Abstract:
The federal Employee Retirement Income Security Act (ERISA) helps medical practices make carriers pay on claims that are now being denied, delayed, and recouped. Only a small percentage of practices understand how ERISA works. Yet with appropriate guidance, ERISA could possibly become a practice's best friend! Practices are in the dark when it comes to understanding how to protect their rights in collecting the monies owed them. ERISA regulates the practice's health benefits, health benefit payments, explanations of benefits, and, most importantly, appeal rights. This article covers ERISA in 2015 and how practices can capture the thousands of dollars that carriers currently are unfairly denying. This overview will empower the reader to stop the unfair recoupments and the timely filing and improper appeal periods that carriers mistakenly quote to physicians and hospital offices.
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