Affordable Care Act – IRS and Treasury Oversee 2015 Employer Reporting

Affordable Care Act employer reporting requirements are effective January 1, 2015.  Penalties may be assessed up to $100 per incorrect return to the IRS, or for incorrect information reported to an individual, employee or equivalent, that is eligible for group health coverage. However, penalties may be reduced if they are corrected. Employers have until August of each reporting year to make corrections.

Those impacted employers must report the cost of care in any group plans they managed.  The U.S. Department of Treasury and the Internal Revenue Service (IRS) oversee and administer employer reporting requirements.   The final rulemaking as of March 2014 details in 26 U.S. Code § 6055 – “Reporting of health insurance coverage” requires health insurance issuers, certain employers, and others report certain data.

“Every person who provides minimum essential coverage to an individual during a calendar year shall, at such time as the Secretary may prescribe, make a return described provide minimum essential coverage to individuals must report to the IRS information…” about the type and period of coverage and furnish the information in statements to covered individuals.

§ 6055 provides reporting requirements for large employers who employ at least 50 full-time or full-time equivalent employees. Section 6056 requires those employers to report information about health care coverage. This is provided for in 26 U.S. Code § 4980H – “Shared responsibility for employers regarding health coverage.”  Additionally, large employers must supply related statements to employees that they may use in determining which months of the year they are able to claim on individual returns for a premium tax credit as specified in 26 U.S. Code § 36B – “Refundable credit for coverage under a qualified health plan.”

If employers provide assistance in paying for any out of pocket costs, The Accountable Care Organization and other value based care structures, as well as ICD-10 may play a role in recalculation of total employer costs, since out of pocket costs may change in value based care or revised definitions of diagnosis or inpatient procedure codes provided for by ICD-10.

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been quoted in the Wall Street Journal, New York Times, and National Public Radio.

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