Healthcare Reform Law PPACA Claim Specialists: New Legal Assignment of Benefits Required Under New Federal Provider’s Bill of Rights

Hanover Park, IL (Vocus/PRWEB) January 17, 2011

On January 17, 2011, ERISAclaim.com officially released 2011 updated Legal Assignment Of Benefits (AOB) (aka Designation Of Authorized Representative) Forms And Notices, to comply with newly effective Federal Health Reform Law for all healthcare providers, as PPACA’s new Providers’ Bill Of Rights provisions of Patient Protection and Affordable Care Act (PPACA), for all health plans and individual insurance policies. Legal AOB is the most important legal link between new Federal Patient’s Bill Of Rights and Provider’s Bill of Rights in order for a healthcare provider to be legally considered as a claimant under new PPACA Claims and Appeals Regulations, which went into effect on Sep. 23, 2010, with an enforcement grace period until July 1, 2011 to give plans and issuers necessary time to make certain procedural and computer system changes to comply with the new requirements. Traditional AOB’s in healthcare industry are not in compliance with PPACA. The new 2011 AOB Forms and Notices are parts of ERISAclaim.com’s ERISA and PPACA Appeals Books and System for Healthcare Reimbursement.

“For the first time in history, new Federal PPACA Claims and Appeals Regulations define a healthcare provider in terms of a valid authorized representative as a claimant as the patient, with 100% & complete rights as a patient, to enjoin all reimbursement protections under new Patient’s Bill of Rights, for all participating and non-participating providers,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA Claims.

“Now, for the first time, Provider’s Bill of Rights is the same as Patient’s Bill of Rights,” explained Dr. Jin Zhou, from his legal research of managed care litigations in the past decades and PPACA compliance consulting and teaching. “That is why ERISAclaim.com completely updated its AOB Forms and Notices for PPACA compliance in 2011 for reimbursement protections as a result of nationwide healthcare litigations, class actions and reimbursement crisis,” added Dr. Zhou.

A claimant is now defined under new Federal PPACA Claims and Appeals Regulations as following:

“(iii) Claimant. Claimant means an individual who makes a claim under this section. For purposes of this section, references to claimant include a claimant's authorized representative.” [Page 43355]
http://webapps.dol.gov/FederalRegister/HtmlDisplay.aspx?DocId=24056&AgencyId=8&DocumentType=2

“This Provider’s Bill of Rights is especially new and important for all non-participating providers, as these non-participating providers will have the same rights in receiving direct reimbursement checks, coverage verifications and appeals rights as patients and all participating providers, if the non-participating providers have valid legal AOB’s and became claimants under PPACA,” reiterated by Dr. Zhou.

However, Dr. Zhou alerted, a provider’s rights under PPACA are not automatic, without additional compliance by a healthcare provider, as PPACA adopted ERISA claim regulation, 29 CFR 2560.503-1, in its entirety, and DOL EBSA ERISA FAQ declared traditional AOB as non-compliance and invalid under ERISA, thus invalid under PPACA. Only a valid legal AOB under ERISA will be valid AOB under PPACA, for a true Provider’s Bill of Rights.

ERISA regulation, 29 CFR 2560.503-1, was adopted as minimum standards under new Federal PPACA Claims and Appeals Regulations:

“Minimum internal claims and appeals standards. A group health plan and a health insurance issuer offering group health insurance coverage must comply with all the requirements applicable to group health plans under 29 CFR 2560.503-1,……” [Page 43355]
http://webapps.dol.gov/FederalRegister/HtmlDisplay.aspx?DocId=24056&AgencyId=8&DocumentType=2

DOL ERISA FAQ declared traditional AOB non-compliant and invalid:

“B-2: Does an assignment of benefits by a claimant to a health care provider constitute the designation of an authorized representative?

No. An assignment of benefits by a claimant is generally limited to assignment of the claimant’s right to receive a benefit payment under the terms of the plan. Typically, assignments are not a grant of authority to act on a claimant’s behalf in pursuing and appealing a benefit determination under a plan…….”
http://www.dol.gov/ebsa/faqs/faq_claims_proc_reg.html

ERISAclaim.com PPACA & ERISA Claim Specialists Certification Programs are established to provide expert guidance in understanding, implementation and compliance with PPACA:

Complete Affordable Care Act Regulations and Guidance can be found on DOL website:
http://www.dol.gov/ebsa/healthreform/

HHS, DOL & IRS: “Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights”
http://www.healthreform.gov/newsroom/new_patients_bill_of_rights.html

HHS, DOL & IRS News Release: “Administration Announces New Affordable Care Act Measures to Protect Consumers and Put Patients Back in Charge of Their Care”
http://www.hhs.gov/news/press/2010pres/07/20100722a.html

HHS, DOL & IRS: “Fact Sheet: The Affordable Care Act: Protecting Consumers and Putting Patients Back in Charge of Their Care July 22, 2010
http://www.healthcare.gov/news/factsheets/protectconsumers_factsheet072210.pdf

For more information on how to become an ERISA-PPACA & ERISA Claims Specialist under new and existing federal appeals regulations: http://www.erisaclaim.com/certification.htm.

Information on ERISAclaim.com’s ERISA & PPACA Appeal Books: http://www.erisaclaim.com/products.htm

Located in a Chicago suburb in Illinois, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers. For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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Read the full story at http://www.prweb.com/releases/2011/1/prweb8070141.htm