Improving Your Bottom Line

Healthcare Revenue Solutions that Fit

ERISA Appeals, Claim Denials, Medicare/Medicaid Reimbursements

Custom Solutions for Hospital Revenue Recovery

According to the American Hospital Association, over the last 12 years, roughly 30% of all hospitals in the United States have suffered from a negative operating margin (i.e. lost money). Part of this negative margin is written-off insurance claims. Whether it’s inefficient processes, lack of resources, or technological limitations, some claims fall through the cracks. Any hospital that struggles to keep up with reimbursements and appeals can benefit from ERISA Recovery.

At ERISA Recovery, helping our clients reclaim their lost revenue is our passion. ER focuses on claims that have been completely written off by using Federal ERISA appeals. ER is the leading expert in recovering dead dollars. Our process brings millions back to the hospital.

General Services

ERISA Appeals

Gain a virtual appeals department that makes full use of the administrative appeal process defined by ERISA that involves automated data-mining of claims to identify ERISA potential. No upfront costs or hospital resources are needed.

Claim Denials

Accelerate reimbursement, minimize denials and establish successful core practices over the entire claim cycle via clean claims. All our claims are worked stateside as we help you recover ALL types of complex, dead commercial claims.

Medicare - Medicaid Reimbursements

Navigate increasingly complex Medicare/ Medicaid cost reports. Our accuracy and compliance ensure uninterrupted and maximized reimbursements for you. Benefit from the billions of dollars usually written off yearly.

Clinical Denials

We recover claim denials based on common payer objections, such as the patient’s length of stay, level of care, or degree of medical necessity, whether claims are concurrent with the patient’s in-house stay or years following discharge.

Specialty Services

Technical Denials

Even when claims are based on medically necessary treatment and otherwise entirely legitimate, if hospital billers fail to meet all procedural requirements, commercial insurers will deny them.

We’ll identify the best opportunities to reverse denials by correcting coding errors, providing additional medical records, creating itemized bills, and other administrative tasks to secure payment based on medical necessity.

Motor Vehicle Accidents (MVA)

The billing and coding process for motor vehicle accident claims can be complex. Commercial insurers routinely deny, delay, or underpay these claims due to common coding errors.

Our proprietary methods and systems expedites investigation into all applicable policies that provide MVA coverage. We can quickly verify all coverages, correct any coding errors, and ensure timely payment on MVA claims.

Workers Comp

Due to complex processes, hospitals often struggle to collect workers’ compensation claims in full. Even clean claims are routinely rejected due to errors in attempting to follow obscure procedural requirements.

Many workers’ comp denials are readily reversible. Using our proprietary machine learning technology, our experienced coders will quickly find underpaid and denied WC claims that are winnable on appeal.

Underpayments/Zero Balance

Most recovery efforts target outright claim denials because they stand out on the balance sheet. Meanwhile, millions of dollars are lost due to claims that were underpaid. The balance is written off and zeroed out.

Let us quickly identify these unseen revenue opportunities by auditing your paid (zero balance) accounts for clear evidence of underpayment on claims that we’re confident we can quickly win on appeal.

Veteran’s Affairs

The VA reimbursement process is a tedious, complex maze, all for notoriously low reimbursement. Even hospital billers with specialized expertise find the process time-consuming and cost-prohibitive.

Your revenue cycle team’s time can be put to better use than attempting to reverse VA claim denials. We’ll investigate these denials for you at no upfront cost to prioritize and appeal your best recovery opportunities.

Denials Management/Special Projects

When denied, delayed, or underpaid claims increase, hospital revenue cycle teams often lack the resources to identify all the root causes. It’s difficult to create an effective recovery strategy without the full picture.

Our machine-learning system can quickly help you identify where your hospital is losing revenue and why. We prioritize claim denial types most winnable on appeal to recover revenue and help you prevent future denials.


Your New, Risk-Free Claims
Recovery Opportunity

Collecting claims and payments for hospital services can be extremely challenging. The number of employee man-hours and resources required to simply collect payments can be very costly. Complicating the process are various state and federal laws. Producing results means either exhaustive, brute-force efforts, or developing a better tool. Fortunately, we have made such a tool through the use of federal ERISA (Employee Retirement Income Security Act) law.

The federal ERISA law could be the most misunderstood law in the United States. Understanding the ERISA law is crucial to being able to intelligently appeal and collect denied insurance claims as a patient advocate. Yet ERISA law is not taught as a core subject in law school, and less than 2% of attorneys have ever even studied it as an elective.

As experts in this area, ERISA Recovery brings a wealth of knowledge and experience assisting hospitals in their negotiations with payors, insurance companies, and contract intermediaries. By properly applying this law, ERISA Recovery can help hospitals potentially deliver substantial portions of the contractual amount for any claim where the commercial insurance coverage was issued by an employer’s self-insured plan. (Government, church, and a few other minor categories are exempt).

We do all our work stateside and are contingency-based. There are no upfront fees for our services in the administrative appeal process. All fees paid to us are a percentage of new claims payments delivered directly to the hospital. There is absolutely no risk to the client hospital, and our payment is contingent on our client getting paid first. Our proven approach has been utilized successfully by hospitals and other providers all across the United States for over ten years.

Did You Know
  • The ERISA Law asserts that “anything less than 100% payment of the claim” is considered a healthcare claim denial, and is therefore eligible for appeal.
  • All disputes, claims, and appeals over benefits paid under employer-sponsored healthcare plans are bound by very specific ERISA procedures.
  • While the Department of Insurance governs fully insured employee healthcare plans, the ERISA law governs self-insured employee healthcare plans, which make up two-thirds of all current health insurance coverage in the US. The “insurance company” is actually not the company that issues the policy; they simply provide administrative services as a claims processor, and they provide the PPO network.
  • All contracts written by the network, PPO, HMO, etc. are superseded by the ERISA Law, as well as all state laws and all insurance company rules. Therefore, two-thirds of all healthcare plans in the US are strictly bound by the federal ERISA Law.
  • Any third party who administers claims and provides a PPO network is defined merely as an “agent” of the employer. This means the employer is still legally considered to be the fiduciary.

The ERISA Recovery Difference

Our claims recovery process acts as a virtual appeals department, providing an outside service that makes full use of the administrative appeal process defined by ERISA.

Thanks to our highly trained and experienced recovery team, we’ve helped recover millions of dollars for providers across the US. We can recover previously written-off denials on cases dating as far back as January 2003.

Our claims recovery services require minimal involvement from hospital staff. Initiating our service takes only about three hours of setup time and one hour per month for maintenance.

Our service has been thoroughly vetted by multiple clients through law firms and state hospital associations, affirming all statements to be within ERISA federal law and procedures.