News & Analysis as of

Employer Shared Responsibility Payments and Reporting Requirements Under the Affordable Care Act: Code Sections 6055 and 6056

Employer Shared Responsibility Penalties - There are two types of employer shared responsibility payments, also known as pay or play penalties, under the Affordable Care Act (ACA). The first penalty under Internal...more

Monthly Benefits Update - July 2014

Two federal appeals courts issued contradictory rulings on the validity of subsidies for the purchase of health insurance under the federal marketplace established pursuant to the Affordable Care Act (ACA). On July 22, a...more

Health Update - July 2014

Avoiding the Regulatory Land Mines of Commercial ACOs - While providers are showing great interest in creating ACOs to participate in the Medicare Shared Savings Program (MSSP), they are showing even greater enthusiasm...more

Medicare's Proposed Home Health Rule for 2015: CMS Suggests Only Limited Relief to the Face-to-Face Encounter Documentation...

On July 7, 2014, the Centers for Medicare & Medicaid Services ("CMS") published proposed changes to the Medicare Home Health Prospective Payment System ("HH PPS") for calendar year 2015 ("Proposed Rule"). The Proposed Rule...more

Applicable Manufacturers Face June 30th Deadline for Sunshine Act Reporting

CMS will begin to enforce what could be significant penalties on manufacturers who fail to report required data. The Centers for Medicare & Medicaid Services (CMS) has announced a short timeframe before detailed...more

Cloudy Skies Ahead for Providers? CMS’ Release of Medicare Billing Data Combined with Physician Payment Sunshine Act Data May...

In February 2013, we reported (on our Healthcare Law Blog) that the Centers for Medicare and Medicaid Services (CMS) announced the final rule for the Physician Payments Sunshine Act. In the interest of providing more...more

CMS Releases Proposed Rules Allowing Meaningful Use CEHRT Flexibility and Extending Stage 2

CMS recently issued proposed rules that would modify 2014 EHR certification requirements and revise the meaningful use Stage 2 and Stage 3 timeline. In response to industry complaints that many eligible professionals...more

The Devil is in the Details: Advising Your Clients on the Affordable Care Act

The Affordable Care Act (ACA) represents a fundamental shift in healthcare delivery and insurance. The law is complex and many of its provisions are delayed due to implementation difficulties. However, virtually all...more

Healthcare Reform Watch List: Top Five Concerns for Healthcare Industry HR Departments

Keeping up with healthcare reform regulations is a challenge for all employers, but healthcare providers may face unique burdens. Here are the top five issues human resources professionals should keep on their radar as...more

Recent OIG Report Underscores Need for Home Health Agencies and Physicians to Comply With Medicare’s Face-to-Face Documentation...

Medicare overpaid the home health industry $2 billion between January 2011 and December 2012, according to a recent report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG). The OIG’s...more

Health Care Reform: Employer Reporting Requirements

Health care reform imposed new employer reporting requirements regarding health coverage provided to individuals, including: (i) reporting of minimum essential coverage for employer-sponsored self-insured plans and (ii)...more

Capital Wrap-Up April 2014 #1

In response to the recommendations made by the Governor’s Task Force on Child Protection, six child protection bills made it to the Governor’s desk this week. Two of those bills have been signed....more

Health Care Reform Update: Employers Must Begin Reporting Details of Health Coverage to IRS

The Patient Protection and Affordable Care Act (“ACA”) imposes significant new reporting requirements on employers providing self-insured group health coverage to their employees and employers subject to the shared...more

Final Regulations Issued Regarding Employer Reporting Requirements Under ACA

Recently issued final regulations on the employer reporting requirements under the Affordable Care Act (ACA) clarify and streamline the process for reporting information relating to the provision of minimum essential coverage...more

IRS outlines new reporting requirements for employers on health care coverage

As has been widely discussed since its enactment in 2010, the Affordable Care Act (ACA) imposes new penalties on individuals who do not have health care coverage and on certain large employers who do not offer health care...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 42: Treasury Department and IRS Issue Final Reporting Rules...

On March 5th, 2014, the Treasury Department and the IRS issued two final reporting rules of critical importance to employers...more

CMS Delays Open Payments Data Submission Deadline, Announces Registration Process; Requires Manufacturers and GPOs to Report...

On Friday, February 7, 2014, the Centers for Medicare and Medicaid Services (CMS) announced that Open Payments registration is scheduled to begin on Tuesday, February 18, 2014 for applicable manufacturers and applicable group...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 47: The Reporting Conundrum

The Affordable Care Act establishes three new, high-level, reporting requirements: Code § 6051(a)(14) - Employers must report the cost of coverage under an employer-sponsored group health plan on an employee’s...more

FTC Successfully Challenges Non-Reportable Acquisition of Physician Group

On January 24, 2014, the U.S. District Court for Idaho held that St. Luke’s Health System (“St. Luke’s”)’s acquisition of Saltzer Medical Group (“Saltzer”), violated Section 7 of the Clayton Act and ordered St. Luke’s to...more

Tax-Exempt Hospitals: IRS Issues Proposed Revenue Procedure to Correct and Disclose Failure to Meet 501(r) Requirements

The Internal Revenue Service (“IRS”) on December 30, 2013 issued a proposed revenue procedure that outlines steps to correct and disclose failures to meet the requirements of new section 501(r) of the Internal Revenue Code...more

Proposed Health Coverage Reporting Rules Under the Affordable Care Act

In September, the Internal Revenue Service (the "IRS") issued proposed regulations under Sections 6055 and 6056 of the Internal Revenue Code (the "Code") that establish annual health coverage information reporting and...more

NPDB Guidebook revision would clarify investigation reporting issues

Physicians always have been justifiably concerned about reports to the National Practitioner Data Bank (NPDB) regarding malpractice payments and adverse peer review actions. Two areas of frequent uncertainty have...more

Group Health Plans: Year-End Action Items and Upcoming Changes

Group health plan sponsors turn their attention to completing 2013 tasks, implementing upcoming 2014 changes, preparing for the ACA Shared Responsibility requirement in 2015, and documenting recent extensive plan changes....more

Employee Benefits Update: 2013 Year End Plan Tasks

As we approach the end of the year, employers and plan sponsors of qualified retirement plans and health and welfare plans should take time to meet various upcoming deadlines. Failure to comply with the deadlines may result...more

December 1 Deadline for New Reporting Requirements for Physician-Owned Hospitals Approaching Fast

Physician-owned hospitals that seek to avail themselves of the “whole hospital” exception or “rural provider” exception to the federal physician self-referral law, commonly known as the Stark Law, should carefully review...more

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