Controversial Medical Billing Practices by the medical profession

Controversial billing practice may account for $1 billion in medical fees paid by patients.
BusinessWeek (8/29, Terhune) reports, "As healthcare costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe" due to a common, yet often illegal practice known as balance billing. When this happens, "an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid," and the provider "demands the balance from the patient." BusinessWeek notes that "state and federal laws generally bar the medical providers from pressuring patients to pay the difference." Yet, as this practice continues, "economists and patient advocates estimate that consumers pay $1 billion or more a year for which they're not responsible." In fact, in California alone, an estimated "1.76 million policyholders...received such bills in the past two years, totaling $528 million," and 56 percent paid.

Typically, patients fall victim to balance billing when "medical providers participating in a managed-care network believe the plan's insurer is imposing too deep a discount on medical bills or is taking too long to pay." Currently, 47 states "ban in-network providers from billing insured patients beyond co-payments or co-insurance required by the plan," and "federal law prohibits providers from billing Medicare patients for unpaid balances." Yet, "regulators in most states have been slow to take action in billing disputes."

Industry experts say small business owners can make use of summer downtime.

The last few weeks of summer can be a useful time for small business owners whose companies are going through a slow period -- they have a chance to tackle some of those tasks they've been putting off. While some owners use summer downtime for big projects like writing an employee handbook, other owners cross off more mundane items from their to-do lists, such as entering that pile of receipts into their accounting software. Summer is a good time to get all this stuff done, in preparation for the fall. ... A mistake so many business people make is they wait until Sept. 1 to really gear up. They're really short-shrifting themselves. In planning downtime projects, owners may want to consider what changes...to make to their products or services, or how to adjust their marketing programs. Other experts recommend making changes to websites, examining costs and seeing what...can be cut, and thinking about employee issues.

Aging U.S. population visiting hospitals more, study shows.

There are reports that the "aging of the U.S. population is translating into many more visits to doctors' offices and hospitals, a reality that is taxing weak spots in the healthcare system, according to a government report released Wednesday." Investigators found that overall, "[p]eople made an average of four visits a year to doctors' offices, emergency rooms, and hospital outpatient departments in 2006, a total of 1.1 billion visits." The data also showed that the "number of medical visits increased 26 percent between 1996 and 2006, significantly higher than the 11 percent population growth during that period."

The national Centers for Disease Control and Prevention (CDC) in Atlanta released the statistics, and they came "from various components of [the] CDC's National Center for Health Statistics National Health Care Survey".

According to the CDC, "the observed increase in medical visits 'can be linked to both the aging of the population, as older persons have higher visit rates than younger persons in general, and an increase in utilization by older persons.'" In terms of racial disparities, the "overall visit rate was not significantly different for white and black persons." But, "African-Americans had higher visit rates than whites to hospital outpatient departments and emergency departments, and lower visit rates to office-based surgical and medical specialists." Additionally, "[r]egardless of setting -- physician office, outpatient clinic, or emergency department -- seven out of 10 patients left the medical visit with at least one prescription, and analgesics were the most common drug prescribed."

Medicare Supplements - Click for rates if you are 65+

At Home Employees doing Company work

Here's a question you may not have thought about: If one of your employee's is working at home and is injured, are you responsible? The answer depends on individual circumstances. For example, electrocution from a faulty cord on a computer you provided is different from a slip and fall on the way to the bathroom. As technology allows more and more work to be performed at home, it's a good idea to adopt safety expectations for your employees' home offices.
Here are some ideas to keep in mind if you have staff working from home:

* Temperature, noise, ventilation and lighting levels should be adequate.
* Electrical equipment should be free from hazards (e.g., frayed or exposed wires). Wiring and electrical cords should be secured and out of the way.
* The work area should be large enough to safely accommodate all equipment, wiring and so on without posing a risk of hazard to the employee.
* Hallways and doorways should be free from obstructions.
* The working environment should be free from clutter or materials that could create fire hazards.
* Floor surfaces should be clean and dry. Carpeting should be properly secured.
* There should be ample lighting for the work that the employee will be doing.
* The working area should be equipped with sufficient electrical outlets to accommodate all necessary equipment safely.
* Desks and chairs should be the appropriate size, height, etc., to provide comfort.
* Some organizations ask employees to sign a statement indicating that they will comply with the company's stated safety requirements; others even ask employees to bring in photos of their work areas indicating that they are in compliance with safety regulations.

Employee safety needs to be your concern even when their working from home.
If you or someone you know has staff that telecommutes or works from home contact your Business Insurance agent or we can offer references to you. For more HR updates ask us about our HR platform offered free to AMS clients. 800-334-7875

AMS Clients receive HR as a client benefit

Information which will help you to manage your business keeps you updated and ready. Sharpening Your Screening Interviews is a current article from our HR Affiliate.

Many employers adopt some sort of interview process. Unfortunately, many employers also abbreviate the process by hastily moving from the resume review stage right into the hiring interview stage. In between those two stages, however, the prudent employer will conduct screening interviews to separate the truly qualified job candidates from the unqualified candidates.There are four basic tips to help managers make the screening interview stage an integral part of a successful employee selection process:

Know Your Business Needs. Before placing that ad or starting the search, you hopefully already developed a job description that defines what your business needs are. The job description should be specific about the job duties, the necessary skills set, the type of required experience / education, and any other information to help you identity the ideal job candidate.

Review the Resume. Get familiar with the candidate’s resume before the phone or in-person screening interview. Make a checklist of standard questions to ask each candidate and any notes specific to the resume in question. Have all this information with you to briefly look over just before the interview to help confirm your mental map for the discussion.

Figure Out the Fit. During the screening interview, exercise sound judgment in assessing the candidate’s personality traits. Pay attention to the candidate’s overall attitude, behavior, and knowledge toward the company and any employees the candidate may have met already. For example, how well does the candidate respond during the interview?

Watch the Warnings. With the resume at hand, be sure to verify statements made on the resume, and isolate any apparently exaggerated or seemingly falsified information. For example, how the candidate phrased his or her familiarity of certain computer office programs on the resume may be questionable. In turn, ask the candidate to provide a concrete example.

By verifying the integrity of each candidate’s resume through the screening interview process, you will gain a clearer perspective of the how to better define your pool of truly qualified candidates towards selecting your next great employee.

Not Understanding At-Will Employment Puts Your Business at Risk

"At-will" employment refers to a common-law rule that the employment relationship may be terminated by the employer or the employee at any time, for any reason, with or without cause or notice. For employers, the ability to terminate an employee whenever they want and for whatever reason is invaluable. This perception, however, is not quite accurate. Over time, the establishment of various federal and state regulations and the application of certain employment law concepts have created conditions and layers much more in favor of today's employee. To minimize the risks of wrongful termination claims, every employer needs to understand at least the three big exceptions to the employment at-will concept:

Public Policy: A wrongful discharge when the reason for employment termination is contrary to an established state public policy (i.e. terminating a pregnant employee protected under the federal Family Medical Leave Act).

Implied Contract: A contract between the employer and the employee although no written documentation exists regarding the employment relationship (i.e. “Probationary Period” language in the Employee Handbook).

Covenant of Good Faith: An implied agreement the employer is to treat employees honestly and fairly (i.e. A “just cause” standard placing a burden of proof on the employer to justify the basis for discipline or discharge of an employee.)

Tool of the Month: HR Checklists

Whether faced with a hiring, performance management, or employment termination issue, the manager needs to make sure certain steps are covered. To help keep track, you may review and download various HR Checklists developed by HR professionals.To learn more about the HR Checklists, become a client of AMS and receive free HR support.

Are Regular Old 401(K)s Better Than Roth 401(K)s?

Conventional wisdom touts Roth 401(k) plans as the better choice for most taxpayers over regular 401(k) plans. But a paper in the July 2008 issue of the Journal of Financial Planning, published monthly by the Financial Planning Assn. (FPA), argues that not only are regular 401(k) accounts superior to Roth 401(k)s for all but the wealthiest of taxpayers, but they’ll also remain superior even if future tax rates rise.

The conventional wisdom is that, if a retiree’s tax rate is the same as the tax rate when they were contributing to a 401(k), it shouldn’t make any difference whether that person puts money into a regular 401(k), whose contributions are tax-deferred or a Roth 401(k), whose contributions are made with after-tax dollars. The retiree will end up with the same amount of after-tax money way.However, side fund analyses argue that it isn’t an apples-to-apples comparison. For example, an affluent taxpayer putting the maximum $41,000 into a 401(k) would actually need $56,944 in order to fund the Roth. That’s because the taxpayer would need to pay $15,944 in taxes on the $56,944 (at a 28% tax rate) in order to have $41,000 left to fund the Roth. A taxpayer using a traditional 401(k) would need only $41,000, as it’s not taxed upfront.

To make the comparison fair, side fund analyses create a taxable side account for the regular 401(k) contributor and fund it with an amount equal to the extra amount needed to fund the Roth 401(k)—in McQuarrie’s example, $15,944. They then compare the after-tax results, and the Roth version wins. McQuarrie illustrates that the supposed superiority of these analyses is flawed because so much depends on analysis assumptions such as the taxpayer’s age and asset allocation.But the more important argument McQuarrie makes for the superiority of the regular 401(k) is the difference between marginal and effective tax rates. Let’s say a taxpayer is in the 28% marginal tax bracket. That is, all or most of that taxpayer’s deferred contributions to a regular 401(k) account would probably have been taxed at that 28% rate if not contributed to the 401(k). That saves the taxpayer money upfront, but of course they have to pay taxes on the contributions and their earnings, when withdrawing funds during retirement. But that person doesn’t pay the 28% tax rate on every withdrawal dollar.

Under our progressive tax system, the first dollars of taxable income are assessed at the lowest tax rate (10%), then the next chunk of income is taxed at the next higher rate, and so on until the last chunk of dollars is taxed at the taxpayer’s highest rate. The result is an effective or average rate for the taxable income that’s lower than the top marginal rate. In McQuarrie’s example, the effective rate is 19.4%, not 28%. Workers using regular 401(k)s are deferring taxes at their marginal rate, but paying taxes at their lower effective rate when they withdraw the money during their retirement years, making them a superior choice for most taxpayers. McQuarrie also demonstrates that, the effective tax rates are likely to remain lower than the marginal rates for most taxpayers even if Congress increases future tax rates, leaving the regular 401(k) still the better choice.

For more information, visit: http://www.quotit.net/ams/pension.htm


Check the difference of: Taxable vs. tax-advantaged saving comparison

401(k)s Are More Important Than Ever

Employees who contribute to their 401(k) plan and who are willing to make small improvements to their saving and investing habits can increase their future income potential, according to a study by Hewitt Associates. When factoring in inflation and increases in medical costs, Hewitt predicts that employees will need to replace, on average, 126% of their final pay at retirement. That is significantly more than the traditional targets of 70% to 90% pay replacement.The Hewitt’s study examined the projected retirement levels of nearly 2 million employees at 72 large U.S. companies using actual employee balances and behaviors. Only 19% will be able to meet 100% of their estimated needs in retirement. On average, employees are projected to replace just 85% of their income in retirement, compared to the 126% they need. In other words, assuming inflation of 3% and a retirement age of 65, an average 40 year old with 10 years of service and earning $83,000 at retirement in today’s dollars would have saved enough to provide just $70,500 per year in retirement in today’s dollars -- a $34,000 annual shortfall. In fact, 67% of employees are expected to have less than 80% of their projected needs at retirement.The scenario is even more serious for employees who do not contribute to their 401(k) plans. Employees who contribute an average of 8% of pay to their 401(k) plan can replace 96% of their preretirement income at age 65, providing about 80% of what is needed to provide the same standard of living during retirement. That number drops to just 54% for employees who do not contribute, which equates to less than 40% of projected needs. Even employees who have a pension plan can expect to replace just 62% of their income at retirement if they do not contribute to their 401(k) plan, compared to 106% for those who do contribute. Recent Hewitt research shows that 26% of employees do not participate in their 401(k) plan, and of those that do, 61% contribute less than 7% a year. Hewitt’s study found that employer-subsidized retiree medical coverage has a dramatic affect on an employee’s ability to achieve adequate retirement savings. The good news is that people can take small actions in several areas and make a big difference. Gradual increases in savings rates, smarter investing, lower fees and delaying retirement can have a significant affect and enable most people to achieve a much more comfortable standard of living once they retire.

For more information, visit http://www.quotit.net/ams/pension.htm

Limited Benefit Plans lower employer costs!

Many small businesses today are struggling to stay ahead in an economy which is causing higher costs of doing business and offering less opportunities to grow business or just maintain business levels. While it makes sense to offer benefits, these small businesses must cut costs and one way to do it is to offer limited benefit plans.

Many companies today have these choices available so it pays to take a look and see how these plans can be used by the employer to continue to offer benefits and make it affordable with a need to trim business costs. In addition to these limited benefit plans most companies will offer a menu of plans which would allow the employee who wants a richer benefit to buy up and have a payroll deduction for the additioanl cost and where there is a section 125 plan inforce receive the benefit of lower costs with pre tax payroll deduction prior to the taxes being taken out.

The employer can also receive a payroll savings helping to lower there costs by 7.6% with this savings. By making these choices the employer will miantain employee loyality with providing benefits and be competitive in the job market.

You can also find these types of plans at http://www.amsinsure.com; http://www.bchealthplans.ws and http://www.kaiserhealthplans.ws.

For more information on how to save benefit dollars contact us at 800-334-7875.

California governor calls for state healthcare reforms.

California Gov. Arnold Schwarzenegger (R) called for reforms to address the woes of the uninsured and healthcare inflation at the Catholic Health Association's yearly meeting. The governor's "$14.4 billion plan to overhaul healthcare in California cleared the state's Assembly in December, but died in the Senate Health Committee the following month." He said that "without action, the [healthcare] situation...will only worsen."

Claims that technology can help fix health care system and low costs.

Healthcare stakeholders should welcome disruption as an opportunity to advance the industry, and "technology is the disruptive innovation that can help fix the broken healthcare system," said Clayton Christensen, author and Harvard Business School Professor, Friday at the America's Health Insurance Plans conference. He claimed that technology could "make healthcare affordable for those who cannot pay for healthcare services." Christensen pointed to "three specific technologies" to implement his ideas: "molecular diagnostics to understand genetic structure, imaging technologies to look inside the body, and high-bandwidth telecommunications to bring expertise to offices with limited healthcare resources." If his "views are borne out, integrated caregivers, such as Kaiser Permanente,...will have a significant advantage over other stakeholders, he said."

Link

Life Expectancy continues to rise in the U.S..

It has been reported in several publications that the life expectancy continues to rise with the disperity amongest various groups becoming less than in previouse reports. While the age has risen to 78.1 and this is only 29th among all nations in the world where the average is 83 years. You can refer to national publications for additional information and check your personal life expectancy with our The Living to 100 Life Expectancy Calculator© is brought to you by Dr. Thomas Perls in partnership with the Alliance for Aging Research, a not-for-profit organization based in Washington, D.C. The Living to 100 Quiz was designed to translate longevity research of centenarians into a practical and empowering tool for individuals to estimate their longevity potential.

The Five Steps of Effective Employee Coaching

In the AMSINSURE monthly newsletter HR Advisor June 2008 addition from HRANSWERLINK.

New employee orientation and job-specific training serve important purposes. Coaching, however, is a critical key that is set aside unfortunately once too often. A business owner may think that spending the time to coach is too difficult, but it is his or her leadership that helps create a great team of inspired, productive, and loyal employees.
Employee coaching involves the managers and employees meeting regularly to discuss and explore each employee's career goals and development. There are five basic steps in facilitating employees to become high-performers in your team. Discuss the employee’s expectations of the job. Whenever a new employee is hired or an employee’s job functions change over time, always address any questions or confusion the individual may have about the job. To help confirm or clarify the employee’s perspective of the job expectations, review together a copy of the job description, department’s goals, and company’s goals.

Understand the employee’s expectations of the manager. While different employees have different communication styles, learn about what each employee expects from you as a manager and come to a reasonable working agreement.

Learn about the employee’s expectations for professional growth. Some employees work for just the paycheck, and some have specific professional development interests and ambitions. Recognizing and gathering relevant resources to help support and build a plan for each individual’s interests help strengthen employee loyalty.

Give feedback about the employee’s performance. Consistent and constructive feedback becomes effective when focused on raising awareness and on improving performance results.
Get feedback about your performance. You are a manager as well as a member of a team. How well you respond to feedback from your teammates will make a significant influence on your team’s synergy and success.

Each employee should come out of every formal and informal coaching meeting with a strong picture of both the specific performance goals to achieve and how his or her contributions impact the department and the company as a whole

Universal Life showing strong growth

A recent report by LIMRA, an industry association with over 850 financial services companies in more than 70 countries around the world turn to LIMRA first to help them build their businesses and improve their performance. In the study it was found that more people are turning to the purchase of Universal Life as sales where up 8% in a recent industry survey.

Other products a decrease in growth including term life which dropped 3%. It seems that the lower premiums of a permanent product like Universal Life can be delivered for less cost and maintain increasing value with long term stability. The average variable universal life policy bought during the first quarter of 2008 was 7% larger than those purchased in the same period of 2007.

Considering life insurance for your business or family then this might offer a solution.

John Beyer
jbeyer@amsinsure.com

Considering a Corporate Wellness Programs

Corporate wellness programs can enhance employee health and productivity. They can also help curb the rising cost of health care benefits. Corporate wellness initiatives are gaining momentum, but they can potentially backfire on employers if they are not designed and implemented properly. To avoid negative consequences, employers must understand the legal aspects of their wellness programs to ensure they comply with a myriad of federal and state regulations. When considering these programs it would be appropriate to review the various HR considerations to be compliant.

"The legal implications of wellness initiatives are far reaching, and designing programs that are compliant with current law can be challenging." "There is a lack of legal precedence in this area, which means there isn’t much to guide employers as they navigate this uncharted territory. But compliance is critical, so employers must be sure they understand and consider compliance issues as part of their program development process."

Its important for employers to be mindful as they plan their wellness offerings to ensure every worker has a chance to benefit from each program available. For example, if a walking program is developed, the employer needs to think about accommodations necessary to include those who use a wheelchair or require some other form of assistance. The key is to provide flexibility and elasticity in all programs so that everyone can participate."

For small employers considering these programs they can use those offered by there health carrier or other commercial programs in the community.

As an owner, should I consider a group LTD (Long Term Disability Policy) or an LTC (Long Term Care Policy).

With the lowest rates currently avaialable on these policies with high limits, no medical exams, and even guaranteed issue it may be time to consider as these plans are one of the lowest cost benefits offered to employer groups. The costs can even be shared with the employee, however with these low cost it makes good sense as a benefit.

Group plans me be offered along with voluntary plans that can add value since the group becomes a base and then the voluntary individual plans will cost less as the employee only needs to supplement a smaller portion of there risk.

What are some of the other benefits of these plans. Employees become more secure knowing they have income if the are sick or hurt and thereby are less likely to leave an employer saving turnover costs and return to work faster with a secure income that assist them with recover by relieving tension form that would have been there from financial stress. LTC policies have the same value with a low cost employer base plan allowing the employee to supplement an invidual policy at less expense to them. Another advantage is they can add not only a spouse, but parents, enlaws and others to a supplemental group plan even though they are not on the base group plan.

For more information: email, jbeyer@amsinsure.com or call 800-334-7875

click on the links below for more information:

Disability Income Plans…Often overlooked building a strong financial plan; this type of policy provides the base of all future plans. Consider the odds of every other risk in life and this one is ahead of them all. Take a moment to consider the possible problems for short term or long-term loss of income from an accident or illness. In a few minuets you can decide on whether you should get a proposal, it only takes a moment. Whether you work for a company, are self-employed or a business owner, there is a plan for you.

Long Term Care…(LTC) is a phrase, which is used to describe a variety of services in the area of health, personal care and social needs of a person who requires assistance with the basics of living. Services can be provided in home care, assisted living, or a convalescent care facility. Recent studies based on nursing home admissions indicate that 40% of all persons age 65 and over will enter a nursing home in the future.

Californians Get on the Web

More Californians are using the Internet than in 2004, especially to locate information about their insurance plan. In 2007, 56% of survey respondents went online to find information about medical conditions or prescription drugs. But only13% of them made provider appointments online and only 12% filled prescriptions online, according to a survey by the California HealthCare Foundation. Only 26% of the Internet users sought rating information on healthcare professionals. Twenty-three percent of respondents viewed online hospital ratings information in 2007. But only 1% actually made a change in their healthcare decisions based on the ratings. For more information, 800-334-7875 infor@amsinsure.com or go onlin at http://www.amsinsure.com/

How is Small Business doing in 2008

As a benefits agency working with small business we are keenly interested and aware of some of the problems facing business owners. If it is an established business or a new business the problems may be the same.

With personal foreclosures on real property and bankruptcy fillings growing it is not news that small business bankruptcies are also on the rise. There has been a 49% increase over last year with an average of 235 daily fillings in recent months according to the latest reports.

As a small business owner you may not be surprised to hear this with tight credit and rising cost squeezing the bottom line.

What can be done to work through these though times and get to the good times we all want to see arrive as soon as possible.

1) If you rely on credit in your business, banks are not going to make it easier even with all the fed interest rate cuts and may want some incentive to provide loan capitol.

2) Evaluating all the costs and revenue sources may help to keep things in line, including holding off on some expansion plans, and not adding new staff. In fact you may have to consider cutting back on staff. One consideration would be to increase the productivity of staff by offering incentives and benefits, which while adding some level of cost may in fact produce more revenue

3) Looking for value added services from your vendors which can enhance your operations without adding costs. Cutting benefit costs with lower cost plans and maintain contributions levels that are affordable.

4) It would be helpful to see both the federal and state governments provide some tax incentives and tax relief which while aiding the small business, which would lead to a strong economic picture and ultimately a broader tax base in the future.

As benefit consultants we can help you to reduce costs and add value through services like are HR and Payroll platforms.

Business Edge Newsletter current issue here
Recruiting: Staying One Step Ahead of the Competition

www.amsinsure.com
info@amsinsure.com
800-334-7875

State Poised to Crack Down on Discount Health Plans

Cindy Ehnes, director of the state Department of Managed Healthcare, wrote an article in Capitol Weekly describing how the state will be cracking down on fraudulent discount health plans. The state will be proposing new regulations to license companies, imposing strict consumer protections for those wishing to operate in California. The department issued an alert, warning Californians of deceptive discount health plans and suggesting questions to ask. In 2007, the DMHC received more than 200 consumer complaints about discount health plans, almost one third of which were because the consumer believed the discount plan to be insurance. “In the past month, we have seen a substantial increase in the number of complaints regarding discount plans, so it would appear that some fraudulent companies may once again be marketing heavily in California,” she said.

The alert is available in English and Spanish at (click on the title above).

HR Services as a value added client benefit!

Today the demand for real-time HR problem identification and resolution is a paramount concern for all successful enterprises, regardless of size. Owners
and managers of small and mid-sized businesses need this information as critically as their big business counterparts. Unfortunately, until now, these executives could not get the needed information without hours of research or without paying an attorney.

AMSINSURE.COM through its affiliated partner offers to meet the needs of such organizations for low-cost access to HR information, resources and personalized assistance.

AMSINSURE.COM through its affiliated partner places HR information, tools and experience at the fingertips of the owners and managers of small businesses. Because we leverage the power of the Internet to deliver HR solution and services directly to the desktop, clients enjoy maximum flexibility and convenience as a valued added service of AMSINSURE.COM and may add additional upgrade service over the basic service provided.

OUR MISSION
Bring required HR information, resources and professional assistance to the millions of small business owners and managers who need it. Present this information in a format that will be easy to access and to understand. Be there for our clients whether on the web or on the phone, not just as a reference but as a personal consultant who can help solve problems. Treat EVERY client with respect and make each one feel like he or she is our only client. Do all this at a subscription price any small business can afford.

OUR COMMITMENT
Our commitment is to provide high-quality HR resources, products and services to help you do your job. All you need to do is access these resources.
Ask how we can provide these services to your company.

info@amsinsure.com
800-334-7875