However obvious it may seem, it bears repeating that the most effective wellness is frequently also the most basic. Case in post: newly released research pitting healthy lifestyles vs. medicine.
According to Reuters Health, a 15-year diabetes study found that in a head-to-head comparison, diet and exercise outperformed the drug metformin in preventing high-risk individuals from developing the disease. “The lifestyle intervention was more powerful in preventing or delaying diabetes development during the original three-year Diabetes Prevention Program and remains more powerful over the entire 15-year study,” said professor and paper coauthor David M. Nathan of the Massachusetts General Hospital.
“However, there are specific subgroups in which the lifestyle intervention had an even more powerful effect – specifically, those older than age 60,” Nathan told Reuters Health by email. Metformin was relatively more effective in people younger than 60 and those who were more obese, he said.
As Ben Franklin so eloquently put it, “An ounce of prevention is worth a pound of cure.” At MedBen WellLiving, we subscribe to this way of thinking, as our program is designed to put prevention at the forefront.
In addition to encouraging proper diet and exercise, Primary Prevention encourages regular checkups and recommended care, thereby improving the chances of catching diabetes and other chronic conditions in their earliest stages. Moreover, seeing a family doctor regularly provides an added incentive to maintain a healthy lifestyle.
Got more information about Primary Prevention through MedBen WellLiving by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
In the months -- more precisely, years -- leading up to the October 1 implementation of the ICD-10 medical coding system, there was no small amount of concern as to whether the massive increase in codes would create claims inaccuracies and turnaround delays. And while it's still early, the initial prognosis is... so far, so good.
Emdeon, a major claims clearinghouse with which MedBen worked throughout the transition, reported in an e-mail that the implementation on their end has been even smoother than expected:
"ICD-10 volume continues to ramp at forecasted rates with over 70% of medical and hospital claims submitted coded in ICD-10. 99.8% of the claims that should be coded ICD-10, providers are coding ICD-10.
"So far in the month of October, Emdeon has received and processed millions of ICD-10 coded claims delivered to thousands of health plans!"
As for MedBen, because we have been preparing for the ICD-10 transition since 2013, internal claims processing has been virtually unaffected. “Any isolated issues have been quickly addressed, and we have remain comfortably above our benchmark turnaround time of 95% of claims examined and paid within 15 calendar days,” said MedBen Director of Data Processing and Technical Compliance Wayne Millard.
For our clients, our goal was to make the transition as seamless as possible. And these initial reports would seem to indicate that the many hours of system coding and testing has been time well-spent.
MedBen clients with questions regarding the ICD-10 coding system are welcome to contact Millard at firstname.lastname@example.org.
Several clients have brought to our attention recent attempts by non-MedBen-affiliated brokers to generate business through the use of scare tactics. Specifically, they are using the looming threat of the “Cadillac” tax and other Affordable Care Act (ACA) requirements to coerce employers into signing them on as their agent of record.
The “Cadillac” tax – so-called because it penalizes health care plans deemed too benefit-rich by the federal government starting in 2018 – has been a particularly useful come-on for brokers to prey on employers. It bears emphasizing that as new health care rules have been introduced, MedBen and its brokers have been advising clients all along on the best ways to proceed – and that will continue to be the case.
At several MedBen University sessions this year, our Vice President of Compliance Caroline Fraker offered a detailed explanation of how the tax works and strategies to avoid it. And as 2018 draws closer, we'll consult clients and brokers individually about recommended plan changes.
Bottom line, always be cautious of anyone who tries to sell you into buying a service through scare tactics. If you are being pressured by a broker into signing an agent of record, please note his or her name and contact MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com.
Lastly, if at any time you have questions about any state and federal regulations and how they affect your health care plan, do not hesitate to contact Caroline Fraker at firstname.lastname@example.org.
Many people covered under the health insurance marketplaces will find themselves with fewer plan options in 2016, as nearly a third of health insurance plans created under the Affordable Care Act have closed or are closing soon.
According to The Washington Post, four co-ops, as the nonprofit plans are known, have decided or been ordered to shut down in the past week alone. In total, eight of the 23 co-ops in existence a year ago will be unavailable to consumers in 2016.
A common reason for the shutdowns pertains to funding promised under the ACA which was intended to help cushion insurers who experience higher-than-anticipated claims due to sicker customers. Earlier this month, the Department of Health and Human Services (HHS) announced that it could afford to pay insurers participating in the marketplaces just 12.6% of nearly $3 billion they were owed under the provision, known as risk corridors.
In related news, the Obama administration announced last week that it expects only a small bump in marketplace plan enrollment in 2016. The Associated Press reports that HHS has set a target of 10 million people enrolled and paying their premiums by the end of next year -- about the same number of individual covered now under the plans.
“If enrollment plateaus, we may see growing discussion of whether the law is fulfilling expectations in covering the uninsured, and whether the subsidies for low- and middle-income people are sufficient to make coverage truly affordable,” said Larry Levitt, an expert on the law with the nonpartisan Kaiser Family Foundation.
Experts cite high turnover, costs and complexity as reasons for the slow enrollment growth.
November means autumn leaves, turkey, football – and of course, Transitional Reinsurance (TR) reporting to the Centers for Medicare and Medicaid Services (CMS). During November, self-funded plan sponsors must provide their TR report to CMS and, in turn, let CMS know when payment will be made.
By way of reminder, the TR program was designed to reduce the uncertainty of insurance risk in the individual market by making payments to establish a pool of funds from which individual health insurance carriers can request reimbursement for their unanticipated high claims costs resulting from health care reform’s expanded coverage. While the majority of the contributions to the program will go to reimburse carriers, a portion will go to the United States Treasury’s general fund.
This year, the amount due per each covered life (i.e., each employee, spouse and dependent on your plan) is $44.00. Generally, that includes all medical benefit plans and policies, including catastrophic coverage. Not subject to the TR payment rules are those plans and policies considered “excepted benefits” under the Affordable Care Act, including hospital indemnification policies, stand-alone dental or vision plans, integrated HRAs, HSAs, FSAs, EAPs, disease management and wellness plans that don’t provide medical benefits, as well as stop-loss policies.
Again this year, a plan sponsor can remit payment in two installments – January and November of 2016. To begin the process, a Contributing Entity (or their TPA) must submit the entity’s enrollment count to the U.S. Department of Health and Human Services by November 16, 2015. MedBen is again offering reporting and filing services for its clients. If you have not already signed up for this service, you can request a description of our service offering and fees be contacting your MedBen group service representative (GSR).
Clients who would like more about the process and rules surrounding the TR Program Fees can request a more detailed summary from their GSR. And if you have any general questions about the TR reporting process, contact MedBen Vice President of Compliance Caroline Fraker at email@example.com.
The rising price of prescription drugs is a frequently-covered topic in the media, but recent events have shown the spotlight that much brighter. Even so, comparatively little has been written about when patients can do to keep their medication costs in check.
Noting that about one-third of Americans have been hit by an unexpected price increase in their medications during the past year, Consumer Reports (via the Fiscal Times) offers strategies that individuals can try to battle rising drug costs. Tips that benefit patients with pharmacy coverage include:
Not included in the list, but a good strategy nonetheless, is for patients with recurring prescriptions to take advantage of mail order pharmacy services if offered under their plan. Depending on your benefits, you may realize additional savings.
Employers can also help their employees to keep prescription drug costs down, by providing a group pharmacy plan that offers additional savings. Under the MedBen approach for pharmacy plans, member receive superior rates on retail and mail order medications, including some of the deepest generic discounts available. Additionally, we can integrate over-the-counter drugs into your prescription plan design... another avenue for member savings.
Finally, MedBen delivers 100% of paid rebates back to the client... which helps to keep pharmacy plan costs down for employer and employee alike.
If you would like to learn more about the MedBen approach to pharmacy plans, we invite you to contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
This month, you may notice a lot of people are wearing pink and showing support for those affected by breast cancer. As the second leading cause of cancer death in women, it’s easy to understand why it gets so much publicity.
The good news? Survival rates have increased from 75% in 1975 to over 90% today. This means the publicity, along with wellness programs like MedBen WellLiving, are proving to be successful. More women are getting checked and catching breast cancer in its earlier stages, thereby getting a better prognosis.
Though it is good to self-examine monthly, MedBen WellLiving recommends any woman 40 years or older receive a mammogram every two years. Of course, depending on your family history, a physician may recommend earlier or more frequent screenings.
Preventing breast cancer is much like preventing many other diseases: exercise regularly, maintain a healthy diet, and discuss any concerns with your family physician while getting all recommended screenings.
To determine your compliance with mammograms and other important screenings, please visit MedBen Access by going to medben.com and selecting “MedBen Access.”
Even though the idea of repealing the "Cadillac" Tax has increasing support from Republicans and Democrats alike, the resulting budget shortfall means that President Obama would probably veto even a bipartisan bill. With that in mind, Bill Sweetnam of the Employers Council on Flexible Compensation (ECFC) suggests an alternative solution:
"Because of the adverse impact of the tax on consumer directed health plans, ECFC is actively working to get the legislation revised so that plans, such as HSAs, HRAs and FSAs are carved out of the excise tax. The carve-out is a good compromise, enabling Americans to set aside money for their health care while allowing for control of excessive costs.
"Today, more than 100 million Americans benefit from consumer-directed health plans by having their health care costs reduced. It is ECFC’s position that it just doesn’t make sense for hard-working Americans to be penalized for trying to set aside money to pay for their health care.
"While it’s not scheduled to take effect until Jan. 1, 2018, companies are analyzing the impact and making decisions now as they plan employee benefits for the coming years.
"If not revised, at least 48% of employers are expected to trigger the excise tax in 2018 and 82% could be subject to it by 2023, according to some estimates, making the excise tax the rule rather than the exception." [Bold emphasis ours]
Oncologists are becoming increasingly resistant about prescribing expensive last-resort cancer drugs that provide little or no benefits, Reuters reports.
In interviews, top cancer specialists say at least a half-dozen drugs, including colon cancer treatments Cyramza and Stivarga, don't justify their inflated prices, which can exceed $100,000 per year.
"There are drugs that don't make much sense given how much they cost, given their small benefits," said Dr Peter Bach, director of Memorial Sloan Kettering's Center for Health Policy and Outcomes in New York. "There are drugs that can cost up to $10,000 a month that provide, at the median, a few weeks or less than a month of additional life, but with substantial toxicity."
Worldwide spending on oncology medicines reached $100 billion in 2014, a one-year jump of more than 10%. The cost of treatment to prolong a cancer patient's life by one year has also shown a marked increase, from $54,100 in 1995 to $207,000 in 2013.
Contributing to the higher costs are medications that cost more than competing products but are actually less effective. Of 51 cancer drugs approved between 2009 and 2013, 21 treatments classified as "novel" had a median annual price of $116,100, while the 30 deemed "next-in-class" had a median price of $119,765, according to a recent study in the Journal of the American Medical Association Oncology.
The IRS has released the finalized versions of the forms that employers can use to comply with Affordable Care Act rules. Under the employer mandate, businesses must certify the coverage offered to their employees.
In general, plans must file Form 1095-B and provide copies to their enrolled employees using the 1094-B transmittal Form. Additionally, large employers must file Form 1095-C and provide copies to their employees using transmittal Form 1095-B.
The IRS will use the information gathered on these forms in order to determine whether an employer's coverage meets minimum value criteria and is affordable. While the forms don't need to be filed with the IRS until the first quarter of 2016, it's critical for employer plan sponsors to have the right mechanisms in place to collect the required information this year so when the time comes, the forms can be properly completed.
MedBen can provide health coverage data reporting services for its clients -- you can read more about that elsewhere on this blog. clients are also welcome to contact MedBen Vice President of Compliance Caroline Fraker at email@example.com with any questions they have regarding the employer mandate.
The federal government is currently challenging hospitals regarding excessive and inappropriate use of implantable cardiac devices (ICDs)... the same excessive and inappropriate use MedBen has been catching for years.
According to Modern Healthcare, hundreds of hospitals have settled with the Department of Justice as part of a multiyear, nationwide investigation into the suspected overuse of implantable cardioverter defibrillators, or ICDs. Settlement figures have not been made public, but individual SEC filings suggest the cumulative amount could total in the billions of dollars.
Under Medicare rules, ICDs cannot be implanted within 40 days of a heart attack or 90 days of bypass surgery or angioplasty. But upwards of 40% are implanted contrary to clinical practice guidelines, as they may not be medically necessary.
MedBen follows similar standards as Medicare, which reflect industry standards for appropriate placement of the cardiac devices. Additionally, MedBen has been performing clinical reviews on ICDs for its clients since 2007 – three years before the Office of the Inspector General started its review. During that time, we discovered and denied 63 inappropriate ICD device placements, saving almost $2.5 million for clients.
“This is a standard part of our clinical review process,” said Kurt Harden, President and COO of MedBen. “Coding software and standard claim payment reviews don’t catch these unnecessary charges. Only a detailed clinical review by cardiologists can root out unnecessary ICD placements.”
At $40,000 or more per unit, ICDs are among the most expensive devices to treat abnormal heart rate – and the devices need to be replaced every 5 years for the life of the patient. But in certain cases, a less expensive pacemaker, or even medication, may be sufficient to treat the condition.
Harden added that MedBen's comprehensive review process doesn't stop with ICD devices. "We employ a team of over 125 expert physician reviewers and a one-of-a-kind system that routes and reviews the claims quickly for clients. The savings are significant and our physicians step in to help the client and the member," he said.
Clients with questions regarding MedBen’s cardiovascular review procedures are welcome to contact Kurt Harden at 888-633-2364.
Today's the day when providers begin using the new ICD-10 medical coding system. The rollout comes after multiple deadline extensions -- but all along, MedBen has been preparing for the changeover and is ready to handle the new codes.
The new system increases the number of descriptive codes from ICD-9's 14,000 to 68,000. Such a substantial expansion has produced some, shall we say, interesting additions. From CIO:
"Some of the diagnostic codes can be archaic or absurd. Code Z63.1, for example, describes 'Problems in relationship with in-laws,' and code V97.33XD covers patients who were 'sucked into a jet engine.'"
Because doctors and hospitals only formally begin using the new codes today, MedBen won't begin receiving claims containing them for several days. But when we do, we're confident that our system components will able to accept and process ICD-10 codes without interruption to our day-to-day processes.
MedBen conducted internal system testing of the ICD-10 modifications as early as 2014. And throughout this year, we've conducted connectivity tests with an external vendor to ensure the accuracy of our work. All told, we've been fully compliant for the better part of 2015.
As claims with the new codes start coming in, there will undoubtedly be a "learning curve" as medical facilities get comfortable with the new codes. But with the advanced preparation, MedBen is confident that clients will see no increase in claims turnaround times. And we'll be ready to assist providers whenever necessary.
MedBen clients with questions regarding the ICD-10 coding system may contact MedBen Director of Data Processing and Technical Compliance Wayne Millard at firstname.lastname@example.org.
From 2008 through 2014, average U.S. prices for the most widely used brand-name drugs jumped 128%, according to prescription benefit manager Express Scripts. Not surprisingly, part of that increase is due to expensive new drugs that can cost as much as $100,000 or more for a year or course of treatment.
As you can see, there are a lot of factors at play in driving drug costs up... and it underscores the need for a pharmacy plan that helps to keep those costs more manageable.
MedBen offers a transparent, full pass-through Rx model -- 100% of discounts and paid pharmacy rebates go directly into the client's health plan -- that results in better savings. In addition, we offer superior discount rates, including generic discounts that are among the best in the industry.
MedBen supports its pharmacy program with strong, useful reports and recommendations that drive groups toward good plan design decisions. We'll work closely with your group to design a pharmacy plan that best meets member needs, with no hidden fees – instead, you get the maximum savings possible.
To learn more about MedBen pharmacy plans, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
The drumbeat to repeal the Affordable Care Act's "Cadillac tax" is growing louder... and now includes a presidential candidate.
BenefitsPro reports that Independent Senator Bernie Sanders (Vt.) has joined seven Democrats in sponsoring a repeal measure. They join other Senate members who have supported bipartisan legislation to drop the measure, which will impose a 40% excise tax on individual health plans worth more than $10,200 and family plans worth more than $27,500.
An increasing number of Congressional Democrats have split from President Obama over the tax, due in part to pressure from labor unions over concern that the tax would affect benefit-rich union health plans. The White House, in turn, has criticized repeal efforts because they offer no replacement funding for the estimated $87 billion the tax would generate.
Sanders, a leading candidate for the Democratic Party's presidential nomination, has said the shortfall could be offset by creating a new tax on rich people.
The Cadillac tax is currently set to take effect in 2018.
Good news for those of you who got a flu shot in 2014 but still got sick: the U.S. Centers for Disease Control and Prevention reports that this year's vaccine should be more successful in helping you battle the bug.
Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said that he expects the 2015-16 flu vaccine to 50-60% effective, in line with most years. This means that if you get a flu shot, your chances of getting the flu are reduced by as much as 60%.
According to HealthDay, last year's flu season was particularly severe because the predominant strain was an influenza A called H3N2. The vaccine didn't include that strain, and as such, was only 13% effective against it.
The vaccine for the 2015-16 season contains the H3N2 strain, Frieden said.
The CDC recommends that everyone 6 months of age and older get a flu shot every year. If you get a flu shot from someplace other than your family doctor's office, it’s a good idea to let him or her know during your next wellness exam. And if you have a fear of needles, talk to your doctor about using a nasal spray flu vaccine instead.
As you know, the Affordable Care Act (ACA) and its supporting regulations require that all employers offering health benefits to their employees report on certain health coverage information. Health coverage data collected during 2015 must be aggregated and reported to employees no later than January 31, 2016 on IRS Form 1095 and reported to the IRS no later than February/March 2016 (depending on filing requirements) on IRS form 1094. Applicable Large Employers (those with 50 or more employees) must report using the IRS’ C-series forms and small employers offering coverage (those with fewer than 50 employees) must report using the IRS’ B-series forms.
To assist our clients who are Applicable Large Employers (ALE) with this important task, MedBen has contracted with an outside vendor to provide ACA-related services, including 6055/6056 reporting, through proprietary on-line applications. After spending the summer vetting multiple companies, we chose one that we found to be among the most knowledgeable and best priced vendors in this market. In doing so, we can offer several service options to help ALEs create and distribute Form 1095-C to employees and prepare and file Form 1094-C with the IRS.
In addition, MedBen will be able to assist our clients who are small employers by preparing related IRS Forms (1095-B – employee notice and 1094-B – IRS transmittal) for a nominal fee.
We understand that this subject is confusing and that there is a lot of information you still need. That said, we wanted to provide clients with information about a company that is among the top vendors in the area of ACA data management and reporting. Over the next few weeks, our clients will be getting that information through various means, including educational seminars and webinars on the subject.
We also know that January still seems a long way off, but please do not wait to consider purchasing these services. Clients who wish to purchase these services through MedBen, please let us know immediately. If you are planning to create these forms yourself or you’re working with another vendor, we would appreciate knowing that too. Either way, it is important that you start planning now.
MedBen clients with questions regarding the data reporting services available, please contact your Group Service Representative or Caroline Fraker, Vice President of Compliance & Chief Privacy Officer, at firstname.lastname@example.org.
"Members of Congress from both parties [...] are calling for changes in the Affordable Care Act to prevent premium increases that are expected to affect workers at many small and midsize companies next year," The New York Times reports:
"At issue is a provision of the health care law that expands the definition of a 'small employer' to include companies with 51 to 100 employees, subjecting them to stringent insurance regulation starting on Jan. 1. States have historically defined small employers as those with 50 or fewer employees.
"Because many organizations with 51 to 100 employees will be reclassified as small employers, they will have to offer a package of “essential health benefits” specified by the health law — in some cases more generous than what they now offer. Insurers will no longer be allowed to set premiums for such groups based on their claims history, industry or size — factors now commonly considered.
"Legislation to let states keep the current definition of 'small employer' has won support from 229 House members, including 43 Democrats. The legislation has been endorsed by 43 senators, including 10 Democrats.”
MedBen clients who have questions regarding employer shared responsibility penalties under the ACA are welcome to contact Vice President of Compliance Caroline Fraker at email@example.com.
Back in the day -- like, four years ago -- there seemed to be a growing consensus that Congress would overturn the provision of the Affordable Care Act that required a doctor's prescription to purchase over-the-counter drugs (OTCs) with FSA or HSA funds. Ultimately, various bills went nowhere, and the matter was dropped... until now.
Business Insurance reports that the House Ways and Means Committee yesterday approved a new bill that would once again allow health care plan members with an FSA, HSA or HSA to use their tax-free contributions to pay for OTCs. The legislation was introduced by Reps. Lynn Jenkins, R-Kan., and Ron Johnson, R-Wis.
This legislation “will help so many families across the country,” said Rep. Erik Paulsen, R-Minn., referring to the restoration of the tax break. But Rep. Xavier Becerra, D-Calif. countered that restoring the tax break would only be “fair if everyone is treated the same,” including individuals not covered by tax-free accounts.
Unlike earlier attempts to overturn the provision, both houses of Congress now have Republican majorities, making passage of the legislation more likely... though, of course, President Obama can still veto the bill if it does get that far. And the 2013 elimination of the "use-it-or-lose-it" rule for FSAs makes the matter somewhat less pressing, as fewer members need to use up leftover account dollars at the end of the plan year.
Older adults at high risk of heart disease could benefit from a daily aspirin, according to the U.S. Preventive Services Task Force.
In a newly-released draft report, the medical organization recommends that men and women between the ages of 50 and 69 take a low-dose (about 81 milligrams) aspirin every day if they have a 10% or greater risk of having a heart attack or stroke during the next 10 years. The aspirin regimen may also help those who have a higher risk for developing colon cancer.
The task force added that the benefits of aspirin are strongest in people 50 to 59, but that people 60 to 69 “can also benefit” after consulting their doctors.
It should be noted that taking a daily aspirin is not without risks of its own, such as bleeding in the stomach and brain -- and carries greater risks still for people with ulcers or kidney or liver problems. Therefore, the guidelines recommend that potential candidates seek a medical opinion before beginning an aspirin regimen.
Lowering your blood pressure to a healthier level can have a huge impact on your well-being, NPR reports:
"Cutting blood pressure below the currently recommended target can significantly reduce the rate of heart attacks, strokes, heart failure and deaths, federal health officials reported [on September 11].
"The findings come from the largest study ever conducted to examine whether reducing systolic blood pressure — the top number patients get when examined — below the currently recommended goal would be beneficial.
"The study was halted early when an analysis indicated the benefits were clear, officials said. 'This is landmark study,' says Dr. Gary Gibbons, director of the National Heart, Lung and Blood Institute, which sponsored the study. 'We think that this study will clearly have an impact on patient care for those with hypertension.'"
Subjects in the study who got their systolic blood pressure down to 120 or lower reduced heart attacks, strokes and heart failure by almost a third and the risk of death by almost a quarter. This was a notable improvement compared to a second group in the study with a target systolic of 140.