Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Indecision and delays are the parents of failure.”– George Canning
Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
In 1869, Arabella Mansfield was the first woman admitted to the bar in Iowa.
On October 1, 2015, ICD-10 will go into effect, displacing ICD-9, which has been in place for 30 years. ICD-10 will introduce greater detail and therefore greater complexity to medical billing and coding practices. Indeed, In excess of 150,000 new procedure and diagnosis codes will be introduced. As a result, it is safe to say that disagreements with carriers and controversy in interpretation will be commonplace for some time to come. Because of this, medical providers need to brace themselves for what is sure to be increases in denials from carriers with a concomitant reduction in revenue. Although these denials of course can and should be challenged at every turn, medical provider cash flow in the short run will certainly be impacted.
This is especially true in light of the fact that ICD-10 is not being mandated, thus far, at the state level. Hence, PIP and WC claims can still be processed under ICD-9. This gives PIP and WC carriers perhaps an additional opportunity for denial—they might request a bill submitted under ICD-9 to be re-submitted under ICD-10 and vice versa—anything to cause delay or denial in reimbursement.
Medical providers need to be especially vigilant and aggressive in their refusal to accept these denials and delays at face value, and should prepare themselves financially for a reduction in revenue, at least in the short run.
If you have questions regarding ICD-10, or any other legal questions, please feel free to contact Callagy Law today! If you are a medical provider, please refer to our Medical Providers page on our website.
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New and existing small businesses have to consider if they will offer health insurance and if so the owner must pick the specific benefits for the company. Under the Affordable Care Act individuals and businesses have new rights and responsibilities regarding health care insurance.
The ACA has instituted new requirements involving various parts of employer-sponsored health care insurance including waiting periods, tax credits, and disclosure rules for employees. Owners and managers of small businesses should be aware of the legal requirements surrounding these regulations to ensure compliance.
Waiting Periods
Under current law, employers who offer health insurance cannot have waiting periods longer than 90 days. Employers occasionally use waiting periods before issuing health insurance to employees. These waiting periods can be to avoid providing costly health insurance to probationary employees before they are hired permanently. Alternatively, waiting periods are sometimes used for employees who are in training periods or have started on a part-time or temporary basis but are moving to a full-time role. Of course, employees must still meet other eligibility criteria in order to obtain the employer-based health insurance.
Tax Credits
For small employers, with fewer than 25 full-time equivalent employees, the Federal government may provide tax credits. Businesses that pay average wages below $50,000 and contribute 50% or more to its employees health insurance premiums, and buy insurance through the small business insurance marketplace may be eligible for the tax credits. The tax credits may equal up to 50% of the employer’s insurance premium costs.
Notably, employers do not have to provide coverage to employee dependents or to part-time employees.
Alternatively, employers who fail to meet IRS requirements with regard to offering health insurance, may face financial penalties.
Disclosures
Employers are now required to provide employees with summary of benefits documents that explain the benefits of the health insurance plan, such as what is covered and what the cost sharing between the employer and employee are under the plan. The coinsurance, copays, and deductibles for individual services as well as annual and lifetime levels are likely going to be included in the summary documents.
Insurance carriers will draft the benefit summary document, which may be based off of a standardized document for small group insurance plans or it may be customized for a particular business. Employers should familiarize themselves with the documents to ensure that they comply with the contract that the business signed with the carrier and so that they can communicate knowledgeably with employees who may have questions about benefits under the health plan.
Employers should note that they may face penalties for failing to comply with the disclosure requirement.
Contact a knowledgeable Lawyer for Assistance
Treading into the field of Federal and local regulatory law can be confusing for busy business owners. The experienced and dedicated attorneys at Callagy Law are ready to help answer your questions about forming a business or ensuring that your existing business is in compliance with the law. Contact the team here at Callagy Law today for legal guidance.
You may also be interested in these Callagy Law Blogs:
Medical Provider, Heal Thyself: Information on the Affordable Care Act
Citizens United and Hypocrisies
Is Obamacare in the Supreme Court Again?
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Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“While one person hesitates because he feels inferior, the other is busy making mistakes and becoming superior.”– Henry C. Link
Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
95 percent of pending lawsuits end in a pre-trial settlement. – The Law Dictionary
Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
According to payscale.com, the average pay for an attorney is $76,999 per year.
