I assist any type of independent healthcare practice or provider within the United States.
3. What size of independent practices can you help?
I typically work with solo and small independent practices. However, I will do everything I can to help those in need so arrangements can be made for larger independent practices. Also, if you're a hospital or other large healthcare provider and just need me to work on one or a few high-dollar ERISA health claims, I can help with that.
4. Does it matter if we are in-network or out-of-network?
No. I can recover lost revenue and help increase reimbursements for both in-network and out-of-network claims. ERISA helps in the recovery of 100% of in-network contracted payments minus patient responsibility and 100% of out-of-network billed charges minus patient responsibility.
5. What are your fees for your revenue recovery services?
There are no upfront fees for my revenue recovery services. You only pay a percentage of the amount I recover or protect from recoupment, and this fee is contingent on my success. Your payments come directly from the payers to your practice; I do not handle any of your payments.
6. What makes you different from typical revenue recovery vendors?
Most revenue recovery vendors only focus on contractual and billing errors. Few will challenge, much less successfully overturn the payers' claim reduction/denial tactics as I will. What's more, most billing vendors, revenue cycle management (RCM) vendors, and even denial management and revenue recovery vendors fail to efficiently use ERISA for capturing full coverage liability from payers. Whereas I'm able to successfully use the ERISA regulations and appeals process along with other federal and state laws for capturing proper and full claim reimbursements.
7. Are you HIPAA compliant?
Yes. Under HIPAA privacy rules, I am considered a Business Associate, and I am compliant with all applicable rules and regulations of the Healthcare Information Portability Accountability Act (HIPAA) of 1996. I am committed to keeping all PHI (Protected Health Information) that you entrust to me private and secure. I understand that keeping your patients' information safe is of the utmost importance, and I take my responsibility for this very seriously. A business associate agreement (BAA) will be provided to all provider clients.
8. What does it mean when a health plan is governed by ERISA?
Most healthcare providers and billing/RCM vendors believe that all claims fall under state insurance laws and regulations when it comes to a denial or underpayment of health benefits. This is not always true. If the denial or underpayment is for a claim with an employer-sponsored plan, the claim most likely falls under federal ERISA laws and not state insurance regulations.
9. How do I determine if a health plan is governed by ERISA?
The easiest way to identify if a health plan is an ERISA plan is to first determine if it's offered through an employer. It doesn't matter if it's PPO, HMO, POS, etc. All health benefit plans provided by an employer engaged in commerce are ERISA plans so long as the employer is not government (federal, state, county, or city) or a religious organization. ERISA does not cover Medicare, Medicaid, governmental, school, church, workers' comp, military, and individual plans. However, ERISA does cover employer-sponsored Medicare Supplemental Plans.
10. Does it matter if our billing is in-house or outsourced?
No. I work with procedures you already have in place, and there's no interruption to your existing billing process. For claims that I appeal, I will be your external Special Appeals Department, handling your claims after your billing staff or vendor has already exhausted their insurance collection efforts.
