Compliance Concerns for Medical Practices

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It’s every business owner’s favorite topic: compliance. When you’ve got a profitable and busy business to run, compliance issues sometimes get put on the backburner… exactly where they don’t belong. Because you specialize in healthcare services and not necessarily government regulations, taking the time to review healthcare-specific laws and policies often take much longer than planned. Unfortunately the Department of Labor (DOL) doesn’t often wait around to administer and enforce its 180 federal laws.

Here are just 3 concerns that medical practices have:

  1. HIPAA: The Health Insurance Portability and Accountability Act protects the privacy of individually identifiable health information. HIPAA also comprises of the HIPAA Security Rule, which sets national standards for the security of electronic protected health information and confidentiality provisions of the Patient Safety Rule, which protects identifiable information being used to analyze patient safety events and improve patient safety. In an earlier post, we addressed how important it is for medical practice owners or employees who are delegated to manage compliance to be fully aware of the HIPAA policy and procedures. A single violation of compliance can result in fines capable of crippling your cash flow.
  2. RACs: Recovery Audit Contractors (RACs) have been auditing claims for the Medicare program nationwide since 2010, which subject health facilities to additional administrative burden and costly payment denials.
  3. Compliance Programs: A compliance program is required as of March 2013 by any healthcare provider, including dental, that bills Medicare, Medicaid, and/or programs funded by federal or state governments. Eligible compliance programs include guidance on billing, coding, and contracts which are now required under the Affordable Care Act. There are nearly 40 policies that include the screening of all employees monthly against state and federal exclusion databases…. Do you have the time?

Many medical practice owners choose to engage a PEO for the sole purpose of eliminating headaches and ensuring employer compliance. In addition to the many other benefits PEOs provide, PEOs protect – against costly lawsuits, against compliance failure, and against preventable workplace mistakes/accidents.

To learn more about PEO solutions, contact us.

Small Group Employers – How Are Premium Rates Determined?

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Are you shopping around for health insurance? You may be wondering where the various health insurance companies are getting their numbers from.

In most states, laws permit small group health insurance companies to determine their initial premium rates for each client company through medical underwriting. Medical underwriting uses medical or health information to evaluate the applicant(s) applying for health insurance coverage. As part of the process, each person’s health information is used to determine whether or not the person (or group) will be provided with coverage, and what the premium rate is going to be.

In other states, small group health insurance companies use a process called modified community ratings to determine their initial rates. In states where this is enforced, modified community ratings require health insurance providers to offer policies at the same exact rate to all persons within a given geographic territory.

Most small group employers have to go through the medical underwriting process, because it is a much more common practice than modified community ratings. Premium charges are directly affected by claims history and your employees’ existing health attributes and habits … do you have employees that are overweight? Do you have employees that smoke? These traits could potentially increase the health insurance company’s risk of taking on your group, which therefore will increase the premium rate.

At Employer Solutions Plus, we represent the “best of” in health insurance options and employee benefits. This allows us the flexibility to customize a cost effective solution to meet the individual needs of our clients. If you’re shopping around, and not seeing the numbers you expected, please contact us for additional insight and help.

Health Insurance: I’m a Small Employer…What Are My Coverage Requirements?

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You’re a small business and you’re growing … you’ve finally got 10 employees! While you’d love to provide them all with health insurance, you don’t actually have to by law. At this time, there are no federal or state laws requiring small employers to offer benefit plans to their employees.

There are however a number of laws surrounding group health plans, if you do decide to offer health insurance to select employees. These include ERISA and HIPAA, and they address issues such as setting minimum standards for most voluntarily health plans in the private sector, as well as the protection of individually identifiable health information and rights granted to individuals.

While you may not be required by law to provide your employees with health insurance, health insurance coverage is a valued employee benefit that will help you attract and retain top talent. A competitive employee benefits package has the power to differentiate you from fellow employers within your market or industry, which gives your organization more ways to grow and thrive.

Does the thought of introducing additional compliance concerns to your workplace scare you? For businesses engaged in a PEO relationship, expert help with risk management and compliance protects the client from costly fines and lawsuits surrounding ERISA and HIPAA. PEOs also assume much of a business’s risk through the co-employment relationship.

For smaller or select companies that may not benefit financially from entirely outsourcing “everything HR,” Employer Solutions Plus offers Benefits-Only Management for Group Health Plans. Our health insurance experts focus on setting up your policies, while you focus on growing your business.

For more information on health insurance and compliance, visit our benefits section within this blog. For immediate questions or concerns, contact us.

Who is Eligible for FMLA leave?

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Background: FMLA (Family and Medical Leave Act) is enforced by the US Department of Labor. This act was established to help employees better balance their work and family responsibilities. It provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. FMLA also requires that the person’s health benefits be maintained the entire time of their leave.

Does FMLA apply to your company? FMLA only applies to companies with 50 or more employees, as well as all public and private elementary and secondary schools, and public agencies. If you are classified as one of the aforementioned, read on!

Only employees that have worked for their employer at least 12 months, or at least 1250 hours over the past 12 months are eligible for FMLA. As an employer, this is just one of the many reasons it’s important to have accurate payroll and employee data. An eligible employee must also work at a location where the company employs 50 or more employees within 75 miles.

Employees requesting to leave work for the following reasons are covered under FMLA. Employers must provide 12 weeks of unpaid, job-protected leave (and a continuation of benefits) to those leaving:

  • for the birth and care of the newborn child of an employee
  • for placement with the employee of a child for adoption or foster care
  • to care for an immediate family member (spouse, child, or parent) with a serious health condition
  • to take medical leave when the employee is unable to work because of a serious health condition

*Source: US Department of Labor

Did you know that in addition to Professional Employer Organization options, Employer Solutions Plus offers human resource management services for FMLA, ERISA, COBRA, HIPPA, ADA and more?

If you’re having trouble sorting through countless compliance issues, employment laws, and regulations, or have a specific question regarding FMLA, please contact us.