Physicians’ practices struggling with ERISA reimbursement issues can now rely on Outsource Strategies International (OSI) to appeal and collect denied payments for services provided to patients in an ERISA health plan.
A federal law, ERISA or the Employee Retirement Income Security Act of 1974 impacts all U.S. pension plans and life, disability, health, accident insurance benefit plans except governmental plans, benefit plans sponsored by religious organizations, and those in which only business owners but no employees are members.
OSI’s insurance benefit verification services are designed to identify gaps and errors before claims go out. However, insurance companies are found to deny ERISA claims on many grounds. OSI provides physicians with services to appeal unpaid claims including retroactive adverse benefit denials, inclusive denials, and experimental denials, negative remittances, and incorrectly paid claims.
OSI has a team of professionals on the job including AAPC-certified medical coders, billing specialists, and experts in claim scrubbing and appeal processing. They are well versed in ERISA law and appeals procedures. This ensures smooth and hassle-free processes to ensure maximum reimbursement. Every claim is checked for 100% accuracy before submission. Appropriate modifiers are used with the appropriate procedure codes. National Correct Coding Initiative (CCI) edits are checked to ensure that procedures are submitted correctly.
If ERISA claims are denied, the company’s appeals team initiates the appeal process within the specified time-frame to ensure accurate and prompt reimbursement. The team
- Ascertains that all the documents necessary for the appeals process are in place
- Examines the Summary Plan Description (SPD) to verify the authenticity of the denial
- Verifies the claim submission time frame, benefits, and payment responsibilities of the payer as well as the patient
- Verifies the appeals process in the SPD and initiates appeal processes in accordance with ERISA law
- Collect payments from patients where they are responsible
ERISA’s regulation of health benefits has a significant impact on physicians and patients as well. By making it easier to pursue collection, OSI’s comprehensive ERISA reimbursement services are proving lucrative and worthwhile for contracted and non-contracted physicians as well as for their patients.