HHS Archives - NueSynergy

HHS Proposes HIPAA Standards for Electronic Health Care Claims Attachments

by Lexi Garcia | Mar 9, 2023 | Blog

HHS has proposed regulations that would adopt a set of standards for the electronic exchange of clinical and administrative data to support prior authorizations and health care claims adjudication. As background, HIPAA requires that covered entities (and their business associates) comply with rules designed to standardize the format and content of specified electronic transactions. Specifically, the proposed regulations would adopt standards for “health care attachments” transactions that would support both health care claims and prior authorization transactions, along with a standard for electronic signatures. Regulations proposed in September 2005 would have adopted certain standards for health care attachments but were never finalized.

Explaining that the prior regulations were not finalized due to comments about the standards’ “lack of technical maturity and stakeholders’ lack of readiness to implement electronic capture of clinical data,” the preamble to the new proposed regulations notes that despite the subsequent widespread deployment of electronic health records and greater industry experience with the HIPAA standards, transmitting health care attachments is still primarily a manual process. The preamble provides detailed information about the organizations responsible for developing and maintaining the transactions standards and advises that the timing for implementation is right because the industry consensus-based standards are now mature, and covered entities are ready to implement them. The regulations do not propose to adopt attachments standards for all health care transaction business needs. Instead, the approach is for covered entities to gain experience with several standard electronic attachment types so that technical and business issues can be identified to inform potential future rulemaking for other electronic attachments standards.

Source: Thomson Reuters

What do all these employee benefit acronyms stand for?

by Lexi Garcia | Feb 21, 2023 | Blog

Everyone in the employee benefits field uses acronyms like COBRA, FSA, and CDHC. What do these and other employee benefit acronyms stand for?

Here’s an explanatory list of common employee benefit acronyms used:

ACA – Patient Protection and Affordable Care Act

AHP – Association Health Plan

ASG – Affiliated Service Group

ASO – Administrative-Services-Only

ATIN – Adoption Taxpayer Identification Number

BA – Business Associate

CDHC – Consumer-Driven Health Care

CE – Covered Entity

COB – Coordination of Benefits

COBRA – Consolidated Omnibus Budget Reconciliation Act

COLA – Cost-of-Living Adjustment

CONUS – Continental United States

DCAP – Dependent Care Assistance Program

DOL – Department of Labor

EIN – Employer Identification Number

EAP – Employee Assistance Plan

EBHRA – Expected Benefit HRA

EBSA – Employee Benefits Security Administration

EEOC – Equal Employment Opportunity Commission

EFAST2 – ERISA Filing Acceptance System II

EOB – Explanation of Benefits

EOI – Evidence of Insurability

ePHI – Electronic Protected Health Information

ERISA – Employee Retirement Income Security Act

FICA – Federal Insurance Contributions Act

FLSA – Federal Labor Standards Act

FMLA – Family and Medical Leave Act

FSA – Flexible Spending Amount

FUTA – Federal Employment Tax Act

GHP – Group Health Plan

HCE – Highly Compensated Employee

HCP – Highly Compensated Participants

HDHC – High Deductible Health Coverage

HDHP – High Deductible Health Plan

Health FSA – Health Flexible Spending Arrangement

HHS – Department of Health and Human Services

HIPPA – Health Information Technology for Economic and Clinical Health Act

HMO – Health Maintenance Organization

HRA – Health Reimbursement Arrangement

HSA – Health Savings Account

ICHRA – Individual Coverage HRA

IIAS – Inventory Information Approval System

MCC – Merchant Category Code

PBM – Pharmacy Benefit Manager

PCOR Fees – Fees for Patient-Centered Outcomes Research

PEO – Professional Employer Organization

POP – Premium-Only Plan

PPO Plan – Preferred Provider Organization Plan

QB – Qualified Beneficiary

QE – Qualifying Event

QMCSO – Qualified Medical Child Support Order

QSEHRA – Qualified Small Employer Health Reimbursement Arrangement

R&C – Reasonable and Customary

RRE – Responsible Reporting Identity

SBC – Summary of Benefits and Coverage

SMM – Summary of Material Modification

SPD – Summary Plan Description

TPA – Third Party Administrator

UCR Rate – Usual, Customary, and Reasonable Rate

VEBA – Voluntary Employees’ Beneficiary Association

Proposed regulations aim to expand contraceptive access and eliminate moral exemption for coverage mandate

by Lexi Garcia | Feb 15, 2023 | Blog

The Internal Revenue Service, Department of Labor, and U.S. Health and Human Services Department have issued proposed regulations that would provide an additional method for individuals to obtain no-cost contraceptive services if their health plan or insurer does not provide such services due to a religious exemption. Under final regulations issued in 2018, qualifying religious employers and other entities with sincerely held religious beliefs or moral convictions are exempt from the Affordable Care Act’s contraceptive coverage mandate, which generally requires coverage of contraceptive services without cost-sharing. Exempt entities may voluntarily engage in an accommodation process that allows plan participants to receive contraceptive services directly from a TPA or insurer without the employer’s involvement. In an FAQ issued in 2021, the agencies announced they were considering changes to the 2018 regulations “in light of recent litigation”. Here are highlights of the proposal:

Individual Contraceptive Arrangement: Leaving in place the existing religious exemptions and accommodations, the agencies have proposed to add a new “individual contraceptive arrangement” through which individuals enrolled in plans or coverage sponsored or arranged by entities with religious objections could access no-cost contraceptive services without the involvement of their employer, group health plan, plan sponsor, or insurer. A provider or facility that furnishes contraceptive services in accordance with the individual contraceptive arrangement would be reimbursed through an arrangement with an Exchange insurer, which would request an Exchange user fee adjustment to cover the costs.
Moral Exemption Rescinded: The proposed regulations would revoke the 2018 regulations’ moral exemption and accommodation. The agencies explain that “there have not been a large number of entities that have expressed a desire for an exemption based on a non-religious moral objection” and that there is no legal obligation (including under the Religious Freedom Restoration Act) to provide such an exemption.

Source: Thomson Reuters

HHS Proposes HIPAA Standards for Electronic Health Care Claims Attachments

What do all these employee benefit acronyms stand for?

Proposed regulations aim to expand contraceptive access and eliminate moral exemption for coverage mandate

Understanding IRS Rules: The Importance of Substantiating Health FSA and DCAP Claims