Healthcare

Monday, 23 November 2015

Four ways healthcare providers can boost revenues and reduce risk

Written by Ginny Martin, CMA, CPC, CPCO, CHBC

In an increasingly complex regulatory environment, healthcare providers must be vigilant to protect their revenue streams and manage risk. Here are four areas providers should focus on now. 1. Disproportionate share hospital payments Under federal law, CMS is required to make additional payments to qualifying hospitals that serve a disproportionate number of Medicaid and uninsured patients...

Published in Healthcare
Tuesday, 03 November 2015

Who pays for reinsurance contributions after a midyear funding change?

Written by Thomson Reuters

Question: Our company sponsors a calendar-year plan, and we changed from a fully insured health plan to a self-insured plan starting on July 1, 2015. We’ve always offered only one coverage option to our eligible employees. How does this change affect the payment of reinsurance program contributions for 2015? Answer: When the funding arrangement changes midyear, each contributing entity — in other words, the insurer and the self-insured health plan — is responsible for paying part of that year’s reinsurance program contributions...

Published in Healthcare
Tuesday, 03 November 2015

IRS publications address electronic information reporting

Written by Thomson Reuters

Beginning next year, many employers will have to file Forms 1094 and 1095 to provide information to the IRS and plan participants regarding health care benefits. The agency will use the forms to enforce the Affordable Care Act's (ACA's) shared-responsibility (or "play or pay") provision, as well as individual mandate and tax credit eligibility rules. If required to file these forms, you may want to do so electronically. To help employers with this process, the IRS has released two final publications setting out specifications for voluntary electronic filings in 2015 via the new ACA Information Returns (AIR) system...

Published in Healthcare
Tuesday, 03 November 2015

Retiree-only HRAs: An ACA-friendly benefits strategy

Written by Thomson Reuters

Many employers establish an HR strategy that encourages, or simply enables, employees to retire before the age of 65. In some cases, they do so to make it easier for staff to start enjoying their golden years a little earlier. In others, the idea is to create opportunities for younger workers. Whatever the reason, retirement before Medicare eligibility at 65 is more viable if retirees can get help with their health insurance premiums...

Published in Healthcare
Monday, 05 October 2015

Forms 1094 and 1095: IRS issues final forms and instructions

Written by Thomson Reuters

Beginning in early 2016, many employers must file Forms 1094 and 1095 to provide information to the IRS and plan participants about health coverage provided in the previous year. The forms will be used by the IRS to enforce the Affordable Care Act’s (ACA’s) shared-responsibility (or “play or pay”) provision, as well as individual mandate and tax credit eligibility rules. The forms come in two versions: “B Forms” and “C Forms.” The B Forms (1094-B and 1095-B) are filed by providers of health care coverage — mostly insurers, but also some self-insuring employers and others...

Published in Healthcare
Monday, 05 October 2015

Must stop-loss insurance comply with the ACA’s group plan rules?

Written by Thomson Reuters

Question: Our company self-insures its major medical plan and buys stop-loss insurance to guard against the risk of higher-than-expected claims. We amended the plan to comply with the Affordable Care Act (ACA) — including covering children to age 26 and covering in-network preventive care without cost-sharing. But our insurer says that our stop-loss policy doesn't have to cover all of these changes. Doesn't stop-loss insurance have to comply with the ACA?..

Published in Healthcare
Friday, 04 September 2015

Do integration rules limit our use of HRA contributions as rewards?

Written by Thomson Reuters

Question: Our company has a wellness program that’s open to all employees. To improve participation in that program, we’d like to start offering rewards in the form of Health Reimbursement Account (HRA) contributions. Most of our employees already participate in a general purpose HRA as part of their major medical coverage. So we’d like to simply expand that HRA to cover everyone else...

Published in Healthcare
Friday, 04 September 2015

IRS issues second notice on Cadillac tax implementation

Written by Thomson Reuters

In late July, the IRS issued Notice 2015-52 addressing the 40% excise tax on high-cost employer-sponsored health coverage. Popularly known as the "Cadillac tax," this particular provision of the Affordable Care Act is set to take effect in 2018. It generally will apply to the extent that coverage exceeds certain thresholds. Supplementing Notice 2015-16 that was issued in February, the new notice describes additional proposals regarding the cost of applicable coverage — particularly with respect to account-based arrangements...

Published in Healthcare
Friday, 04 September 2015

Beware of rising pharmacy benefit costs

Written by Thomson Reuters

The proportion of total health care benefit costs represented by pharmaceuticals is rising rapidly. Last year, more than three-quarters — 77% — of employers reported that pharmacy benefit costs were at least 16% of the total, according to the fifth annual Prescription Drug Benefit Survey by Buck Consultants at Xerox. That number was up from 57% five years earlier, according to the same report. Also, nearly 5% of employers in the survey reported that drug benefits represented more than 30% of the total, while only half that number reported exceeding 30% last year...

Published in Healthcare
Friday, 14 August 2015

Affordable Care Act Reporting Requirements

Written by Rehmann Team

The IRS has developed a series of forms that will be used to implement the reporting requirements contained in the Affordable Care Act (ACA) The ACA requires applicable large employers (ALE) to file information returns with the IRS and provide statements to their full-time employees about the health insurance coverage the employer offered. An ALE is an employer that employed at least 50 full-time employees, and full-time equivalent employees, during the prior calendar year. A full-time employee generally includes any employee who was employed on average at least 30 hours or more of service per week. Under the regulations, an ALE may be a single entity or may consist of a group of related entities...

Published in Healthcare
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