Nomi Health’s Post

Calling self-insured employers — or those considering the switch! Are you concerned about compliance? Getting up to speed with rules and regulations can be a daunting prospect. Here are three key steps to make sure you’re compliant — and ready for everything. → Understand the legal obligations → Make sure you have adequate reserves → Handle claims processing fairly and accurately And an expert TPA can help make this whole compliance process a lot smoother. #compliance #self-insured #healthcare https://lnkd.in/ed-7MtkM

Physicians: Three tips to avoid legal risks with employees at your medical practice. #Physicians #Healthcare #RiskManagement #MedTwitter #Leadership #HR #Insurance #Phoenix #Scottsdale #Doctors via Medical Economics

Curious about what regulatory changes in 2024 will impact your employee benefit plans? Watch this on-demand webinar 👉🏼 https://bit.ly/48L3zRj from our Looking Ahead to 2024 Compliance Updates hosted by VP of Compliance, Matthew LoPorto. Matt provides the latest updates from the Council of Insurance Agents and Brokers’ Legal Counsel Working Group. Including high priority regulatory issues that the Legal Counsel Working Group will continue to engage in, such as the proposed regulations applicable to pharmacy benefit managers and how those regulations impact group health plans. #InsuranceBroker #EmployeeBenefit #Webinar #Compliance #Insurance

Check out our blog post on Bristol SL Holdings Inc., v. Cigna Health & Life Ins. Co., an excellent ERISA preemption decision just out of the Ninth Circuit. In short, a health plan's pre-service coverage communications do not give rise to obligations independent of the ERISA plan. "[I]f providers could use state contract law to bind insurers to their representations on verification and authorization calls regardless of plan rules on billing practices, benefits would be governed not by ERISA and the plan terms, but by innumerable phone calls and their variable treatment under state law. This is the type of discordant regime that 'ERISA's comprehensive pre-emption of state law was meant to minimize.'" #troutmanpepper #ERISA #healthcarelaw #ninthcircuit #litigation #consumerfinancialservices

Great advice, Devora! Sometimes business attorneys structure the companies in a way to avoid liability, not knowing the intricacies of employment law (joint employers being a great example). Speak to an employment attorney when you consider these kinds of corporate formations! #employmentlaw #jointemployers

Medical practices often have one corporation for the practice and clinical staff, and a separate management company that employs the administrative staff. Don't be like the company that obtained Employment Practices Liability Insurance for the practice . . . but not for the management company. They got sued by a former employee, and now have to have two law firms represent them, the one assigned by the insurance company, and a second one for the defendants insurance isn't covering. These two companies will likely be joint employers under the various employment laws. However issues could be raised as to whether they need separate handbooks, health insurance policies, etc. etc. If your organization has related companies, consult with employment counsel regarding these types of issues so you are not caught short. #employmentlaw #lawyers #business #management #humanresources #hr #DevLInTheDetails

#HR PROS - are ready to get sued for breaching fiduciary standards? If you’re using a benefits broker for consulting or procurement of vendors, then you’re a sitting duck for the wave of lawsuits coming your way. This is because — unbeknownst to most people — benefits brokers get paid on both sides of health insurance transactions. ERISA law prohibits this type of transaction because this conflict of interest leads to wasteful spending. This is a key reason why businesses overpay for healthcare by ~$300 billion a year…that’s ~$2,500 PEPY. In turn, this undermines your ability to maximize the return on your organization’s benefits investments and grow your business’s value. Many companies don’t even have a contract with their broker, which means that they don’t know how they get paid, how much they get paid, or what their scope of services are. If you want to maximize your ROI and fulfill your fiduciary responsibilities, you’ll need to replace your benefits broker with a fractional fee-based benefits consulting firm for consulting and procurement services. If you’d like me to help you navigate this transition, just send me a DM. SHRM Kate Shockey Gail Brown Carol Lanneau

Healthcare coverage compliance is more than avoiding penalties—it's about safeguarding your employees' well-being and your company's reputation. Discover how in our blog on ACA employer mandate penalties.

Healthcare coverage compliance is more than avoiding penalties—it's about safeguarding your employees' well-being and your company's reputation. Discover how in our blog on ACA employer mandate penalties.