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One important aspect of the Affordable Care Act (ACA) is the Patient-Centered Outcomes Research Institute (PCORI) charge, which businesses must navigate like a maze.  Every year, all health insurance issuers and sponsors of self-insured health plans covered by the Act are required to pay a charge designed to fund clinical procedure and patient-centric outcome research in the United States.

To put it simply, the complexities of calculating, recordkeeping, and payment pose more of a challenge than the provisions themselves.  At this stage, it is critical to have a PCORI fee compliance services specialist to ensure that your responsibilities are fulfilled accurately and on time. Failure to do so will result in fines and a waste of time and effort on the side of the company.

 

The form of your health plan has a significant impact on the extent of its use, the computation techniques, and the recipients of the payments.  For instance, the insurance carriers typically pay the fee for fully insured plans, but the businesses that sponsor level-funded or self-insured plans bear direct responsibility for the decision, filing, and implementation in a variety of circumstances, such as HRAs.  In order to determine whether compliance is accurately guaranteed, it is crucial to stay up to date with the rate adjustments, which are set annually based on the rate of inflation, as well as the specific guidelines for calculating the "covered lives" (spouses and elected dependents are the individuals to be considered along with the employees to form the list of those involved in the utilization of the services; special attention is paid to HRAs and FSAs).

 

 

Neglecting or improperly managing your PCORI fee obligations could have unintended repercussions.  The price is not always a straightforward charge just because there is no "PCORI penalty" associated with it.  In other words, normal IRS penalties for late filing or under recovering may be triggered if Form 720 (Quarterly Federal Excise Tax Return) is not filed by the July 31st deadline or if an improper payment is made.  Your bottom line might be severely impacted by these penalties, which can be several percentages more than the unpaid tax plus interest.  Non-compliance can also lead to problems since it may require you to make corrections to inaccurate records and communicate with the IRS, which can be a highly time-consuming process.

 

 

A strong defense against all of these issues is to enlist the help of expert PCORI fee compliance services.  Our professionals are well-versed in both the PCORI fee requirements and the constantly evolving IRS regulations.  We can

Determine your obligation accurately:  We look at the health plan to determine which types of health plans are covered and whether a PCORI charge needs to be computed.

Determine your fees as precisely as possible:  We verify that the results of your fee computation are accurate by using one of the three IRS-recommended ways (Actual Count, Snapshot, or Form 5500); possibly we can determine which strategy is best for your company. Complete and submit precisely.  

Form 720:  We oversee the meticulous preparation and timely filing of IRS Form 720, specifically Part II, Line 133, which calls for us to enter all pertinent information when the time comes.

Encourage you when things change:  The number of practitioners, PCORI fee rate regulations, and other factors are always subject to change.  We will take advantage of the opportunity to explain the changes in PCORI fee rates and their implications as they happen, and we will also offer the assistance you need to maintain compliance for the upcoming years.