Tuesday, August 31, 2010

Senate to vote on repeal of Form 1099 health reform provision

The Senate is scheduled to vote on September 14 on two amendments to an unrelated bill that would alter the 1099 provision. One amendment would exempt businesses with fewer than 25 employees, raise the reporting threshold to purchases above $5,000, and exclude those purchases made with a credit card, while the other amendment would eliminate the provision completely.

The original provision would require businesses to file 1099 tax forms on any purchases of goods or services above $600. The provision was designed to prevent tax evasion and was projected to raise $17.1 billion over 10 years.

While Democrats have been reluctant to consider repealing or modifying such a substantial funding source for health reform, the uproar from small businesses has caused members of Congress from both parties to take notice.

For more information on the provision, please see our initial post: Form 1099 tax change in health reform law exposed.

New primary payment notice process implementation with BCBSNC

The Medicare Secondary Payer Recovery Contractor (MSPRC) is implementing a new Primary Payment Notice (PPN) process, effective this month, to improve the accuracy of Medicare Secondary Payer (MSP) demands. On August 30, the MSPRC will begin issuing PPNs ahead of MSP Demands, to both the impacted employer and the insurer/TPA.

What is a Primary Payment Notice?
The Primary Payment Notice, or PPN, is a notice to employer groups to advise them that the Centers for Medicare & Medicaid Services (CMS) has identified instances where Medicare may have mistakenly made a primary payment when other primary insurance exists. Enclosed with this notice is a PPN worksheet that lists Medicare beneficiaries and corresponding coverage dates. The notice requests employer groups to review the worksheet, make corrections and additions as necessary, and mail or fax the completed worksheet to the MSRPC.

BCBSNC will also receive a copy of the PPN notices and worksheets that our employer groups receive.

What will BCBSNC do with the copy of the PPN notices they receive from the MSRPC?
BCBSNC will complete the worksheet (review the form, check the "insurer" box, and enter the appropriate information), and we will fax or mail it in to the MSRPC. BCBSNC will work with employer groups to ensure that the worksheets we submit are correct.

What will occur if employer groups do not complete and return the PPN worksheets to MSRPC?
If employer groups do not complete and return the worksheet to the MSPRC within 45 days of the issue date of the letter, a demand (referred to as a Medicare Secondary Payer demand) will be sent for repayment for all of the claims associated with the beneficiaries and corresponding coverage dates identified in this notice.

The PPN is considered a courtesy before a demand is issued and is not considered a valid, documented defense to a MSP demand.

Does the MSPRC require that both copies of the PPN worksheets (the copies sent to both the employer and BCBSNC) are completed and returned?
No; MSPRC does not require both copies.

Can employer groups send their PPN worksheets to BCBSNC, so that BCBSNC can submit the PPN worksheets on the group’s behalf?
Yes; employer groups can do this; however, BCBSNC encourages employer groups to complete and send these worksheets to the MSPRC. Employer groups can contact BCBSNC, so that they can verify coverage information and assist employer groups in completing these worksheets.

As always, the MSP mailbox, MSP.ReqCorrsub@bcbsnc.com, is available to employer groups for status requests, questions, and correspondence submissions.

My employer group just received a PPN and PPN worksheet from the MSRPC. What should the employer group do?
Employer groups should review the worksheet, make corrections and additions as necessary, and then contact BCBSNC, so that they can verify coverage information. Employer groups should then mail or fax the completed worksheet to the MSRPC.

Key points about the PPNs and PPN worksheets:
• A PPN worksheet should be reviewed by both the insurer and the employer and completed within 45 days from date of letter. This will ensure all parties involved in the process are aware of the data being reported to the COBC (Coordination of Benefits Contractor). The certification statement on the PPN worksheet must be completed and signed in order for the COBC to report changes to the COBC. The PPN Worksheet does not have to be signed by both the employer and insurer, but the MSPRC would like to receive both copies from insurer and employer.
• The MSPRC will report changes to the COBC on the employer’s and insurer’s behalf, based on the PPN received.
• A PPN cannot be accepted once a MSP Demand has been issued and will not be reported to the COBC by the MSPRC. In addition, responding to the PPN does not mean that a MSP Demand will not be issued.
• An employer's response that the Insurer/TPA has authorization to respond on the employer's behalf is not a valid response to a PPN.
• Employers must report current and accurate information to the insurer regularly.
• Employers must provide the Insurer with a correct address for MSP correspondence and Section 111 reporting.
• The MSPRC will not acknowledge or respond to the PPN.
• PPNs only serve as verification of coverage.
• The MSPRC will accept PPNs by fax and mail. The MSPRC will not accept PPNs by phone.
• The MSPRC will be reducing MSP Demand issuance while rolling out the PPN program for the next few months.

For more information, click to view the MSPRC Presentation and Sample PPN.

Monday, August 16, 2010

Tobacco cessation drug coupon currently available

Chantix is a prescription medicine to help adults 18 and over stop smoking. It is currently available at a $30 discount to some patients at participating pharmacies by presenting the coupon referenced below.

If your health plan does not currently cover the full cost of tobacco cessation medications, this offer may be able to assist your employees with their out-of-pocket costs (including copayments) associated with the prescription. The coupon is limited to $30 or the copay amount, whichever is less.

Click to access the Chantix Coupon. This offer expires December 31, 2010.

BCBSNC to reduce administrative costs through data entry outsourcing

On August 12, Blue Cross and Blue Shield of North Carolina (BCBSNC) announced that it will outsource certain claims data entry work as part of an ongoing effort to reduce administrative costs.

The outsourcing will result in the elimination of 80 to 90 jobs over the next nine months and an estimated $1.6 to $2.1 million in annual savings to the company. Jobs impacted do not involve customer service calls or direct contact with BCBSNC customers.

BCBSNC has selected SOURCECORP for this outsourcing based on their extensive experience in records management, business processing outsourcing and consulting. The Dallas-based company has 4,100 clients, including 14 health plans. The work being outsourced will be done by SOURCECORP employees in North Carolina and the Philippines.

This step is part of a larger BCBSNC initiative to reduce its current operating costs by 20% by 2014 in an effort to keep premiums competitive and invest in improvements.

For more information, click to access the BCBSNC News Release.

Thursday, August 12, 2010

Senn Dunn presents the 2010 Employee Benefits Mid-Market Survey & Seminar

Why take the survey?
• Receive a complimentary Individual Custom Report
• Benchmark your plan design to make better informed plan decisions
• Attend the survey seminar for a comprehensive review of local and national survey results

How can I participate?
Simply click to access the survey: 2010 Employee Benefits Mid-Market Survey

Then join us for the 2010 Survey Seminar, conducted by an independent actuarial consulting firm, to review local and national survey results:

Employee Benefits Benchmarking, Best Practices & Strategies
September 16th, 2010
8:00*-10:30 AM
Deep River Event Center
606 Millwood School Road
Greensboro, NC 27409

*registration and refreshments from 8:00-8:30 AM

RSVP to Susan Shanahan at sshanahan@senndunn.com or 336.346.1317 by Wednesday, September 1st.

The use of this seal is not an endorsement by the HR Certification Institute of the quality of the program. It means that this program has met the HR Certification Institute's criteria to be pre-approved for recertification credit.

Friday, August 6, 2010

Virginia judge refuses to dismiss state’s lawsuit against health reform

On August 2, U.S. District Court Judge Henry Hudson denied a motion submitted by the Obama administration to dismiss a Virginia lawsuit that claims the individual mandate in the federal health reform law is unconstitutional.

Filed by Virginia Attorney General Ken Cuccinelli on March 23, the lawsuit argued that Congress exceeded its power to regulate interstate commerce in the new legislation and that the individual mandate requiring individuals to obtain health coverage or pay a penalty violates the Constitution’s 10th Amendment.

Hudson’s ruling means that the suit will move forward to a hearing scheduled for October 18. While the ruling has no direct impact on a larger challenge filed by 20 states in Florida, it may be indicative of how similar suits will be handled.