Articles

OCR HIPAA Audits

On June 10, 2011, KPMG was awarded a $9.2 million contract by the Department of Health and Human Services (HHS) to develop HIPAA audit protocols and then conduct audits based on those protocols of HIPAA Covered Entities and Business Associates. Almost immediately the speculation started on what would be audited and what documents might be requested as part of the HIPAA audit.

Read more

How Employers Should Handle MLR Rebates

As August 1st approaches, employers that sponsor an insured group health plan may be receiving a Medical Loss Ratio (“MLR”) rebate from their insurers. Self-funded medical benefit plans are not subject to these requirements.  The rebates raise several fundamental questions for employers including:

Read more

ACA Ruling: Impact on Employer-Sponsored Health Plans

On Thursday June 28th the Supreme Court issued its much anticipated decision on the constitutionality of the Affordable Care Act (ACA).   In a split 5-4 decision, the court ruled the so-called “individual mandate” contained in the ACA constitutional.  This provision of the ACA requires individuals to maintain health insurance or pay a “shared responsibility payment” if they fail to do so. 

Read more

The Supreme Court Rules the Affordable Care Act is Constitutional

In what may be the most anticipated decision in at least a generation, the Supreme Court has upheld the constitutionality of the so called “individual mandate” contained in the Affordable Care Act (ACA). In a split 5-4 decision, the court has ruled that it is constitutional for the government to require individuals to maintain health insurance or pay a tax if they fail to do so. Since the individual mandate was held to be constitutional, the court did not need to rule on issues related to the rest of the law. Consequently, by taking this position on the individual mandate, the court has affirmed that the entire ACA is constitutional, other than a particular provision related to Medicaid expansion explained below.

Read more

Preparing for the Supreme Court Decision on the Affordable Care Act

The Supreme Court is expected to issue its decisions on questions related to The Affordable Care Act (ACA) by the end of June.  It would not be an exaggeration to say that millions of words have already been written regarding the Supreme Court’s review of the ACA.  However, what has been missing from most of the hours of cable TV coverage and thousands of newspaper, magazine and internet articles, is a discussion of how various court decisions will affect employer-sponsored group health plans.

Read more

Estimated Cost Impact of the ACA Reinsurance Fee on Employer Plans

The Department of Health and Human Services (HHS) recently released final regulations regarding the transitional reinsurance program that the Affordable Care Act (ACA) requires each state to establish beginning in 2014. The transitional reinsurance program is intended to help stabilize premiums in the individual market during the first three years that the state-based exchanges are in effect (2014 – 2016).

Read more

New Guidance on $2500 Health FSA Limit

The IRS has released Notice 2012-40 which provides welcome guidance to employers regarding the $2500 limit on Health FSA (HFSA) pre-tax contributions imposed by the Affordable Care Act (ACA). Most significantly, Notice 2012-40 clarifies that the $2500 limit only applies to HFSA plan years beginning on or after January 1, 2013.

Read more

Documentation Risks in Electronic Medical Records

Many organizations are rushing to get Electronic Medical Records (EMR) programs implemented or enhanced in order to take advantage of the monetary incentives currently being offered for participation in the “Meaningful Use” program.  While one of the goals of electronic documentation is to improve the quality of the patient visit, certain practices could actually do more harm than good.

Read more

IRS releases 2013 HSA limits

The Internal Revenue Service (IRS) has released the HSA limits for calendar year 2013. Revenue Procedure 2012-26 details the maximum contribution and the deductible and out-of-pocket limits.

Read more

Hospitality Industry Risks: Data Privacy and Security

Most hospitality businesses allocate time and capital to efficiently collect and process data in order to improve sales, customer service and loyalty, and operations efficiency. Technological advances have made it easier to manage a wide range of information about customers, vendors, and employees.

Read more

Strategies for a Firming Insurance Marketplace

The insurance marketplace took it on the chin in 2011. Recent estimates peg the total economic loss resulting from last year’s collection of catastrophic events at over $350 billion, the most costly year on record.

Read more

Handling Medical Loss Ratio (MLR) Rebates

Under the Affordable Care Act (ACA), health insurers are required to disclose the percentage of medical plan premium that is spent on claims and health quality improvement initiatives versus the portion spent on administration, marketing and insurance company profits. Under the Medical Loss Ratio (MLR) rules, insurers in the large group market (100+ employees) must maintain a loss ratio of no less than 85%, while insurers in the individual and small group markets must maintain a loss ratio of no less than 80%.

Read more