Performance Driven

In today’s health care climate, hospitals need to find new sources of revenue. Medicare and Medicaid reimbursements alone is not enough. Most profits that are to be gained must come from patients who have commercial insurance.

Unfortunately, commercial payers add to this problem by denying a large portion of claims causing providers to write-off desperately needed revenue. Re-appealing, through ordinary methods has limited success, often serves only to delay the write-off process and is very time consuming for very little
achieved benefit

Hospitals needed to identify a new revenue stream to help infuse the hospital with additional cash. With a large amount of written-off claims collecting dust, it only seemed logical to target this pool of lost revenue.

Most hospitals do not have the resources or expertise to file a valid federal ERISA appeal – it’s too complicated and too labor intensive. ERISA can be leveraged for certain commercial claims, particularly when reimbursement is less than expected and all appeals avenues were unsuccessful.

A valid and compliant ERISA appeal will ensure maximum benefit reimbursement or recovery for denied benefit claims, in accordance with the United States Supreme Court unanimous ruling in Aetna v. Davila (2004).

ERISA Recovery understands the difference. We are Experts in the ERISA appeals process and can assist you in recouping a good portion of the revenue that you have had to write-off.

PPACA fully adopted all ERISA rules and regulations – 

System access with this client was granted including our first report in September 2016. To date, off of 7-quarterly reports ER was able to recoup revenues of over $2.7M.

Currently there is an additional $7.7M in appeals and $14.8M currently being vetted through our proprietary ERISA appeals process. With consistent reporting revenues will continue to increase! ER takes a very analytical approach vetting reports which would produce the most revenues for our client. The only lift we ask from our clients is to generate reports. ER  does all the heavy lifting!