Keep More of Your Reimbursement, Make ERISA Work for You

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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 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 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 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, CHC, 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. David is nationally recognized for his presentations and expertise. He is well versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered 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, marketing, fee structures, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. His activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types, including 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, so he has knowledge of what the expectations are from the payers.

David’s firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management including start‐ups, buy‐ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, governance documentation, policy and procedure development and implementation, credentialing and contracting, human resources staffing and management, compliance, coding and chart reviews, physician education and many other areas. David has helped to maximize both profitability and reimbursement of physician practices, facility and ambulatory practices, re‐engineered operational and human resources, and addressed coding and billing issues for providers to curtail fraud, abuse, kickback, OIG, and IRS issues. He is also an original member of CMS’ PECOS Power User Group, CMS Compliance Focus Group and MIPS Design Lean Work Group which provides feedback and recommendations to Medicare’s Center for Program Integrity and Provider Enrollment Operations Group on design and improvements to the PECOS enrollment environment, as well as, NPPES and MIPS and conducts beta testing of the EHR/HITECH user interfaces and environments at the request of the Office of e‐Health Standards & Services Director. David is also on the CMS contracted team awarded the PECOS 2.0 contract to rebuild PECOS from the ground up.

David has conducted practice management, human resource, coding and compliance education and seminars in many states over the past twenty‐five years. David speaks often on a variety of practice management subjects at hospital residency programs, the National Society for Certified Healthcare Business Consultants, the Medical Management Group Association, the American Academy of Professional Coders, AHIMA, Florida Institute of Certified Public Accountants, Florida Medical Society, many other venues and is often called upon by the MGMA, HFMA, Decision Health, Part B News, Part B Insider, and many others, to conduct audio conferences and webinars. He has been published in Medical Economics and interviewed and quoted in many publications including Report on Patient Privacy and Report on Medicare Compliance.

David is a past President and current Executive Board Member of the National Society of Certified Healthcare Business Consultants. He has served on the Education Committee for more than twenty years and is a Certified Healthcare Business Consultant. He is a member of the Society for Human Resource Management and is a past Professional Development Chair and past Vice President of Human Resource Professionals of Central PA. David is also a past board member of the Central PA affiliate chapter of the American Academy of Professional Coders and is certified as a Professional Coder for physician practices, hospitals, and facilities. David is also a Certified Compliance Consultant and Officer. David is also a member of the American Health Lawyers Association, the Medical Group Management Association, and the Healthcare Financial Management Association.

David advises on and publishes operations policies and procedures manuals, employee handbooks, compliance manuals, HIPAA and OSHA and has published articles in numerous healthcare and human resource related magazines on subjects like coding and compliance, interviewing, recruitment, evaluations and disciplinary processes.


I attended this webinar and learned a lot from it!
Tina Borden
Evergreen Family Medicine