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Tag: Employer Group

Why Health-Care Reform Might Mean More Jobs, Less Automation

Using technology to automate business processes is a good thing that enhances operational efficiency and drive cost savings, right? Not always. Today’s health-care industry offers a counter-intuitive case in point.

As the Affordable Care Act continues to transform the health-care market, a growing number of health-care insurers are finding that maintaining and upgrading automated claims processing applications is becoming prohibitively expensive. In fact, decreasing automation and increasing investment in personnel can in many cases produce a more cost-efficient outcome.

In recent years, health-care payers have poured significant resources into developing software applications that automate the process of reviewing and processing claims for reimbursement of health-care costs – in some cases achieving auto-adjudication rates approaching 90%. At the time, this approach made sense, and these highly customized legacy systems were proven to be effective in relatively static environments.

Today, of course, it’s a different ballgame: health-care reform is driving fundamental and ongoing changes in regulatory and data reporting requirements. This means the myriad applications involved in auto-adjudication require constant upgrades, which not only drives costs but piles layer upon layer of additional complexity on to already highly customized and heavily engineered systems.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Health Care Reform Update: Minimum Essential Coverage and Employer Mandate IRS Reporting – IRS Code Sections 6055 and 6056

To make sure people have Minimum Essential Coverage (MEC), the Internal Revenue Service (IRS) needs reports to be sent by those who offer MEC. This is called Minimum Essential Coverage Reporting, or IRS Code Section 6055 Reporting. This applies to all group sizes, fully-insured and self-funded (ASO).

To check if employers are offering insurance that gives minimum value and is affordable to their full-time workers, the IRS needs reports to be sent by “applicable large employers” – those with 50 or more full-time workers. This is called Employer Mandate Reporting, or IRS Code Section 6056 Reporting, and applies to fully-insured and self-funded (ASO) employers with 50 or more full-time workers.

The first reports are due no later than March 31, 2016 for the 2015 coverage year (February 28 if using a paper report) and will be due every year. Statements also have to be sent to workers by January 31, 2016 (like W-2s) who have their information reported, and by January 31 every year going forward.

See the fact sheet for information on MEC reporting and frequently asked questions.

Look at this fact sheet for more about Employer Mandate Reporting.

Contact Steven Cosby with questions or to request more information and to schedule a
healthcare plan evaluation, savings analysis or group plan solution for your company.

The Employer-Sponsored Health Care Facts of Life

High deductible health insurance plans are a fact of life, particularly for the employees of small businesses. But it doesn’t have to hurt morale or loyalty among workers. There are ways small-business owners can help defray some of the costs if high deductible insurance plans are all they can offer. “With the Affordable Care Act there is clearly a movement toward higher deductible plans,” says Barry Sloane, CEO of Newtek, a health insurance agency for small businesses. “Unfortunately higher deductibles are a fact of life whether you live in New York or Nebraska.”

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Health Savings Accounts Offer Real Benefits

Fom the ATR website:
We at ATR are proud to support a new bill introduced in the U.S. House of Representatives last week. H.R. 4777, the “Health Savings Act of 2014,” is sponsored by Congressman Michael Burgess, M.D., R.-Texas. Health savings accounts (HSAs) are tax-advantaged accounts that are used to pay for routine, out-of-pocket medical expenses. They are used in conjunction with insurance plans which tend to cover large and/or unexpected health events.
H.R. 4777 makes HSAs more readily available to the public by implementing the following reforms:
Creation of Child HSAs. As a way of saving for the future health needs of children, child HSAs are created with a maximum annual contribution limit of $6,350 (indexed to inflation). Importantly, these HSAs can be rolled out of or into upon the death of a family member. This allows for a kind of prefunding of a child’s anticipated Medicare liability decades before she turns 65.

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

For Telehealth Patient Safety Insists Upon An Evolution In Policy

The nation’s ongoing battle to strike a delicate balance between increasing access to quality health care for all Americans and reducing overall health care spending just scored one of its most substantial victories. In late April, after several months of thoughtful and robust collaboration, the Federation of State Medical Boards (FSMB) ratified a new model national policy – the Appropriate Use of Telemedicine in the Practice of Medicine – at its annual meeting in Denver. This marks the first time the medical community has unilaterally acknowledged the impact technology has had on the practice of medicine, and the ability telemedicine — or connected health — has to facilitate and improve the delivery of health care.
Let us first put this in perspective. We all know health care is at a critical juncture. The implementation of the Affordable Care Act means millions of newly eligible Americans will seek access to an already over-burdened health care system. The nation faces a serious shortage of primary care providers, specialty care is becoming more diversified, and access to care in rural areas is an ongoing challenge. All of these issues are on the rise.
Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.