Stop Payers from Taking Back Your Claim Payments with ERISA

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Payers don’t want you to know how much control you really have regarding your claims’ reimbursement. They don’t want you to know that by applying ERISA regulations, you can force your payers to:

  • pay your claims more quickly,
  • stop downcoding your office visits,
  • overturn claims that were previously denied,
  • expand inadequate appeal deadlines, and
  • return recouped funds previously taken from your practice.

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 of 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 is going to 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 attending 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 upcoming 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.

Payers are counting on the fact that only about 10% of practices really understand how to apply ERISA regulations to their claims. They don’t want you to know that ERISA regulations provide you with more control when it comes to how, when and what you are reimbursed for your services. But now you know….

The bottom line is that by mastering the complexities of ERISA, you can significantly increase your reimbursement, and reduce the number of hoops that payers require you to jump through to get paid. Don’t wait, sign up for this online training today.

Meet Your Expert

David J. Zetter
PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHPFounder & President, Zetter Healthcare Management Consultants

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.