May 2020 •
Volume 5 •
Issue 13
Providing Current Information on
Health Insurance Industry Issues and Legislation
The Impact of Capping Out-of-Network Payment
Limiting payments for out-of-network hospital care could yield savings of an estimated
$108 billion to $124 billion annually, according to a recently released study by the Rand Corporation. Rand
researchers analyzed the impact of four different approaches to
capping out-of-network payments in terms of savings for payors, provider profitability
and viability and the healthcare system overall.
$108 billion to $124 billion annually, according to a recently released study by the Rand Corporation. Rand
researchers analyzed the impact of four different approaches to
capping out-of-network payments in terms of savings for payors, provider profitability
and viability and the healthcare system overall.
Minimizing Payments in the Mean Time
At some point in the future, mandatory caps on out-of-network payments and
the end of surprise billing may become realities. Until then, HHC Group's attorney
case managers will continue to secure signed agreements from providers to
accept appropriate amounts as payment in full for their services. We'll continue
to access our national and regional PPO partners' network discounts to minimize
the amounts our clients pay on their out-of-network claims. And we'll continue
to conduct Bill Reviews on out-of-network, and when allowed in-network, claims
to assess their true value and secure signed agreements from providers to accept
those amounts as payment in full.
the end of surprise billing may become realities. Until then, HHC Group's attorney
case managers will continue to secure signed agreements from providers to
accept appropriate amounts as payment in full for their services. We'll continue
to access our national and regional PPO partners' network discounts to minimize
the amounts our clients pay on their out-of-network claims. And we'll continue
to conduct Bill Reviews on out-of-network, and when allowed in-network, claims
to assess their true value and secure signed agreements from providers to accept
those amounts as payment in full.
CARES Act Provides Business Tax Relief
The Coronavirus Aid, Relief and Economy Security Act (CARES Act) includes provisions
for an employee retention credit and an employee payroll tax deferral. The employee
retention credit is a refundable credit equal to 50% of the "qualified wages" of each
employee of an "eligible employer". Regarding the Payroll Tax Deferral, the Act allows for a
deferral of "applicable employment taxes," and it appears that the deferral can be used in
conjunction with the Credit when the Credit does not result in a refund.
for an employee retention credit and an employee payroll tax deferral. The employee
retention credit is a refundable credit equal to 50% of the "qualified wages" of each
employee of an "eligible employer". Regarding the Payroll Tax Deferral, the Act allows for a
deferral of "applicable employment taxes," and it appears that the deferral can be used in
conjunction with the Credit when the Credit does not result in a refund.
COVID-19 Self-Funded Plan Benefits Issues to Consider
Self-funded Plans face a multitude of employee benefits issues in response to the
coronavirus pandemic. This article addresses some of what should be considered
regarding amending the plan document, whether or not to stop accruing funds or
reduce IBMR, modify prescription drug ordering rules, how to treat reductions in
workforce must and other COVID-19 related do's and don'ts. It also includes some of
the financial costs Self-Funded will be likely to have associated with COVID-19.
coronavirus pandemic. This article addresses some of what should be considered
regarding amending the plan document, whether or not to stop accruing funds or
reduce IBMR, modify prescription drug ordering rules, how to treat reductions in
workforce must and other COVID-19 related do's and don'ts. It also includes some of
the financial costs Self-Funded will be likely to have associated with COVID-19.
Three Star Preferred Provider Program Additions
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Latrobe, PA 15650 Impact Physician Group Peachtree City, GA 30269 Broward Health North Pompano Beach, FL 33064 |
Chicago, IL 60613 William Vlach, Ph.D. San Francisco, CA94172 |
