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Complying with CMS reporting requirements can be easy

By Rand Johnson on Fri, Dec 05, 2014 @ 05:30 AM

Likely you read the article in the November 14, 2014 McKnight’s Daily Update entitled, SNF staffing data will be submitted quarterly, payroll vendors might be responsible, CMS officials say, which reported that CMS has launched a pilot to solicit information directly from providers’ payroll systems. The crux of the matter is the lack of confidence in the accuracy of the information providers are reporting to CMS annually to comply with Five Star Rating information requests.


Topics: business intelligence, Data Mining

Improve claims turnaround and business processes – a case study

By Proclaim Partners on Wed, Aug 13, 2014 @ 07:00 AM

CMS Says Skilled Nursing Will Face Negative Margins By 2040,” so read the headline in last Wednesday’s AHCA/NCAL Gazette. In fact, it was the top story. Yep. It grabbed my attention really quick. Now granted, I may likely not be around by 2040, but judging by my parent’s longevity, I could. I’ve been affiliated with LTC since 1978 and it’s in my blood. I care. And, yes, to be frank, the article somewhat spooked me when I read the following, “By 2040, two-thirds of skilled nursing facilities will be operating in the red, signaling more consolidations, partnerships and accountable care organizations (ACOs) on the horizon, according to a recent memo issued by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary.”


Topics: Improved Business Processes, claims management, clearinghouse, IT hosting services, claims turnaround, claims turn-around, clinical and financial software, claims processing, EMR, claims management process

Reporting Automation is Key to ACA Compliance for Large Employers

By Rand Johnson on Mon, Jul 14, 2014 @ 08:00 AM

Most large employers are aware of the potential “Pay or Play”1 penalties of the Affordable Care Act (ACA) that they will be facing starting January 1, 2015, assuming no postponement in the current timetable.  However, are these employers also aware of the many other pitfalls and penalties that they will face if they fail to be completely ACA compliant?  Chances are that whatever methods, systems, or software an employer is using, it won’t be able to easily attain all of the data necessary for ACA compliance requirements. To avoid penalties, large employers will need systems that are capable of tracking employee hours, benefit eligibility, dependents, waiting periods, health care coverage offerings, and enrollment by lines of coverage.  Even employers electing NOT to offer medical coverage will be required to send notices and reports to employees and the IRS. For employers with fluctuating work schedules, such as restaurants and health care providers, gathering this information can be difficult, time consuming, and expensive. 


Topics: ACA, Accountable Care Act, reporting automation

ACA Employer Mandate Delays Update - 2015 Is Not That Far Away.

By Rand Johnson on Wed, Jul 09, 2014 @ 08:30 AM

It's Time to Refocus

On July 2, 2013, the Obama Administration announced that it would postpone until 2015 the implementation of two key elements of the Affordable Care Act (ACA).  These two elements pertain to the reporting requirements for large employers (50 or more full-time equivalent employees) that determine whether or not employers provide affordable, qualified health coverage to full-time employees:


Topics: ACA, Pay or Play, Accountable Care Act, large employers, small employers

Dealing with the Realities of ObamaCare (ACA)

By Rand Johnson on Wed, Jul 02, 2014 @ 07:00 AM

The following blog posting was contributed by William E. Allison, Jr., Partner, Benefits Design Group, Inc. For the purposes of this discussion, the premise assumes that employers qualify as a large employer as defined by the ACA and are subject to all the provisions and penalties associated with the Act.

On July 2, 2013, the Obama Administration announced that it would postpone the implementation of two key components of the Affordable Care Act (ACA) that were set to start at the beginning of 2014. The two provisions relate to the “shared responsibility” penalties, sometimes referred to as “play or pay” provision, and the reporting requirements necessary for the government to determine if employers provide affordable, minimum health coverage to their full-time employees. The implementation of these two points was delayed until 2015. These provisions have again been postponed until 2016 for employers with 50-99 full-time or full-time equivalent (FTE) employees. 


Topics: ACA, Affordable Care Act, play or pay, minimum value coverage, Obamacare, MEC, internal revenue code, sections 6055 and 6056, MEC penalty

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