July 1, 2011 – U.S. Hospitals’ PPACA Readiness for New Federal Claims & Appeals Laws
This preliminary Internet search revealed less than 0.001% education and implementation on PPACA & ERISA Claims & Appeals Regulations by about 5,815 hospitals, millions of healthcare providers and providers’ Associations (including AMA, AHA & HFMA).
“PPACA claims regulations under healthcare reform law should be the No. 1 priority for every hospital, as PPACA protects hospitals’ claims reimbursement and revenue cycle, for almost all non-
This preliminary Internet search was designed to assess the PPACA readiness of U.S. hospitals to appeal for the delayed or denied health claims by fully trained PPACA & ERISA Claim Specialist or
ERISAclaim.com's PPACA market research is in response to and a follow-up with a Congressional GAO PPACA report published on
Why ERISAclaim.com Did This Study?
PPACA required GAO to study the rates of coverage denials and appeals. ERISAclaim.com did this follow-up study to assess the PPACA readiness of hospitals and providers by
U.S. GAO, (GAO-11-268 March 16, 2011):
Why GAO Did This Study?
"The large percentage of Americans that rely on private health insurance for health care coverage could expand with enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. Until PPACA is fully implemented, some consumers seeking coverage can have their applications for enrollment denied, and those enrolled may face denials of coverage for specific medical services. PPACA required GAO to study the rates of such application and coverage denials. GAO reviewed the data available on denials of (1) applications for enrollment and (2) coverage for medical services.”
“Further, the data GAO reviewed indicated that coverage denials, if appealed, were frequently reversed in the consumer's favor. For example, data from four of the six states on the outcomes of appeals filed with insurers indicated that 39 percent to 59 percent of appeals resulted in the insurer reversing its original coverage denial. Data from a national study conducted by a trade association for insurance companies on the outcomes of appeals filed with states for an independent, external review indicated that coverage denials were reversed about 40 percent of the time.”
“Reversals of coverage denials were limited to denials for which an appeal was initiated. The data we reviewed did not allow for a systematic calculation of an “appeal rate”—the number of coverage denials for which an appeal was initiated—for several reasons, including different data sources or data years for denials and appeals data. Data from
“Please note that GAO reports that ‘Reversals of coverage denials were limited to denials for which an appeal was initiated’, a non-ERISA appeal, non-PPACA appeal or a ‘provider inquiry’ won’t count as an appeal”, explained Dr. Zhou.
On
On
On
http://www.dol.gov/ebsa/newsroom/tr11-01.html
Complete PPACA Regulations and Guidance can be found on DOL website:
http://www.dol.gov/ebsa/healthreform/
Since the enactment of PPACA on
Located in a
To find out more about the Total PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/Press_Releases.htm
For any questions, please contact Dr.
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Read the full story at http://www.prweb.com/releases/2011/6/prweb8532290.htm
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