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Monthly Archives: August 2014

  • Planning for 2015 – Open Enrollment and Other PPACA Issues

    Posted on August 13, 2014

    Below is the link to the August 12, 2014 UBA Employer Webinar Series: “Planning for 2015 – Open Enrollment and Other PPACA Issues”


    The Patient Protection and Affordable Care ACT (PPACA) continues to phase in. Many plan design requirements took effect in 2014 for both large and small plans. This next year will bring employer-shared responsibility (“play or pay”) requirements for larger employers. PPACA has also affected the notices employers need to give as part of the open enrollment process and it affects COBRA. To heop plan sponsors understand their options and obligations, this webinar will cover:


    • A review of the 2014 plan design requirements, including the eligibility waiting period rules
    • How group health plans and the Marketplace handle special enrollment and Section 125 change in status events
    • Upcoming fees
    • The health plan identifier requirement
    • Notices that should be included in your open enrollment packet – and those that are no longer needed
    • A refresher on Summary of Benefits and Coverage requirements, including the transition and distribution rules
    • A review of the common law employee definition
    • A reminder of how to count workers correctly – and why it matters
    • Recent developments, and what is in the regulatory pipeline




    Joy M. Napier-Joyce, Shareholder, Jackson Lewis P.C.

    Joy is a shareholder in the Baltimore office of Jackson Lewis P.C. She counsels clients in a broad range of benefit matters, including general compliance, administration of qualified retirement plans under ERISA and the Internal Revenue Code, and welfare plan issues involving cafeteria plans, health plans, flexible spending accounts, group insurance products, COBRA and HIPAA. She is a member of the Jackson Lewis Health Care Reform Task Force and leader of the firm’s Employee Benefits Practice Group.


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    Please feel free to watch/listen to this whenever it is convenient for you and your staff. It will be available for you to view for the next 11 months. Your name and email are required for registration. There is no cost however this webinar has been approved for one credit hour toward PHR, SPHR and GPHR recertification through the HR Certification Institute. Once you have viewed the webinar, the last page will provide details on receiving the credit hour.


  • Tips From Paula – Understanding Coding For Annual Exams

    Posted on August 4, 2014

    One of the provisions of the health care reform Affordable Care Act (ACA) is that plans provide benefits for preventive services with no member cost share, such as copayments, deductibles, and coinsurance.

    Therefore, many of us book our routine exam appointments with the expectation that we will not receive a bill from the doctor’s office for this visit.

    However, there are times when we may be surprised to receive a bill for services related to this exam. For instance, if a patient goes for their annual exam, and discusses a certain health problem with their physician, that doctor may submit the claim with a “diagnosis code”, which will in turn, generate cost sharing for that service.

    For example, a patient may be experiencing knee pain in the months leading up to his/her routine physical. They decide to hold off contacting the doctor about the symptoms, thinking that they will just wait until their annual exam to have this discussion. During that discussion of the knee pain, the doctor may decide that the patient needs physical therapy, medication, or some other treatment for that knee pain. Since this now becomes a “diagnosis” situation, the doctor will most likely check off a code for that on the encounter form (that slip of paper they hand to you on the way out).

    A copy of this form gets submitted to the doctor’s billing department, which is turn sent to the insurance company. The insurance company processes the claim based on what was submitted, and because of the “diagnosis” being checked off, there will most likely be cost sharing being charged to the patient.

    If you receive a bill for this type of situation, it is best to call the insurance company to find out exactly what code was submitted, and then place a call to your doctor’s office if you still have questions.

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