Displaying items by tag: employee benefits
Benefit Eligibility and Tax Treatment of Domestic Partners
In 2014, Colorado legalized same sex marriage, which allowed a spouse of either gender to be a qualified dependent for benefits. Domestic partnership is still a different situation. A domestic partner is defined as an employee’s unmarried partner who lives with them and is of the same or opposite sex. The definition of an eligible dependent for benefit plans may vary depending on the employer and carrier definitions, so it’s important to check in your carrier documents.
Increased Costs Due to Unnecessary Medical Care and Insufficient Member Education
Recent articles from Benefits Pro and National Public Radio (NPR) claim that many patients are receiving unnecessary or “low-value” medical procedures, which are significantly increasing health care costs.
According to Benefits Pro, “health care consumers are sinking $25 billion a year on low-value procedures”. The Washington Health Alliance, after reviewing claims for 1.3 million patients in the state, found that 600,000+ patients per year are receiving treatment they do not need. The staggering cost for this unnecessary treatment is estimated at $282 million, and ultimately impacts rising health care costs.
FMLA Tax Credit 2018
The Family and Medical Leave Act of 1993 (FMLA) provides employees of companies with 50 or more workers up to 12 weeks of protected unpaid leave annually for their own serious health condition, for the adoption or birth of a child or to care for a spouse, child, or parent who is ill. On December 22, 2017, the Tax Cuts and Jobs Act was signed into law, creating a federal tax credit for employers providing paid family and medical leave beginning in 2018 and ending at the end of 2019.
Review your HIPAA Practices
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted to protect the privacy of healthcare consumers, including who has access to a patient’s medical records and who can be designated to act on their behalf. You have probably filled out a HIPAA Authorization or Acknowledgment form for every new provider you’ve seen over the last 20 years. On the surface, HIPAA compliance seems to adhere primarily to providers and insurance carriers; however, if you are an employer sponsoring health plans for your employees, there are some basic provisions you need to be aware of. Fines for not complying with HIPAA are very real and can range into the tens of thousands of dollars.
The Ever-Changing World of ACA Taxes
There are several healthcare-related taxes that employers have been responsible for under the Affordable Care Act. Some have gone through a sunset while others continue, and some were given a temporary holiday and were scheduled to start anew in 2018.
Following a short government shut-down, President Trump signed a short-term spending bill (a Continuing Resolution or “CR”) on January 22nd to reopen and fund the federal government through February 8, 2018. Attached to the bill are suspensions of three ACA taxes and a six-year extension of the Children’s Health Insurance Program (CHIP).
Wellness on a Shoestring
Some employers struggle to understand how to create a wellness program with little or no budget, but it can be done.
Individual mandate repealed for 2019
For starters, the individual mandate is still in effect for 2018, meaning that employees may have to pay a sharp tax penalty of 2.5% of their income if they do not have health insurance. Early reports that this is no longer in place are false.
Even after the individual mandate is eliminated in 2019, the individual market, federal subsidies and Medicaid expansion (32 states and the District of Columbia implemented this) will all still be in place, barring further congressional action.
What Made the Cut in the Final Tax Cut Bill
Will Cost Sharing Reductions to Insurers Continue?
The “BAILOUTS” that President Trump is referring to is the approximately $7 billion in cost-sharing reduction subsidies the federal government pays annually to reimburse insurers who are required under the ACA to reduce deductibles and out-of-pocket maximums for low-income Americans. Because of a pending lawsuit, the payments, which are determined by the Department of Health and Human Services, are currently being doled out on a month-to month basis.
ICD-10 Implementation May Increase Claims Issues
Employers were warned in 2014 that the ACA came with a new medical billing and coding system. As of October 1st, the United States implemented the tenth revision to the ICD (International Classification for Diseases) codes in an effort to more thoroughly define diseases and injuries.
This change will allow key industry stakeholders to better track and manage diseases and patterns, measure the quality of care, evaluate patient outcomes, ensure patient safety, manage population health, detect fraud / abuse and track detailed data on injuries and accidents to compare global pandemics—all of which support the shift toward value-based healthcare.
However, the coding system comes with other changes that are not so exciting. Doctors and other medical professionals will now have to learn the 140,000 new codes which have been added to describe treatments provided on billing statements as well as private insurance claims. This is a huge leap from the 17,000 codes that previously existed before October 1.
This complex conversion could lead to disruptions across the medical field. Providers may see overall delays in claims processing, and some individuals may have insurance claims that are denied for services that were provided, but not properly coded.
The Health Information and Management Systems Society (HIMSS) published an article earlier in the year stating coding errors can reach a staggering 19.7% out of total claims submitted. The Centers for Medicare and Medicaid Services (CMS) published a counter article in July 2015, indicating the ICD-10 testing results displayed a 98% success rate and they would not expect ICD-10 to impact patients unfavorably. Another hurdle facing a clinic or a provider is that medical billing and coding is a highly demanded profession and this transition of codes would make it more competitive and thus more costly than before.
If you or your employees are experiencing escalated claims issues, please reach out to your account manager at Fall River - This email address is being protected from spambots. You need JavaScript enabled to view it.