(303) 369-3200

In a Twitter message on July 29th, U.S. President Donald Trump threatened to end government payments to health insurers if Congress did not pass a new healthcare bill. Trump tweeted "If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!"

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. 
Published in Industry Trends

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.

Published in Healthcare Reform
Thursday, 23 April 2015 09:21

Are You on Pace for a Cadillac Tax?

 

While most employers are busy figuring out the Affordable Care Act (ACA) Employer Mandate and the 2015 ACA reporting requirements, there’s an important tax coming down the road in 2018 to plan for now.

The “Cadillac Tax” is a 40% excise tax applied to any plan whose premiums exceed certain thresholds in 2018.  (Add click here to read more link)  The intention of this section of the ACA is that extremely rich healthcare plans contribute to unnecessary utilization, and thus are being discouraged.  The premium limits are $10,200 for single coverage and $27,500 for family coverage, which sound like enormous amounts.  

But, if you take your monthly premiums this year, and project them 3 years down the road, you’d be shocked at how close you may already be to facing this huge excise tax.  If your premiums today exceed about $640 single or $1,725 family, your plan is already on pace to being a Cadillac plan (assuming 10% healthcare trend).

If you’re in the danger zone, please give us a call at (303) 369-3200 or This email address is being protected from spambots. You need JavaScript enabled to view it. to get some ideas of how to head off this damaging excise tax before it arrives!

 

Published in Healthcare Reform
Tuesday, 11 November 2014 17:00

Make Your 2015 Compliance Game Plan

It's almost 2015.  Is your benefit compliance game plan ready? 

We'll help you create the plan you need to ensure you are ready for the coming year:

  • What you need to do in 2015 to meet ACA requirements and deadlines;
  • An overview of what all private employers MUST do to comply with ERISA; and 
  • The most common mistakes employers make on Section 125 plans.

Join us on Wednesday, December 17th, from 10-11 am to learn the latest up-to-date information. Register now to get your game plan in place!

 

Published in Best Practices