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The Centers for Medicaid and Medicare Services (CMS) instituted the VDSA program to provide better communication between itself, employers and insurers. This exchange of information ensures all parties, including Medicare, have all necessary information to determine which insurance company should be paying medical claims first. Employers who sign a VDSA with CMS will provide a quarterly [...] When considering a claim audit there are several approaches that can be taken. The most traditional type of audit is retrospective in nature and includes the most recent 18-24 months of claims. Retrospective audits can be performed differently depending on the employers audit objective. Understanding your objectives and clearly defining those objectives will aid in [...] Our previous white paper on dependent eligibility under health care reform highlighted the importance of maintaining your plan’s grandfathered status in order to reduce the cost-impact of the Patient Protection and Affordable Care Act (PPACA). Chapman Kelly has access to a copy of the proposed rules regarding how plans can maintain their grandfathered status. You [...] As an employer you may believe that not requiring your Medicare eligible population to enroll in Medicare is somehow a benefit to your employee. You may believe that you are not allowed to force your Medicare eligible members to enroll. However, both of these statements are false. How does mandatory Medicare enrollment work? As an employer [...] Now that HHS has provided a first round of guidance for the implementation of the dependent coverage provisions of Health Care Reform, new questions emerge. Question #1: Do the changes negatively impact the expected results of a dependent audit? The short answer is “yes,” but it is important to consider the size of the impact and [...] The Department of Health and Human Services(HHS) issued interim final rules regarding how dependent eligibility can be defined under health care reform. The rules (excerpted and linked below) reinforce how critical it is to maintain the grandfathered status of a group health plan. See our white paper for a complete overview of the strategies that can be used to reduce the financial impact of health care reform on dependent eligibility. Employers should begin planning right away to implement an affidavit process to determine if adult dependents have access to health coverage as a result of their own employment. Contact us to find out more about how this process would [...] Chapman Kelly has just released the first white paper regarding how health care reform will impact dependent eligibility for group health plans. Dependent Eligibility Under Health Care Reform: Cost-Containment Strategies Employers Should Take From The Signing Of The Bill to Beyond 2014 The impact of the Patient Protection and Affordable Care Act (PPACA) and The Health Care [...] Document-based Dependent Audits are the most effective way to be sure that you are paying for only those dependents that are eligible for coverage under your plan. Best practice approaches include both an initial audit as well as ongoing audits. Using a layered approach to dependent verification provides you with the confidence that on an [...] A recent report by PricewaterhouseCoopers lists identifying ineligible dependents as one of the top 10 issues facing the health industry. “Employer dependent audits: Employers are increasingly hiring experts to check whether their employees’ dependents should be insured under their benefit plans. With 3% to 8% of people failing to produce dependent verification and a $1,900 average annual [...] In a letter from the Defense Contract Audit Agency (DCAA), Department of Defense (DOD) contractors were informed that they will need to be able to verify that adequate controls are in place to prevent and remove ineligible dependents from the contractors’ health plans. The DCAA indicated that DOD contractors would be subject to penalties under FAR 31.205-6(m)(1), [...] Tony Schy, Partner, was quoted in an article on the effectiveness of dependent eligibility audits in reducing employer health plan costs and helping the employers with compliance. “These days, employers will stop at nothing to eliminate excessive health plan costs. Increasingly, more benefit managers are finding they can wipe out millions of dollars worth in one fell [...] We published an article in the June issue of Benefits Selling. Below is an excerpt: “Dependent-eligibility audits are an all-too-often overlooked cost control tool Employers continue to use an arsenal of strategies to help control their health care costs. Wellness and disease management programs, consumer-directed health plans, and quality initiatives are all valuable tools in an employer’s [...] As Human Resource and Benefits professionals you understand the importance of confidentiality and security when handling sensitive personal data and health care information. During a dependent audit some of the most sensitive employee data available is gathered and processed. This data includes: Birth Certificates, Divorce Decrees, Tax Forms, Marriage Licenses and many other documents. If you are considering a dependent eligibility [...] A survey conducted in late April by the International Foundation of Employee Benefit Plans indicated that many plan sponsors are seeing increased utilization of their health plans during the financial downturn. Here is an excerpt from the press release: “About one-third of plan sponsors have noticed an increase in the number of participants filling prescriptions and [...] Question 1: Isn’t my enrollment vendor already verifying the eligibility of the dependents on our plan? Question 2: When the average person looks under the hood of a used car, can they really tell if anything is wrong with it? Answer to Question 1 and Question 2: Not Really A large number of organizations are under the impression that their enrollment vendor is verifying the eligibility of the dependents on their plan. But this is a dangerous assumption. The problem with most of their verification processes is one of both consistency and [...] Most people are not aware that there are laws that govern Coordination of benefits. In my experience, most consumers think they can just pick which Insurance carrier that they want to be primary. For example, a spouse on a plan may also carry his/her own coverage through their employer. However, that policy may have a [...] Self-Insured employers have the opportunity to recover a substantial amount of money from a recent settlement regarding Average Wholesale Price and how it was used to pay pharmacy claims between 2001 and 2005. However, claims must by filed by July 9th 2009. Read more about the opportunity at the AWP McKesson Settlement website. Choosing what documents to require during a dependent audit is an important step in an effective audit process. Many organizations only require a marriage certificate in order to prove this relationship. While this is certainly acceptable, it is important for employers to understand how this decision will impact the audit. A marriage certificate only proves that [...] Tony Schy recently published an article on dependent eligibility audits in Employee Benefit Adviser. “Dependent eligibility audits are a hot topic. The high return on investment has helped this cost containment strategy become a central point of discussion between many advisers and their clients. While audits can be extremely effective, advisers should make sure that their [...] If your organization is going to conduct a dependent eligibility audit, you should consider new federal requirement regarding Third-Party Administrators and their reporting of Social Security Numbers (SSN). Your TPA’s will start requiring all employers to provide SSNs for all covered individuals. “A new Mandatory Insurer Reporting Law (Section 111 of Public Law 110-173) requires group [...] |
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