Regulators Propose to Eliminate Form 5500 Small Plan Exemption and Expand Data Collection for All Plans

The US Department of Labor (DOL) recently published proposed regulation revisions to Form 5500 Annual Return/Report in the Federal Register. Form 5500 is the primary source of information about the operation, funding, assets, and investments of pension and other employee benefit plans. A July 11, 2016 DOL news release states the proposed revisions are intended to improve and modernize Form 5500.

Currently, employers sponsoring a group health plan with 100 or more participants must electronically file Form 5500 on an annual basis. The DOL is now proposing to eliminate the current exemption from filing Form 5500 for employers that sponsor group health plans with fewer than 100 participants. If finalized, small employers would then have the same reporting burden as large employers.

The DOL also proposes all employers sponsoring a group health plan must complete the new Schedule J, Group Health Plan Information, through selected new questions regarding plan operations, service provider relationships and financial management of the plan.

According to a Legislative/Regulatory Update issued by the Self-Insurance Institute of America (SIIA), the administrative burden associated with the proposals will be considerable. “This new Schedule J requires the reporting of certain data regarding the plan’s assets. The Schedule J will also capture certain information like enrollment and disenrollment, data on the number of denied claims, and information on cost-sharing with respect to out-of-network coverage, all of which is required under the new Public Health Service Act (PHSA) section 2715A reporting requirement.  In addition, the Schedule J will require an employer to explain (1) how its plan improves health outcomes through quality reporting, effective case management, and chronic disease management, (2) how its plan prevents hospital readmissions, and (3) how its plan implements activities to improve patient safety and reduce medical errors and activities to promote wellness, all of which is required under the new PHSA section 2717 reporting requirement.”

SIIA also reports, “the DOL estimates that the elimination of the “small plan” exemption will add 2.2 million work hours and $241.6 million in reporting costs for small employers (both self-insured and fully-insured).”

The proposal was published in the Federal Register on July 21, 2016, with public comments from interested persons due no later than October 4, 2016.

To Download:  Form 5500 Proposed Changes




For more information on EthiCare Advisors, Inc., please call Mark S. Hartmann, Jr., MS at (888) 838-4422 extension 703 or e-mail him at

CMS Releases 2017 ICD-10 Revisions

The Centers for Medicare and Medicaid Services (CMS) recently released the ICD-10-CM updates for fiscal year 2017. The thousands of updates are to be used for patient discharges occurring from October 1, 2016 through September 30, 2017 and for patient encounters occurring October 1, 2016 through September 30, 2017. CMS will post the 2017 General Equivalence Mappings in August 2016.

The revisions will take effect as the specificity grace period ends. CMS implemented a 12-month period following the ICD-10 implementation on October 1, 2015, in which Medicare review contractors would not deny physician or other practitioner claims billed under the Part B physician fee schedule, through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code, as long as the physician/practitioner used a valid code from the right family.

You must be prepared to use the revised ICD-10 codes and to use precise specificity in your coding, starting on October 1, 2016.

To Download:  CMS Releases 2017 ICD-10 Revisions

Go here to download the 2017 ICD-10-CM updates.



For more information on EthiCare Advisors, Inc., please call Mark S. Hartmann, Jr., MS at (888) 838-4422 extension 703 or e-mail him at

Insurers Will Consolidate Even if Mega-Mergers Fail

The U.S. Justice Department is in the process of reviewing two healthcare insurance mega-mergers, Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna. The rhetoric coming out of the Justice Department suggests these deals may not be approved. However, that doesn’t mean the industry will not continue to consolidate.

An article out of Modern suggests that even if the deals are quashed, “the big five health insurers are likely to forge new transactions to scale up and improve their position at the bargaining table with consolidating hospitals and health systems.”

The next round of consolidation will likely center around smaller sized, publically traded companies such as Centene Corp., Molina Healthcare and WellCare Health Plans. Centene boasts annual revenue of $40 billion while Molina and WellCare both have revenue of $14 billion. All three have a primary focus on Medicaid, a program with heavy recent enrollment growth due in large part to the ACA’s Medicaid expansion.

The large carriers may also be interested in Universal American Corp., which specializes in Medicare Advantage and accountable care organizations or Magellan Health, a managed-care company with a large pharmacy benefits arm.

No matter the outcome of the Justice Departments reviews of the two mega-mergers, it seems clear that consolidation remains an industry goal.

To Download: Healthcare Insurance Consolidation

Click here to read the entire article.




For more information on EthiCare Advisors, Inc., please call Mark S. Hartmann, Jr., MS at (888) 838-4422 extension 703 or e-mail him at

The 10 Largest US Dialysis Providers in 2016

Here is a recently published list that ranks the 10 Largest US Dialysis Providers by patient count:


The past 12 months have also seen some interesting developments in renal care. Here are a few highlights:

o  As of 2013, new data shows the mortality rate among prevalent dialysis patients is going down. The trend continued in 2014 and 2015.

o  Providers are investing in new product development and new relationships. Examples of this are Fresenius’ interest in regenerative medicine and new bloodstream infection control products, and DaVita creating joint venture partnerships with other health care providers.

o  The prior 12 months included two major industry buyouts: U.S. Renal Care finalized the acquisition of DSI Renal in January 2016 and DaVita acquired Renal Ventures Management. When the DaVita acquisition is complete, it will push them past Fresenius in total patient count for the first time.

o  There was an uptick in the number of peritoneal dialysis and home dialysis patients in 2016.

To Download: The 10 Largest US Dialysis Providers in 2016

Click here to view the entire article from Nephrology News.


EthiCare Advisors, Inc. is a market leader in Dialysis Claims Settlement™. For more information, please call Mark S. Hartmann, Jr., MS at (888) 838-4422 extension 703 or e-mail him at


Top 50 Most Active US Kidney Transplant Centers

Here’s a list of the top 50 most active kidney transplant centers in the United States for 2015, including the number of transplants performed:

1 Univ of CA San Francisco Med Ctr 356   26 Georgetown Univ Med Ctr 183
2 Methodist Specialty & Transplant Hosp 323   27 Indiana University Health 177
3 UCLA Medical Center 322   28 Florida Hospital Medical Center 177
4 Jackson Memorial Hospital 317   29 Univ. of Minnesota Medical Center 175
5 UC Davis Medical Center 313   30 Northwestern Memorial Hospital 174
6 Mayo Clinic Hospital 309   31 The Methodist Hospital 171
7 St Barnabas Medical Center 297   32 Wake Forest Baptist Medical Center 167
8 Emory University Hospital 277   33 Montefiore Medical Cente 161
9 Univ of Wisconsin Hosp and Clinics 272   34 Ohio State Univ Med Ctr 159
10 Univ of Maryland Med System 264   35 MCV Hospitals 154
11 Johns Hopkins Hospital 254   36 Keck Hospital of USC 152
12 Barnes-Jewish Hospital 229   37 Piedmont Hospital 151
13 New York-Presbyterian/Weill Cornell 228   38 Mayo Clinic Florida 150
14 Tampa General Hospital 224   39 Duke University Hospital 149
15 Cedars-Sinai Med Center 218   40 Ochsner Foundation Hospital 148
16 Univ of Alabama Hospital 210   41 Baylor University Medical Center 147
17 Medcial Univ of SC 207   42 Methodist University Hospital 134
18 The Hosp of the Univ of PA 205   43 The Nebraska Medical Center 131
19 New York-Presbyterian/Columbia 200   44 Cleveland Clinic Foundation 129
20 California Pacific Med Ctr 200   45 Banner- University Medical Center 129
21 Rochester Methodist Hosp-Mayo Clinic 199   46 University of Kansas Hospital 126
22 Univ of Pittsburgh Med Ctr 198   47 Univ Hosp of Cleveland 126
23 Univ of Michigan Med Ctr 196   48 Massachusetts General Hospital 125
24 Vanderbilt Univ Med Ctr 196   49 Uni of Colorado Hospital/HSC 119
25 Mount Sinai Med Center 192   50 Univ of Utah Medical Center 117


The data was provided by the Organ Procurement and Transplant Network ( and includes both kidney and kidney/pancreas transplants. The University of California San Francisco Medical Center was the most active transplant center in the United States in 2015, performing 356 transplants. It also had the distinction of being the busiest center in 2014 with 354 transplants and in 2013 when it performed 357 transplants.

Per a research report on organ transplant cost estimates by Milliman, the estimated average cost of a kidney transplant in 2014, including pre-transplant, procurement, hospital transplant admission, physician during transplant, post-transplant discharge and related pharmaceuticals was $334,300. This is up $71,400 or 27.2% from the 2011 estimate of $262,900. The estimated average cost in 2014 for a kidney/pancreas transplant was $558,600, compared to $474,700 in 2011, an increase of $83,900 or 17.7%.

The same research report estimated there were 16,107 kidney transplants in the US in 2014 compared to 16,313 in 2011, a decrease of 1.3%. There were an estimated 777 kidney/pancreas transplants in 2014, a decrease of 2.3% of the estimated 795 transplants performed in 2011. The 2014 average hospital length of stay was 7 days for a kidney transplant, essentially the same as 2011. The estimated hospital length of stay for a kidney/pancreas transplant was 11 days in 2014, one day shorter than the 2011 estimate of 12 days.


EthiCare Advisors, Inc. is a market leader in Dialysis Claims Settlement™. For more information, please call Mark S. Hartmann, Jr., MS at (888) 838-4422 extension 703 or e-mail him at

To Download: Top 50 Most Active US Kidney Transplant Centers