Seminar -- Hospital Association

Believe it or not, misconceptions about ERISA exist at every level. Multi-disciplinary groups, local practitioners, large practice groups — and even hospitals — have all “heard” about ERISA, but do they know that it is powerful “medicine”. Richard was invited to a recent gathering of hospital revenue cycle and contracting personnel in California. The gathering was sponsored by a newly merged set of hospital associations who wanted to learn more.

With a show of hands, most of the crowd thought that ERISA was “bad”. Their source: “That’s what the insurance companies told us.” Well, much to their surprise, these executives found out how they can take advantage of the ERISA statute, its governing Department of Labor regulations, and how putting these tools into action could increase their bottom line.

One way to use ERISA is to prevent the “takebacks” of funds that the health insurance companies have paid on prior claims. These unlawful entries on EOBs represent an invasion of ERISA trust funds by a claims administrator. Taking money on current, unrelated claims is a “big no no” as we call it here at Quadrino Law Group.

Richard also explained how provider agreements are actually partially “pre-empted” by ERISA. This means that health insurance companies cannot enforce many of their beloved contract terms regarding audits and recoupment.

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