Denial Recovery Series: Using ERISA and PPACA to Overturn More Payer Denials

Calendar

Tuesday, June 16, 2015 • 1:00 PM – 2:30 PM EST

The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for all commercial health plans to provide protection for individuals in these plans. PPACA expanded the reach of ERISA’s federal claims regulations to all employer funded plans. Learning how to use these rules to your advantage can dramatically improve your denial overturn rate.

Join denial management experts Brian McGraw, CEO of Intersect Healthcare and AppealMasters, and Richard Quadrino, CEO of Quadrino Law Group, as they discuss solutions and strategies for holding payers accountable and ensuring carriers who manage plans (and other fiduciaries) meet certain standards of conduct regarding claim denials.

What you will learn

  • Whether federal laws and/or state laws apply to the health plan so you know which appeal rights apply.
  • How to find valuable information in the patient’s health plan coverage document and how to use it in your appeal procedures to win more cases.
  • What specific information you should demand from the payer and utilization review entity (and that they are required by law to provide you) to help you prepare your best appeal.
  • How to win more appeals as the patient’s Authorized Representative.
  • How to file complaints against payers with the proper government agency (state insurance department or U.S. Department of Labor) when the payers don’t comply with applicable laws.
  • How to construct payer demand letters and appeal letters that “telegraph” your intent.

Who Should Attend

  • Chief Financial Officers
  • Revenue Cycle Directors
  • Physician Advisors
  • UR/Case Management Directors
  • Compliance Directors
  • Managed Care Directors
  • Denial Coordinators
  • Appeal Coordinators

About your presenters

Brian McGraw –Mr. McGraw is the Founder, President & CEO of Intersect Healthcare and Denial Research Group (AppealMasters), each firm a national leader in their respective categories for Appeal Support services and next-generation Denial/Appeal Management technology. The systems he designed are used by hundreds of hospitals and health systems nationwide. He consults with and educates revenue cycle and compliance leaders throughout the U.S. on government and commercial claim dispute resolution management. Over the last twenty years, he has worked with over 100 hospitals and many of the nation’s largest healthcare systems in the development of best practices to improve their managed care reimbursements, denied claim recoveries, billing integrity, RAC audit management and Medicare compliance.

Richard Quadrino -Richard J. Quadrino is the CEO and founder of Quadrino Law Group. For nearly three decades, he has been a leader and innovator in the field of insurance law. In fighting for his clients, Richard has forged new ground, shaped aspects of the field of health insurance law, and obtained results for clients throughout the country. His work has helped thousands of individuals and providers in their quest to be treated fairly by insurers. Richard and his firm challenge health insurers and claims administrators by using ERISA and its regulations as a powerful set of tools in representing medical providers. Quadrino Law Group provides claims consulting, claims management and litigation services, including opposing post-payment audits, for medical providers across the United States.