ERISA Protections for Laboratories and Pathology Groups:
How to Defend Against Recoupments, Repayment Demands, and SIU Audits
If you missed the webinar from Pathology Webinars on “ERISA Protections for Laboratories and Pathology Groups: How to Defend Against Recoupments, Repayment Demands, and SIU Audits,” you still have a chance to purchase the CD of this event.
At least 75% of healthcare providers—including laboratories and pathology groups—are targets of recoupments by commercial payers, along with the SIU audits that often accompany them. It is said that these actions are extremely profitable for insurance companies, which recover millions of dollars a year, in part because providers rarely appeal the payers’ repayment demands. Why is that? Because providers don’t think they can.
Recent federal case law has determined that a recoupment is an adverse benefit determination, which means it falls under ERISA. Now, when your laboratory is hit with a recoupment or repayment demand, you have the right to an appeal, and to a review of that appeal. Insurers must give you the reasons behind their repayment demands—and allow you to challenge them.
While you now have the right to appeal, you may not have any idea what that entails. To get information on the various techniques you can use to minimize your liability and avoid paying big money to insurance companies, order the CD of “ERISA Protections for Laboratories and Pathology Groups: How to Defend Against Recoupments, Repayment Demands and SIU Audits” that originally aired on January 14, 2016. You’ll hear Thomas Force from The Force Law Firm provide a review and analysis of the latest federal case law as well as relevant laws on the federal and state level. And come away with a better understanding of your rights under ERISA, sample appeal strategies you can use, essentials of a good appeals letter, and a review of some good (and not-so-good) appeals.
Whether you’re a CFO, laboratory director, laboratory business manager, compliance officer, or pathologist—anyone who needs to know how to handle recoupments, repayment requests, and SIU audits—You’ll want to purchase this CD today.
- What a recoupment is and why it happens.
- The appeal rights you have under ERISA.
- What you should do when you get a notice of recoupment or audit.
- The obligations that health plans have regarding recoupments and audits as prescribed by federal and state laws.
- How to prepare an effective objection letter.
- What to include in a formal appeal letter.
- What options you have if your appeal is rejected.
…and much more
Thomas J. Force from The Force Law Firm P. C. is a state and federally licensed attorney in both New Jersey and New York. He has more than 21 years of experience in the healthcare and insurance industries.
Mr. Force is an expert in revenue-recovery techniques, managed care contracting, appeal strategies, and healthcare compliance.
Mr. Force is an active member and frequent speaker on a variety of healthcare revenue recovery and compliance issues for the American Medical Association, the Health Finance Management Association, the Suffolk County Bar Association, and other medical societies and physician organizations.
Mr. Force is also co-Chairman of the Health and Hospital Committee of the Suffolk County Bar Association. He is co-founder of the Healthcare Reimbursement Attorneys Network, a national association of attorneys that represent physicians and hospital clients. He also works closely with the American Medical Association and various state medical associations.
Mr. Force received his JD in 1994 from Touro College Jacob D. Fuchsberg Law Center and his BA from St. Joseph’s College in 1985.