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Overview of ACA Reporting Requirements for Healthcare Professionals

Hospitals, as significant providers of healthcare services, face unique obligations under the Affordable Care Act (ACA) to ensure their employees have access to quality health insurance. Specifically, the ACA mandates that hospitals and other large employers submit annual reports to the Internal Revenue Service (IRS) detailing the health coverage offered to their employees. This requirement is facilitated through Forms 1095-B/C, which must be provided to each employee eligible for coverage, and Form 1094-B/C, a transmittal form summarizing all full-time employees' employer-provided health insurance offerings and coverage status.

These forms play a crucial role in enforcing the ACA's employer mandate, which requires employers with 50 or more full-time employees to offer health insurance that meets certain minimum affordability and coverage standards. Failure to comply with these reporting requirements can result in significant penalties, underscoring the importance of hospitals meticulously managing and reporting their employee health coverage data.

Collaborative ACA Reporting: Multi-User Setup for Healthcare Networks and Facilities

  • Multi-User Collaboration: Enables healthcare networks to collaboratively manage ACA reporting with individual facilities, streamlining the process.
  • Centralized Setup with Local Completion: Central teams can initiate reporting, setting up the necessary framework, before handing off to facility teams for finalization.
  • Optimized Workflow: Encourages specialization and division of labor, improving the accuracy and efficiency of ACA submissions.
  • Seamless Handoff Process: Ensures a smooth transition between the central team and local facilities, with clear guidelines to prevent oversight.

What is Form 1095-B?

Form 1095-B is an information return filed by health insurance providers or employers offering self-funded coverage with fewer than 50 full-time + full-time equivalent employees.

Insurance Providers
OR
Self-Funded Small Employers

less than 50 full-time + full-time equivalent employees

For more info on Tax Year 2023 Form 1095-B, click here.

What is Form 1095-C?

Form 1095-C is an information return filed by employers with at least 50 full-time + full-time equivalent employees. These employers are known as 'Applicable Large Employers' or ALEs by the IRS. This form tells the IRS if the employer met ACA guidelines for the healthcare coverage they offer, and it requires that employees receive a recipient copy.

Applicable Large Employers

at least 50 full-time + full-time equivalent employees for all EINs added together that share a common owner

For more info on Tax Year 2023 Form 1095-C, click here

We also recommend checking out the IRS.gov ACA FAQ, which contains many common 1095-C questions in an easy-to-understand format.

Common Challenges in ACA Compliance for Medical Centers

Navigating the complexities of Affordable Care Act (ACA) compliance presents a significant challenge for hospitals, given their extensive and diverse workforces and the intricate nature of health care benefits administration. One of the foremost issues is the meticulous data management required to accurately track and report employee eligibility, coverage offers, and enrollment status in accordance with ACA mandates. This task is further complicated by frequent changes in employee work hours, shifts in employment status, and the need to consolidate data across multiple departments or affiliated entities within a hospital system.

Additionally, hospitals must interpret and apply complex ACA regulations correctly to ensure compliance. This task demands a deep understanding of legal nuances and constant vigilance for regulatory updates. Healthcare facilities increasingly turn to specialized software solutions that automate data tracking, simplify reporting processes, and ensure accuracy through built-in compliance checks to overcome these challenges. By addressing these challenges head-on, hospitals can mitigate the risk of penalties, enhance operational efficiency, and maintain their focus on delivering quality patient care.

Importance of Data Accuracy

Ensuring data accuracy is paramount for healthcare institutions in the context of ACA compliance, as even minor discrepancies in employee or coverage information can lead to reporting errors, potentially resulting in penalties and the need for time-consuming corrections. Recognizing this challenge, the adoption of advanced importer tools becomes crucial. These tools are designed to flag all data errors before importing information into the healthcare ACA compliance account.

3 step process

This preemptive approach to data validation allows hospitals to identify and rectify inaccuracies in employee details, coverage offers, and enrollment statuses before they become compliance issues. The importer tool works by scanning data against a set of predefined compliance criteria, ensuring that every piece of information aligns with ACA reporting standards. This not only streamlines the compliance process but also significantly reduces the risk of errors that could lead to penalties from the IRS. By integrating such a tool, hospitals can safeguard their compliance posture, enhance operational efficiency, and maintain their focus on providing high-quality healthcare services.

Benefits of Compliance

Compliance with the Affordable Care Act (ACA) offers numerous benefits beyond simply avoiding financial penalties for healthcare facilities. For medical centers and healthcare institutions, adhering to ACA mandates reinforces a commitment to employee welfare by ensuring staff access to essential health coverage information, which is crucial for personal health management and fulfilling individual tax responsibilities. Moreover, by demonstrating rigorous compliance, acute care hospitals and specialty clinics can enhance their reputation as responsible employers, attracting and retaining top talent in a highly competitive healthcare industry.

Teaching hospitals, in particular, benefit from ACA compliance by setting a strong example of organizational responsibility and legal adherence for the next generation of healthcare professionals. Furthermore, healthcare systems that consistently meet ACA standards may find administrative processes streamlined, reducing the burden of managing complex employee health benefits and allocating more resources toward patient care and medical innovation.

Efficient Data Solutions for Healthcare

Our extensive experience collaborating with healthcare systems across the spectrum—from acute care hospitals to expansive health networks—has honed our expertise in handling vast amounts of complex data with precision and efficiency. Recognizing the diverse challenges these healthcare institutions face, we've tailored our solutions to manage large datasets seamlessly and significantly simplify the data import process. Our approach integrates advanced data processing technologies with customized support, ensuring that medical centers and specialty clinics can easily upload, verify, and manage employee health coverage information.

This streamlined process is designed to reduce administrative burdens, allowing healthcare providers to focus more on delivering exceptional patient care rather than navigating the complexities of data management. Our commitment to easing the intricacies of ACA compliance through sophisticated data solutions has made us a trusted partner for healthcare institutions looking to enhance their operational efficiency and ensure regulatory adherence without compromising on data integrity or security.

All Features Included

Purchasing any BoomTax package will give you everything you need to complete your filing.

This includes:

  • Federal E-File
  • State E-File
  • Recipient Copy Download as PDF
  • Official IRS Copy Download as PDF
  • Unlimited Corrections

1095-C Bulk Import

Import many companies in one spreadsheet to simplify data input.

Data Validation

We validate your data against hundreds of IRS rules.

Hands Off E-File

No IRS registration or testing required.

Free Corrections

Make as many changes as needed for free.

Our Commitment to Data Security in E-filing

Our data centers, printing facility, and helpdesk are all HIPAA compliant, and all activity on the platform is automatically audited, monitored, and logged to fend off intrusions actively. All data received on the BoomTax platform is encrypted at every junction. From transport to encryption at rest for private blob stores (256-bit AES encryption) to database and row-level encryption in SQL Azure, we make sure your company's data and information are safe.

Social Security numbers are masked in our UI. They are also masked in employee printouts by default (as suggested by the IRS). We don't store any billing details in our system, as this is handled through a 3rd party merchant service. We will only ask for what is necessary to complete your filing. This keeps the surface area for a potential attack small and limits the fallout in the unlikely event of a breach. As a dedicated serverless Azure IaaS consumer, we also benefit from Microsoft's security posture as our resources are compliant with a myriad of security controls (including SOC-2).

Training Our Team on Data Privacy

We recognize that a secure system is only as strong as its weakest link. That's why we invest in comprehensive training for our team, emphasizing the importance of data privacy, phishing awareness, and secure information handling practices. This commitment to education fortifies our security culture, safeguarding your data from accidental breaches.

When Should I Submit Form 1095-C?

Here are the critical dates for filing and distributing Form 1095-C deadlines.

February 28th, 2024

Paper File Deadline

March 1st, 2024

Employee Copy Deadline

April 1st, 2024

E-File Deadline

What are the types of Form 1095 Penalties?

ACA penalties are typically split into two categories:

  1. Employer Shared Responsibility Payment (ESRP): This penalty applies to large employers who do not offer minimum essential coverage to at least 95% of their full-time employees (and their dependents), and at least one of their full-time employees receives a premium tax credit for purchasing individual coverage on one of the health insurance marketplaces. The ESRP is also known as the "employer mandate" or "play or pay" penalty.

  2. Reporting and Disclosure Penalties: These penalties are assessed for failing to file required information returns with the IRS or to provide required statements to individuals. These information returns include Form 1094-C and Form 1095-C, which large employers must file under the ACA's reporting requirements.

Please click here to learn more about the various types of IRS ACA penalties and their corresponding fines.

What are the penalties for not submitting ACA Forms 1095-B & 1095-C?

The IRS determines ACA penalties based on various factors, including missing the deadline, providing incorrect information, or using paper forms when electronic filing is required.

The IRS has increased the penalty amounts for the 2024 filing year.

Failure to file ACA 1095 Forms 2024

$310 per form

up to

$1,261,000 per year (smaller businesses)

$3,783,000 per year

Failure to furnish ACA 1095 Forms 2024

$310 per form

up to

$1,261,000 per year (smaller businesses)

$3,783,000 per year

Intentionally not filing for 2024

$630 per form

no maximum penalty

Can I submit ACA 1095 Forms with BoomTax?

BoomTax will streamline your ACA filing process in 3 simple steps!

Import Your Data

You can import your data as Excel, XML, or use files from popular payroll providers like QuickBooks, UKG, ADP, and many more.

Step-By-Step Wizard

We walk you through the process with no complicated jargon. You can also live chat with a real person as you work on your filing for hands-on help.

E-File & Mail Employee Copies

Once your data is loaded, you can e-file and distribute employee copies in minutes.

Takes Only 30 Seconds

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