Cypress, CA - March 31, 2004 - To help healthcare
providers understand and benefit from protections under
California's new fair payment practices regulations, ERN
Enterprises, Inc. announced today the kickoff of the STOP THE
ABUSE CAMPAIGN that takes registrants into a two (2) day boot
camp on laws that prohibits Knox-Keene licensed-health plans
(HMOs, Blue Cross PPO, and Blue Shield PPO) from engaging in
unfair payment patterns and authorizes the California
Department of Managed Health Care (DMHC) to fine and penalize
plans that engage in such practices.
Front and back end operations play a significant role in
increasing a provider's high quality, census/patient flow and
fiscal ratings. While these professionals cannot control how
much experience a provider has with different types of care or
the time patients arrive in an urgent care or emergency
department, they can dramatically increase the cash flow and
quality care of a facility, if they possess the education,
knowledge and skills to avoid unnecessary claim delays and
denials and aggressively advocate for medically appropriate
healthcare that helps patients recover and more importantly,
survive.
DAY 1 of the program is an 8-hour training course on "How
to Identify and Combat Unfair Payment Practices" defined under
the Knox Keene Act and New AB1455 Regulations. Under
California law, an "unfair payment practice" means any
practice, policy or procedure that results in repeated delays
in the adjudication and correct reimbursement of provider
claims, including, but not limited to:
Time periods to acknowledge receipt of claims not met;
Overpayment request asserted too late and not requested in
accordance with State law; Attempts to rescind or modify an
authorization for health care services; Accepting (failing to)
late claims under appropriate circumstances; Bills that have
not been timely paid, properly contested or denied; Emergency
Service Claim Denials; Submission requirements of information
that is not reasonably relevant; EOBs that fail to set forth
the specific reasons for denying, or contesting a claim.
OUR SEMINARS WILL INSPIRE AND EMPOWER YOUR STAFF TO
MAXIMIZE IN-HOUSE RECOVERIES, DRAMATICALLY IMPROVE PATIENT
CARE AND YOUR BOTTOM LINE!
Too often,we OVERESTIMATE
the event and UNDERESTIMATE the process. To equip registrants
with strength and confidence for the battle, DAY 2 is a
hands-on workshop that combines online and face-to- face
activities (including self-assessment, EOB review, role play,
emergency claims counseling and auditing of delinquent claims,
collaboration, discussions and presentations) to help them
apply their newly acquired knowledge and skills to actual live
situations.
The Day 2 Workshop will provide one-on-one sessions with
your staff at their workstations (as they work on claims) and
conclude in the classroom for a final overview session. One
registrant at CHW successfully resolved a delinquent patient
claim for over $275,000, after sitting just one hour with one
of our Master Trainers!
"I LEARNED MORE IN TWO HOURS THAN I DID IN FIFTEEN
YEARS!"-- Adam Paul, COO, Coastal Radiation
In just two
(2) powerful days of this life-changing atmosphere, you will
learn: A basic understanding and application of current
California prompt payment laws and how some interpretations
may pose real dangers to a provider, their autonomy and
financial well-being. How to identify "unfair payment
practices" and how they affect the delivery process. When to
take aggressive action--How to discover non-compliance of
statutory codes and enforce obedience to the law. Denial
Notice Requirements in California. Case law and its
application to the dunning campaign and statutory citations.
How to enforce a forfeiture of discounted fee for service when
payment is made untimely. How to detect and respond to an
E.O.B. or denial that does not comply with State regulations,
statutes and/or case law. Combat techniques on how to address
routine denials and delays such as: timely filing
requirements, coordination of benefits, third party liability,
retroactive denials on authorized/verified services, above
usual and customary, not medically necessary, unauthorized
treatment, pre-existing, underpayments, refunds and MUCH MORE!
Who Should Attend: CFOs, Senior Management, Managed Care
Personnel, Utilization Review Managers, Case Managers, Nurse
Auditors, Billing/Collection Personnel, Insurance Clerks,
Business Office Supervisors, Managed Care Contract Manager,
and Admissions Coordinators.
Registration Information
The STOP THE ABUSE
CAMPAIGN is conducted at your campus, facility or office
location and can be customized for OUT OF STATE Providers as
well. The fee of $199.00 for ERN Alumni members/per person and
$249.00 for non-Alumni members/per person includes: 1. 16
powerful and dynamic hours of pure, unrelenting, mesmerizing,
no-holds barred Ed Norwood and his expert consultants. 2.
Hundreds of pages of informational and practical instructional
materials 3. Case Study Examples 4. Sample Policy and
Procedures 5. Ready to Use Appeal and Demand Letters with
Statutory and Case law. Travel Expenses are NOT included.
Company Website: http://www.ernenterprises.org
Faculty
Ed Norwood, President of ERN Enterprises,
has been acknowledged as a unique and distinctive authority in
the field of Administrative Laws that govern the Healthcare
Delivery Process and Team Development. As a proven National
Advocate for Patient and Provider Rights, Ed is a dynamic
leader with energy and vision who has demonstrated the
critical ability to stimulate true breakthrough thinking and
execution throughout organizations such as The California
Ambulance Association, CAHAM, Tenet Healthcare, HCA, Catholic
Healthcare West, Adventist Health, Memorial Care and a host of
other associations and providers.
Tax Deduction. Pursuant to Treasury Regulation 1-162- 5, an
income tax deduction is allowed for educational expenses
undertaken to (1) maintain or improve skills required in one's
employment or trade business; or (2) meet expressed
requirements of an employer or law imposed as a condition to
retention of an employment, job status, or rate of
compensation. Attendants are advised to consult their tax
advisors and maintain a daily record of their expenditures
pursuant to Treasury Regulation 1-162-5.
The intent of
this program is to present accurate and authoritative
information in regard to the subject matter covered. It is
presented with the understanding that ERN Enterprises is not
engaged in the rendition of legal advice. If legal advice or
other expert assistance is required, you should seek the
counsel of an attorney with the expertise in the area of
inquiry.
