WHY ARE PEOPLE IGNORANT ABOUT ERISA?

9 out of 10 times, when I mention that ERISA will help a clinic, I get a blank stare or the question “what is ERISA?”. I’ve said many times that 95% of people in the healthcare field that SHOULD know ERISA do not have any idea what it is, including most attorneys that docs turn to! So, why do I (and those that understand ERISA) believe it IS important? It’s simple. It makes insurance carrier follow the rules when they don’t want to!

No – not every person working for insurance carriers are out to rip off the doctors, hospitals and patients… That is ridiculous. Of course, it is equally moronic to think that some decision makers at the largest corporations in the world are not out to increase profits by any means. One of those means may be to not pay the claims that they should pay or not to pay them at the rate they should pay. In fact – that happens every single day, to almost every medical practice. The problem is that the people that SHOULD know better are ignorant about it. For instance:

1. When was the last time your practice received a denial because of timely filing? (The truth is that you are not limited to what the carrier says is timely filing – as the contract your doc signed is not valid on 80% of those commercial claims!)

2. How often do carriers retroactively deny a claim they paid 3, 6, 12 or 24 months ago and demand a refund from your clinic or hospital?

3. How frequent do the insurance carriers change the code you filed and pay a lower code (hint – you won’t know when they do because the EOB doesn’t show the code they paid)

4. When was the last time a carrier bundled something on your claim and reduced your payment?

5. What was the last claim you did not appeal because you believed the appeal period had expired? (The appeal period you think you have is not what it really is!)

6. How many claims have the carrier not paid because they said the service was experimental or not necessary?

7. How often do you get denials because the carrier claimed a pre-authorization was not obtained? (You would be surprised at how often they say it was – yet the patient’s policy says it was not – and the policy always wins out!)

8. When was the last claim recouped on because the carrier said they had previously paid on a claim when the patient was not eligible, or their policy had lapsed?

Every one of these are ERISA related and every one of these could be successfully appealed or fought using ERISA. Of course, if you’re ignorant about ERISA, then the carriers win, your employers lose… due to not knowing what you don’t know.

The one hour live webinar next Tuesday night (TNL hosted by JFAMC and DSA) is on ERISA and it includes one CEU from AAPC and AMBA. It’s only $30, which is a paltry amount considering it can increase the income of your clinic by tens of thousands and your hospital by hundreds of thousands.

https://donself.com/shop?olsPage=products%2Ferisa-jfamc-live-webinar

Here are comments about it from folks like you, except they have learned how ERISA helps them.

"I have been using Don Self's ERISA methods from his webinars and books. We have stopped every single overpayment request! Yes, every single one! My staff estimates in 2017 about 270 times and in 2018 about 60+. A dramatic drop from one year to another. The payers know we are going to call them on their BS. We literally get clients contacting us just to write overpayment letters. Because they have heard from other clients. I just got a call asking "are you the dude (we are in California) that stops the insurance company's overpayment retractions?"  David Martinez, Owner, CEO, CMRS, CMBS, CCPB, CCBS, CPC-P, CPC-I, CCA, CBCS, CCPC, CMB, CHP     Accurate Medical Billing & Audit           Rancho Cucamonga, CA [email protected] www.AccurateMedBilling.com

"We had an out of network surgery with innovative services on a small child done by a pediatric surgeon. Many unlisted codes, all told 132,000$ surgery. Originally they paid $648.00, Medicare rate. After ERISA appeal, they paid 64,000$, the 50% of billed charges as the plan spec outlined.    It works. I had to share. "

Zia Rivera-Clarkson MBA MDiv CPC  BCS EHR MAA CBCS 

Adjunct Professor, American Business and Technology University

Director of Coding, Auditing and Compliance, The Patriot Group

I have used Don’s books, Coding Advisor, slide rule and I am love them all.  They are done so expertly yet are so easy to use.  Don is a great resource to anyone in the coding field. 

Lois A Simmons, RHIT, CCS-P

Coder/Abstractor, OSF Medical Group Surgery     Peoria, IL

"Don, your advice was right on the money! I received a request for a refund due to policy termination and responded on 06/30/15 with your letter from your book addressed to the CEO. I was delighted to receive a call on 07/07/15 indicating the request had been made in error and to disregard it. How refreshing to have something work the first time and immediately. Please feel free to share this to encourage them to get on the ERISA band wagon. "    Mary Bergstrom    St. Cloud Ear, Nose & Throat Clinic    St Cloud MN

"Can't stress enough to you all how effective it is when you send your complaints directly to the CEO/Attorney's of the Insurance Companies.   I had sent an appeal to Anthem 3 times without a response and then tried to contact our Provider Rep and couldn't get a response from her either. I typed up a letter to the CEO explaining how this lack of response was "In my opinion' a violation of the ERISA and said if I received no response within 5 days we would look into a potential law suit with punitive damages. Low and behold I got a call from our Rep THE NEXT DAY!"  Lori Braidic    Billing Manager    Womens Care Center of Columbus, Inc.   Columbus, OH

"How appropriate to end the day with notification from a major insurance company that an appeal previously denied for timely (due to the 90 day payer contract) was successful!  Prior attempts the "conventional" ways had failed and without the ERISA knowledge the claim would have been written off. ---Suzanne “   [email protected]

"I have had so MANY problems with my own insurance policy which is ERISA.. and double whammy.. UNION plan..     Friday, I picked up my mail and they paid all claims I had in appeal using ERISA..     THANK YOU DON!!!!! In all my years of working in this business I never realized how much ERISA really mattered until you taught me..    Linda Walker”    Practice Managers Resource & Networking Community     https://www.billerswebsite.com

I normally don't buy "work" books unless the company pays for them, but after using Don's website and his medical list serve for years now, I felt they would be well worth my money and, boy, they have been. The ERISA books have helped me get claims paid and recoupments reversed. The sample letters have made my job much easier, too!  You need all the help you can get in medical billing and I highly recommend all 3 of his books, his newsletter, his free list serve and his coding software.

Cindy Block,    Billing Manager

Tri-Care Family Medicine   [email protected]

Anytime an insurance company has requested a recoupment or takeback in the past, we would just hand it over...until now.  I did my first ERISA appeal to BCBS and within 8 weeks, received a letter that the decision had been overturned!!!  We "won"!  BAM.    Its been a huge plus for our practice.    Heather   Billing Manager    TIMC -Texas

"This is not a subject they teach in school and every medical office needs to have knowledge of this subject."  Virginia Hart Craig    Austin Family Allergy,   Austin, TX

"He provided me with a new path for appeals. Even after 34 years in billing and coding it is always exciting to get those "AH HA" moments that will help increase your revenue.  Lynn Meadows    Advanced Surgical,  Mesa AZ

"If you do not have ERISA tools in your denials toolbox, you are walking around with an empty toolbox and are unable to optimize the compliant income your providers worked for and should be paid for."  Barbara Cobuzzi CPC

"Highly recommend! I learned there is help to fight back, great examples to help you take the correct steps, and the right verbiage to make your case!"  Melanie Rowls,  ENT Specialists of Arizona,  Tempe AZ

"If you bill insurance, you need to know about ERISA. Don't just give your money away!"  Linda Vargas    University Physician Associates,  Kansas City

"I started a new job with a large DME company and they had tons of recoup letters and getting more daily. I sent Don Self’s letters on the ERISA claims and 6 weeks in guess what?! No recoups and zero letters received yesterday in Monday’s mail. I don’t think this is coincidence and hopefully they will leave us alone!    Thank you Don!!!!"   Krystal Spencer,   Nashville, TN

"We have the same testimony in that we win all the time using Don Self's methods. I might have changed the language a little and told them to kiss it!!  I’ve had several calls from assistants to CEOs attempting to calm me down. I wasn’t very understanding. They got the message loud and clear. "   Stacy Carruth,   National Birthing Centers,    San Antonio, TX

"I use Dons ERISA letters too and have had good luck!     Karey Lawson,   KC Medical Management,    Fillmore, CA

I have been following you since 2009. I have purchased a couple of your books as well as Jin Zhou books. I have been billing and consulting for 30 years . I can honestly say that learning ERISA from you has defiantly been a positive adjustment and has contributed to increased revenue for my docs.    I refer every single one of my clients’ staff to your site as a valuable resource.     Thank you for all that you do.     Respectfully,   LisaMarie Partridge, CMC, CMIS     [email protected]

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