ERISA (the Employee Retirement Income Security Act of 1974) is a set of federal laws and regulations that govern welfare benefits plans and qualified retirement plans. ERISA was enacted in 1974 and signed into law by President Ford on September 2, 1974, Labor Day. ERISA applies to all employee pension, health, and other benefits plans established by private sector employers (other than churches) or by employee organizations such as union.

There are, amongst others, two essential components of ERISA. The first is in the administrative rules governing these plans. ERISA establishes standards of conduct, responsibility and obligations for fiduciaries of employee benefit plans. Even though ERISA has been substantially amended at least 40 times since it was passed over 35 years ago, what has remained the same has been ERISA’s requirments that any procedures for allocating responsibilities for the operation and administration of a plan must be described under the plan. ERISA also requires disclosure of other required documents in addition to Summary Plan Descriptions (“SPD”) such as Summary Annual Reports (SARs), Summary of Material Modifications (SMMs), and annual Form 5500s.

The second is related to fiduciary conduct. ERISA mandates what is described as the “prudent person rule” which means that a fiduciary’s actions will be compared against those of a hypothetical prudent person. Fiduciary duties also include avoiding conflicts of interest and minimizing financial risks. Whether a fiduciary acted prudently in any given situation depends on the facts circumstances of each case.

As most medical professionals will admit, their biggest challenge is keeping up with the continuing evolution and changes in rules and regulations in the health care industry while still giving the best in patient care. Given today’s legal and regulatory scrutiny, healthcare providers not only must wear multiple hats and work a multitude of hours for minimal pay, but often they feel patient care suffers as a result of these demands.

AccordMS Can

• Develop effective internal operating procedures
• Ensure compliance with regulations, payment policies and coding rules
• Improve medical record documentation procedures
• Minimize billing mistakes, reduce denial of claims
• Attain quicker proper payment of claims utilizing the proper ERISA appeals strategies