By: Pearl Walia What is ERISA in Simple Terms? ERISA, the Employee Retirement Income Security Act of 1974, is a federal law that establishes standards for most employer-sponsored retirement and health benefit plans in order to protect employees’ retirement assets. Before ERISA, employers often mishandled funds and failed to deliver promised benefits, leaving workers vulnerable to arbitrary coverage denials. In
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Revenue Recovery Series Part 2: What is a Clinical Denial and How is it Different From Standard Administrative Appeals?
By: Pearl Walia Healthcare providers routinely face claim denials from payers, but not all denials are the same. Understanding their differences is critical to effectively manage revenue cycle operations. A clinical denial occurs when a payer determines that a medical service, procedure, treatment, or admission does not meet its coverage requirements. Clinical denials differ from administrative denials, which typically result…
Understanding Provider–Payer Disputes: Key Issues in Reimbursement, Denials, and the NSA IDR Process
By: Pearl Walia Changes in politics, public policy, and economic conditions continue to influence contract negotiations between healthcare payers and providers. Shifts in reimbursement legislation, regulatory requirements, Medicaid eligibility rules, and compliance obligations all affect how parties evaluate contractual provisions. As a result, payer disputes remain a persistent and significant challenge across the healthcare industry. Payers include health insurance companies…
In the Spotlight: Jamaal Jones Joins Gary Miles on The Free Lawyer Podcast
Jamaal Jones, Esq. was recently featured on The Free Lawyer Podcast, where they discussed Jamaal’s professional journey, insights into the legal industry, and the values that continue to guide our firm’s work. Listen now on Apple Podcast and Spotify
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Revenue Recovery Series Part 1: What is Revenue Cycle Management and What are Recent Trends in Lost Revenue?
By: Pearl Walia Revenue Cycle Management and the Current Landscape of Lost Revenue Revenue cycle management (RCM) refers to the financial process used by healthcare organizations to track and collect incoming patients, and encompasses the entire revenue lifecycle: from the initial patient scheduling to the final payment collection. Deficiencies in an organization’s RCM processes such as timeliness, accuracy and missing…
What is a Physician Income Guarantee Agreement and How to Negotiate with a Hospital?
By: Pearl Walia An Income Guarantee Agreement is a type of forgivable loan provided by a hospital to a physician who is newly entering practice. Under this agreement, the hospital offers financial support to help the physician establish their practice within the community. If the physician makes the guaranteed amount under the agreement and continues to practice in the community…
Jamaal Jones is Interviewed on the Missing Briefs Podcast
Dominic Grew and Bob Furlong invited Jamaal Jones on the Missing Briefs Podcast for an engaging discussion filled with insights, stories, and valuable takeaways. Tune in to hear the full conversation and discover what they had to say. Listen to the episode here.
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ABA Payer Audits and What Providers Need to Know What is a Payer Audit
By: Pearl Walia For Applied Behavior Analysis (ABA) providers–those who offer research-based behavioral therapy–receiving notice of a payer audit or payment suspension can be one of the most disruptive events their practices face. An ABA payer audit occurs when a health insurance company conducts a formal review of a provider’s claims, documentation, and billing practices to verify that its services…
Jones Health Law Strengthens Connections at the Florida Dental Convention
Jamaal Jones connects with dental professionals, industry leaders, and colleagues at the Florida Dental Convention in Orlando. Attending events like these is a valuable opportunity to stay informed on the latest developments affecting the dental community while building meaningful relationships
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Jamaal Jones attends the 2026 World Health Expo at the Miami Beach Convention Center
Jamaal Jones attended the World Health Expo in Miami, where healthcare leaders, innovators, and professionals came together to shape the future of the industry. As an attorney, it’s invaluable to stay connected to the legal, regulatory, and business developments impacting healthcare.
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