Healthcare

Tuesday, 04 November 2014

IRS proposes changes to play-or-pay measurement periods

Written by Thomson Reuters

Under the Affordable Care Act (ACA), large employers (as defined under the act) risk a penalty if they don’t offer affordable, “minimum essential” health care coverage to their full-time employees. This is the concept popularly known as “play or pay.” In September, the IRS released Notice 2014-49 to propose approaches for identifying those full-time employees in situations where the measurement period applicable to an employee changes. Available methods Under the final play-or-pay regulations, applicable large employers may identify full-time employees using either of two methods: 1...

Published in Healthcare
Tuesday, 04 November 2014

Offer a cafeteria plan? New election changes now allowed

Written by Thomson Reuters

If your organization offers a cafeteria plan, take note: The IRS has expanded the permitted election change rules. Now allowed are midyear election changes for two additional situations in which employees may want to drop their employer-sponsored health care coverage. Beginning Sept. 18, 2014, cafeteria plans may allow employees in these two situations to prospectively revoke an election for coverage under a group health plan that:  Isn’t a health care Flexible Spending Account Provides minimum essential coverage when specific conditions are met These changes were announced in IRS Notice 2014-55...

Published in Healthcare
Monday, 13 October 2014

A Wellness Checkup for Your Internal Controls

Written by Sandy Shecter, CPA, CGMA

Owners of small- and mid-sized medical practices often think they’re immune to employee fraud and embezzlement. However, a 2014 report by the Association of Certified Fraud Examiners (ACFE) revealed that smaller businesses (those with fewer than 100 employees) were victimized more frequently than larger ones and suffered a median loss per case of $154,000. ACFE also found that the healthcare industry ranked fourth in the number of occupational fraud cases, behind banking, government and manufacturing. Physicians who know and trust their employees often feel that “it can’t happen to me...

Published in Healthcare
Friday, 03 October 2014

A Wellness Checkup for Your Internal Controls - Bonus Content

Written by Sandy Shecter, CPA, CGMA

Occupational Fraud: Know the Warning Signs Learning to spot the most common behavioral indicators exhibited by fraud perpetrators can help you identify potential fraud before it escalates out of control. Here are the most common behavioral red flags, according to the Association of Certified Fraud Examiners: Living beyond means (43.8 percent) Financial difficulties (33 percent) Unusually close association with vendor/customer (patient) (21.8 percent) Control issues, unwillingness to share duties (21...

Published in Healthcare
Wednesday, 01 October 2014

ACA spurring interest in self-insurance and captive insurance programs

Written by Thomson Reuters

This year, employers have gotten their first taste of the Affordable Care Act’s (ACA’s) community rating rules. As a result of the rules, many organizations with fully insured health benefit plans and relatively healthy workforces have seen their premiums go up. This development has, in turn, spurred interest in self-insurance and captive insurance programs. Community rules The ACA’s community rating rules constrain insurers’ ability to vary premiums significantly by the health risk profile of companies within a particular geographic area...

Published in Healthcare

Question: Our group health plan has a gatekeeper feature that requires participants to designate and coordinate covered health care through a primary care physician. Do we have any special notice requirements associated with this plan requirement? Answer: Yes, group health plans that require designation of a primary care physician (PCP) must provide a notice describing the requirement and certain related rights. The Affordable Care Act (ACA) established new patient protections, which took effect starting with plan years beginning on or after Sept...

Published in Healthcare
Wednesday, 01 October 2014

3 highlights of the newly allowed one-month orientation period

Written by Thomson Reuters

Back in February, the Department of Labor, IRS and Department of Health and Human Services issued final regulations on the Affordable Care Act's (ACA's) permissible waiting periods for health care coverage. This included creating a "reasonable and bona fide employment-based orientation period" as a substantive eligibility condition that wouldn't count against the established limit of, generally, 90 days. At the time, the agencies also issued proposed regulations describing such an orientation period. Then in late June, they issued regulations finalizing the proposed orientation period as one month — effective for plan years beginning on or after Jan...

Published in Healthcare
Tuesday, 23 September 2014

Affordable Care Act – Individuals

Written by IRS

New IRS Publication Helps You Find out if You Qualify for a Health Coverage Exemption Taxpayers who might qualify for an exemption from having qualifying health coverage and making a payment should review a new IRS publication for information about these exemptions. Publication 5172, Health Coverage Exemptions, which includes information about how you get an exemption, is available on IRS.gov/aca. The Affordable Care Act calls for each individual to have qualifying health insurance coverage for each month of the year, have an exemption, or make an individual shared responsibility payment when filing his or her federal income tax return...

Published in Healthcare
Friday, 12 September 2014

What to do During the ICD-10 Delay

Written by Don McAnelly

The latest ICD-10 delay was happily received by those who had not yet invested valuable resources in planning and training; however, the delay did not bring joy to those who invested time, money, and effort in taking the October 1, 2014 deadline seriously. For these, the delay puts their ICD-10 training investment at risk. This risk can be minimized during the delay by adopting the following recommendations. Stay the course and use the delay to apply the skills learned from ICD-10 training sessions...

Published in Healthcare
Friday, 29 August 2014

Small employer tax credit regulations now final

Written by Thomson Reuters

The premium tax credit for small employers has been on the books since the enactment of the Affordable Care Act (ACA) in 2010. But the IRS only recently finalized regulations governing the incentive. The final regulations took effect on June 30. However, the proposed version of these regulations, published in 2013 and little changed by the final version, pertains to actions by employers from the beginning of this year...

Published in Healthcare
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