When it comes to the law, the reflex is to say “I just want to stay out of trouble.” Of course you do, but can the law ever be your friend? Yes it can, especially if you know it better than the guy on the other side of the table. My guest today is an expert on ERISA, a law that is quite broad and applies to practices almost daily. He helps his clients apply ERISA to their benefit, and he’ll give us a few tips on this episode.
David Zetter is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 24 years of operational and healthcare experience. David is nationally recognized for his speaking, presentations and healthcare business expertise. He is well versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients, but also through consultant colleagues and healthcare attorneys across the country. David is an expert on ERISA regulations, which protect over 80% of the claims in the US, and he knows how to stop payor recoupments dead in their tracks and what is legal and illegal in many payor contracts. David’s firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management.
In this episode Carl White and David Zetter discuss:
- ERISA – its definition and scope, and the role of a fiduciary
- How practice owners can invoke ERISA to fight health insurance carriers 1) on systematic denials, 2) when the carrier is negligent, and 3) if a dispute goes to court
- How to fight an ERISA dispute related to a denial or underpayment
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Connect with David Zetter
https://www.linkedin.com/company/zetter-healthcare/
https://www.linkedin.com/in/djzetter/
Connect with Carl White
Website: http://www.marketvisorygroup.com
Email: whitec@marketvisorygroup.com
Facebook: https://www.facebook.com/marketvisorygroup
YouTube: https://www.youtube.com/channel/UCD9BLCu_i2ezBj1ktUHVmig