Oxford News: Claim Payment Changes Impact Medicare Eligible Members

For years Oxford has not specifically required members who were Medicare eligible to have both Medicare Part A & B. Effective July 1, 2020, this will end because of a change in how Oxford pays their claims. This is important for Medicare eligible members because Oxford will be applying the Medicare Estimation claims process. In other words, the… Continue reading Oxford News: Claim Payment Changes Impact Medicare Eligible Members

Spending Bill Repeals Three Major ACA Taxes and Extends PCORI

On December 20, 2019, the House and Senate, with the final signature from President Trump, passed a bipartisan legislative package of spending bills to avoid a government shutdown. This package of bills is collectively referred to as the Further Consolidated Appropriations Act, 2020 (the “Act”). The Act includes a permanent repeal of three Affordable Care… Continue reading Spending Bill Repeals Three Major ACA Taxes and Extends PCORI

Is Price Transparency Coming for Health Care?

Proposed Rules Would Require Hospitals to Publish Retail Prices for Health Care Services The Centers for Medicare and Medicaid (CMS) proposed rules that would require all Medicare-participating hospitals to post their negotiated prices for standard health care services. The Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule is intended to increase… Continue reading Is Price Transparency Coming for Health Care?

IRS Extends Deadline for Furnishing Form 1095-C, Extends Good-Faith Transition Relief

The Internal Revenue Service (IRS) has released Notice 2019-63, which extends the deadline for furnishing 2019 Forms 1095-B and 1095-C to individuals from January 31, 2020 to March 2, 2020.  The Notice alsoprovides penalty relief for good-faith reporting errors and suspends the requirement to issue Form 1095-B to individuals, under certain conditions.  The due date… Continue reading IRS Extends Deadline for Furnishing Form 1095-C, Extends Good-Faith Transition Relief

IRS Releases Draft 2019 ACA Reporting Forms and Instructions

The IRS has released draft forms and instructions for the 2019 B-Series and C-Series reporting forms (Forms 1094-B, 1095-B, 1094-C and 1095-C) used by employers and coverage providers to report certain information to full-time employees and the Internal Revenue Service (IRS).  As background, the Affordable Care Act (ACA) added Sections 6055 and 6056 to the… Continue reading IRS Releases Draft 2019 ACA Reporting Forms and Instructions

Can we let an employee change their benefits outside the 30 day window?

An employee experienced a qualifying life change but did not notify us until the day after the required 30-day notification period had passed. Can we still allow this employee to make a change to their benefit elections based on the qualifying event? There would be significant risk in allowing this employee to make a change… Continue reading Can we let an employee change their benefits outside the 30 day window?