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Provider News
30-Day Extension for 1095 Reporting to Individuals
IRS Notice 2019-63 extends the due date for furnishing to individuals the 2019 Form 1095-B (Health Coverage) and Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) from January 31, 2020 to March 2, 2020.
PCORI Fee Extended 10 Years
The Patient-Centered Outcomes Research Institute (PCORI) fee was set to expire in 2019 for most self-insured health plans (2020 for others), but the SECURE Act has extended it for 10 years.
IRS Lowers Affordability Threshold for 2020
In Revenue Procedure 2019-29, the IRS announced that the 2020 shared-responsibility affordability percentage will be decreased from the 2019 limit. Under the Affordable Care Act (ACA), employer-sponsored health coverage will satisfy the affordability requirement if the lowest-cost self-only coverage option available to employees does not exceed 9.78 percent of an employee’s household income.
Reporting of Prescription-Drug Coverage Mandatory in 2020
As of January 1, 2020, responsible reporting entities (RREs) must report prescription-drug coverage to the Centers for Medicare & Medicaid Services (CMS). Currently, RREs are required to report information to CMS about individuals who are entitled to Medicare and are covered under a group health plan, so CMS may determine whether the plan is primary to (pays before) Medicare.
PCORI Fee due July 31, 2019
The Patient-Centered Outcomes Research Institute (PCORI) fee under the Affordable Care Act is due from sponsors of applicable self-funded health plans by July 31, 2019.
Providers Must use ICD-10 Diagnosis Codes Beginning Oct. 1, 2015
All providers covered by HIPAA must begin using ICD-10 diagnosis codes with dates of service October 1, 2015 and beyond. Pursuant to HIPAA, the Centers for Medicare & Medicaid Services (CMS) has mandated the transition to ICD-10 diagnosis codes. Consequently, ICD-10 codes are required to replace the ICD-9 codes.