants (and, by extension, you). But there are up-front steps you must take to enjoy these protections, avoid related pitfalls, and get paid.
Attorneys Dana Berkowitz, Esq. and Radha Pathak, Esq. can help you get the law on your side and navigate your intake process to improve your ERISA claims payup. During their 60-minute online training, Radha and Dana will provide you with step-by-step instructions on how to tighten your intake procedures and take advantage of the ERISA protections you are entitled to. You’ll learn how to get paid more of the money you’re due — and hold onto it.
Attending this one-hour online training event will give you the practical tools necessary to fight back against wrongful insurer and payor tactics and get paid more for your ERISA claims. Dana and Radha will help you:
- Identify and resolve weaknesses and loopholes in your intake process
- Stop insurance companies from ignoring your assignments of benefits and get paid
- See real-world examples of common intake mistakes that are costing you money
- Craft legally sound responses and beat common insurer payment denial tactics
- Fight back against claim underpayments with arguments that work
- Argue against unsupported ERISA-governed claim denials and win
- Stop insurers from sending payments directly to your patients
- Incorporate proven tactics that will get you through payer “radio silence”
- And so much more…
PART 2: Keep More of Your Reimbursement, Make ERISA Work for You
Available Immediately, Order the On-Demand Recording to Watch at Your Convenience.
Payers know that approximately 83% of your non-Medicare/Medicaid claims are governed by ERISA regulations. For these claims, insurance companies also know that their timely filing deadlines of 90-120 days don’t apply, that they can’t legally recoup funds you’ve been paid and that in most cases, your claims can’t be downcoded without your input. However, they do it anyway because no one is pushing back.
Well, if you are tired to feeling like payers are holding all the cards, David Zetter, CHC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP, can help. David will break down the complexities of ERISA regulations into plain English. He’ll walk you through only the pieces you need, and then provide you with actionable advice on how to use it.
By viewing this 90-minute online training, you’ll learn how to utilize the applicable portions of ERISA regulations to have more control of your payer requirements and reimbursements. If you’ve experienced even one of the scenarios below, and want to “push back” to change futures outcomes, this online training is for you:
- Without warning, the payer takes back reimbursement from your future claims.
- Your claim is downloaded with no request for progress notes or doctor review.
- Your claim is refused because it arrived past the payer’s timely filing period.
- Your reimbursement is reduced because the payer bundled your services.
- Your payment is sent to the patient by mistake, and you’re expected to collect from them.
- Your appeal is denied because it reaches the payer past their 90-day deadline.
- Your claim is downcoded and the payer refuses to tell you why, or who authorized it.
- Your claim is denied for “investigational or experimental” services.
- You’re told to comply with state balanced billing laws when federal ERISA rules apply.
- You are denied assignment of benefits for being a non-contracted provider.
PART 3: Overturn Rejected Claims: ERISA Appeal Letters to Get You Paid
Available Immediately. Order the On-Demand Recording to Watch at Your Convenience.
Over 80% of your non-Medicare and non-Medicaid claims fall under ERISA control. When applied correctly, ERISA gives you the power to overturn denied claims for missed filing deadline rejections, get back reimbursement recoupments, stop payers from downcoding your claims, and so much more.
But you must know how to write and correctly submit ERISA-based appeal letters. This is where ERISA expert and nationally recognized healthcare consultant Don Self, CPC, CMCS, CASA can help. During his 60-minute online training, Don will walk you through the complexities of writing successful ERISA appeal letters to get more of your non-government payer claims paid.
Here are just a few of the practical, step-by-step ERISA appeal letter writing strategies you’ll receive during this training:
- Negate adverse rulings with proven ERISA appeal letter verbiage
- Fight back against payer downcoding with a simple phrase
- Write an engaging ERISA appeal letter without overstating your case
- Combat denials for lack of preauthorization when it is even required
- Increase reimbursement, successfully dispute bundled services
- Speed up appeal responses – send your letter to the right person
- Uncover what Plan Administrators really look for in an appeal letter
- Overturn payer recoupments and get your money back
- Correctly utilize emotion in your appeal response & get more claims paid
- Reverse denials, make claim administrative records work for you
- Master ERISA appeal timelines and get more denials paid
- And so much more…
Past Webinar Reviews:
“I think it was awesome, Don did any amazing job! He is very thorough and explains things very well making it easy to understand. My team absolutely loved Don and we look forward to future Webinars with him!”
– Jennifer Jenkins, Billing Consultant, 365 Medical Billing Services
“I thought Don Self did an excellent job in his presentation. He is very knowledgeable and relatable. I learned a lot and am excited to apply what I learned.”
– All Colleagues, Silver Health Care
“Amazing Webinar! I can’t wait to use in my practice!”
– Pablo Arteta
“I attended this webinar and learned a lot from it!”
– Tina Borden, Evergreen Family Medicine
100% Satisfaction Guaranteed or a Full Refund.
You take no risk whatsoever. If you find this essential session doesn’t meet your expectations or you are not satisfied for any reason, simply et us know.
Radha (Rachana) Pathak primarily represents pension and welfare plan participants and beneficiaries in individual and class actions under the Employee Retirement Income Security Act of 1974. Prior to joining the firm full-time, she was an Associate Dean of Student & Alumni Engagement, Associate Professor of Law (with tenure), and Director of the Institute for Trial and Appellate Practice at Whittier Law School. She also served as a judicial clerk to the Honorable Raymond C. Fisher of the United States Court of Appeals for the Ninth Circuit.
Radha has litigated numerous cases involving complex procedural issues in federal district and appellate courts throughout the country, and she has been litigating cases before the Unites States Supreme Court since 2005. In 2017, she received the Daily Journal’s prestigious California Attorney Lawyer of the Year (CLAY) award for her victory in Montanile v. Board of Trustees, 136 S.Ct. 651 (2016), a case in which she served as lead Supreme Court counsel. She has been a core team member on many other Supreme Court merits cases, including Unicolors, Inc. v. H&M Hennes and Mauritz L.P., 142 S.Ct. 941 (2022) and Thole v. U. S. Bank N.A., 140 S.Ct. 1615 (2020).
Radha frequently speaks and writes about complex procedural issues, especially those pertaining to ERISA. Her ERISA publications include Mandatory Arbitration of ERISA Claims, Spring 2021 Issue: Employee Benefits Committee Newsletter; 9th Circuit rightly upholds California’s retirement backstop, Daily Journal, May 21, 2021 (with John Stokes); Enough About the Constitution: How States Can Regulate Health Insurance Under the ACA, 31 Yale L. & Pol’y Rev. 275 (2013) (with Brendan S. Maher), Health Insurance and Federalism in Fact, 28 ABA J. Lab. & Emp. L. 73 (2012) (with Brendan S. Maher), Discretionary Clause Bans & ERISA Preemption, 56 S.D. L. Rev. 500 (2011), Statutory Standing and the Tyranny of Labels, 62 Okla. L. Rev. 89 (2009), and Understanding and Problematizing Contractual Tort Subrogation, 40 Loy. U. Chi. L.J. 49 (2008) (with Brendan S. Maher).
David Zetter is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 30 years of operational and healthcare experience.
Many recognize David nationally for his presentations and expertise. He excels in revenue cycle management, credentialing and contracting, compliance, coding and documentation. People see David as an expert on Medicare, not only by his clients, but his consultant colleagues across the country. He has evaluated existing ambulatory care facilities and practices with respect to patient flow, operations, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. David Zetter’s activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types. This includes coding and broad‐based regulatory issues. David has also conducted chart audits on behalf of Medicare contractors and Blue Cross/Blue Shield early in his career. This gave David the knowledge of what the expectations are from the payers.
David’s firm works with healthcare professional clients and facilities coast to coast. Zetter’s specialties include all areas of practice and facility management including start‐ups, buy‐ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, and governance documentation. Zetter’s firm may also assist you in policies and procedures, credentialing and contracting, HR management, compliance, chart reviews, and more.
David has helped to maximize both profitability and reimbursement of physician practices, facility, and ambulatory practices. He also re‐engineered operational and human resources, addressing coding and billing issues for providers to curtail fraud, OIG, and IRS issues.
Don Self is the CEO and founder of Don Self & Associates, a consulting firm specializing in medical reimbursements and helping physician practices improve patient outcomes and increase profits while staying compliant with all regulations. Don is also the President of Telecare-USA and has over 38 years of industry experience.
