By: PRWeb
Webinars On New Federal Penalties In $100 / Day / Patient On Insurers, HMO's, TPA's & IRO's Under External Review Laws

On August 24, 2010, IRS, DOL and HHS released new federal external appeal regulations with a detailed Technical Release for compliance, as one of the various new federal group health plan mandates, and for any noncompliance, imposing new excise tax penalties in $100 per day per patient, on IRS Form 8928 under Internal Revenue Code, 74 Fed. Reg. 45994, issued by IRS on Sept. 08, 2009, effective on Jan. 01, 2010, in the wake of the new Federal Appeals Regulations released by IRS, DOL and HHS on July 23, 2010. announced the nation's first series of new Webinars, Seminars & Certification Classes for healthcare providers, coding and billing professionals, and health plans, employers, insurers, HMO', TPA's & IRO's to comply with these new Federal External Appeals Regulations.

"With this $100 per day per patient excise tax as a new federal external review law violation penalty under PHS Act 2719(b) and new penalty in $1,000 per enrollee for "Mini-SPD" violation (Summary of Benefits and Coverage) under PHS Act 2715(f) of PPACA, and existing SPD Statutory Penalty in up to $110 per day per patient under ERISA 502 (c) & 29 USC 1132 (c), PPACA will revamp entire U.S. healthcare reimbursement practice after Sept. 23, 2010, going beyond the Patients Bills of Rights as attempted by President Bill Clinton," said Dr. Jin Zhou, President of, the only company in the country providing complete education and consulting on ERISA and PPACA reimbursement laws for healthcare providers in the past 10 years.

"A tax bite with $100 per day per patient shall be stronger teeth than that from the Patient Bills of Rights dreamed in 80' to 90's", said Dr. Zhou.

According to Dr. Zhou, in order to avoid these heavy penalties, the new Regulation Notice from IRS, DOL & HHS released on August 24, 2010 provides:

"If a plan complies with one of the interim compliance methods of this notice, no excise tax liability should be reported on IRS Form 8928 with respect to PHS Act section 2719(b): Compliance with the procedures outlined in Technical Release 2010-01......Voluntary compliance with State external review processes".

As further explained by Dr. Zhou, the Technical Release 2010-01 from IRS, DOL & HHS requires a health plan to make preliminary review decision within five business days and notify its decision within six business days after receiving such request for standard external reviews. Then the health plan must refer the case to a contracted external Independent Review Organization (IRO) accredited by URAC or a similar body. Both Plan and IRO's will be liable for compliance with Technical Release 2010-01, thus liable for excise tax as a result of failures.

For a copy of Technical Release 2010-01:

Most importantly, from practical and legal stand of points, to both health plans and providers, as cautioned by Dr. Zhou, the new Federal Appeals Regulations released by IRS, DOL & HHS on July 24, 2010 require health plans to "strictly adhere to all the requirements of" ERISA and PPACA claims regulations, as PPACA incorporated ERISA claim regulation as minimum requirements, in addition to new "Additional Standards" and "Continued Coverage" standards. In any failure by a plan to 100% comply with internal appeal laws under ERISA & PPACA, the new federal external appeal right is triggered, and in any failure by a health plan or IRO to comply with new Federal External Review Laws, $100 excise tax penalty is triggered against the plan, IRO or employer, as "if a plan does not satisfy these requirements, an excise tax is imposed of $100 per day per affected beneficiary" under Internal Revenue Codes.

Sec. (b)(ii) (F) of Interim Final Rules on Internal Claims and Appeals and External Review Processes from IRS, DOL and HHS provides in part:

"(F) Deemed exhaustion of internal claims and appeals processes. In the case of a plan or issuer that fails to strictly adhere to all the requirements of this paragraph (b)(2) with respect to a claim, the claimant is deemed to have exhausted the internal claims and appeals process ...... Accordingly the claimant may initiate an external review......"

As demystified by Dr. Zhou, PPACA has imposed strict adherence to or 100% compliance with ERISA and new federal external review laws under PHS Act section 2719(b), as a part of various federal group health plan mandates, such as HIPAA or COBRA, for all group health plans, under Internal Revenue Code, 74 Fed. Reg. 45994, for all employers, Insurers, HMO's, TPA's and IRO's. An excise tax liability must be reported on IRS Form 8928 for any noncompliance with new federal external reviews laws.

Any healthcare providers or patients can report any such violations to IRS, in addition to the plan's or insurer's self-reporting liability to IRS for this excise tax, a copy of the IRS Instruction Form 8928 can be found on IRS website: has been offering these educational Webinars, Seminars and Certifications Classes on ERISA for 10 years and on new Health Reform Laws since the Health Bill was signed into law by President Obama on 03/23/2010. These ongoing Webinars, Seminars and Certification Classes were scheduled on bi-weekly, monthly and customer request basis to teach basic, practical and expert level of appeals practice strictly in accordance with new and existing Federal Appeals Regulations for all types of claim denials and delays. For more information, please visit, or contact Dr. Jin Zhou, president of, at 630-808-7237.

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