Understanding Health Insurance Coverage: A Primer

Health Insurance Coverage: What are Covered Services?
Health insurance coverage is a contract used to determine medical benefits that are covered, or not covered, between you and your insurance provider. The insurance company, based on a fee that you provide them on a regular basis, promises to pay health insurance coverage on certain items or benefits listed in that contract. These are called covered services. Covered services can include a wide variety of things, such as implements, prescriptions, services (such as massage), checkups, tests and/or research.

Your contract should also list all of the things NOT covered in your health insurance coverage these are items or services that you will need to pay for out of your own pocket, should you require them.

Health Insurance Coverage: What is a Medical Necessity? How is this Different from Covered Services?
Just as it seems, a medical necessity is something that your health professional has deemed a required service/ item that will affect your health negatively should you decide not to purchase it. However, just because your doctor tells you something is a medical necessity does not mean your health insurance actually offers coverage for it.

Since insurance companies decide what health coverage they will and will not provide, you really have no leeway in this area.

Health Insurance Coverage: What Do I Do?
Most doctors try and keep themselves abreast as to what the major insurance companies do, and do not cover when it comes to health coverage. However, there are a LOT of plans out there, so this just isnt enough. So how can you avoid any nasty surprises during an emergency?

Read your health insurance coverage. Youre better off knowing what your health insurance company will, and will not provide coverage for right off the bat. Then, if your doctor decides on a treatment plan that isnt covered, you can ask for alternatives that may be.
If there are questions regarding your health insurance coverage, do not hesitate to contact the insurance company. Questions are good, and they expect them.

Health Insurance Coverage: What Do I Do if Something I Need Isnt Covered?
The gross majority of what your doctor orders for you will be covered in your health insurance plan. If you do get a treatment or supply that isnt covered, you can always challenge the health insurance coverage. You may not be the only one who requires the same type of service, benefit or item so youll end up fighting not just for yourself, but for others in the same situation.

Ask your doctor for their side, and use this in your claim. It may not help in the end, but if your doctor is on your side, you may be able to convince the health insurance company that coverage is required.

For more more information about health insurance coverage please visit http://www.1health-center.com/articles/Health-Insurance-Coverage.php

Is Pet Health Insurance an Option?

Most pet owners arent aware that health insurance for their loved animals has been available for about 15 years now. However, both the availability and restrictions on most plans have made this type of health insurance out of reach for most pet owners.

Interestingly enough, pet health insurance has changed in the past couple of years. Now, animal owners are able to afford medical procedures previously prohibitive because of the cost. But many skeptics are concerned that health insurance for pets will see an increase in the red tape us humans already encounter every day.

Animal medicine is one of the few health care services that isnt financially dependent on health insurance. Medical, dental, surgical and pharmaceuticals are all pretty much covered by health insurance in humans, but veterinary patients are responsible for all of that, themselves. Or, at least their owners are.

Health insurance for pets is very similar to insurance for humans. The same fees, deductibles, coverage rates and plans are all in place, with different plans based on the age, species, and general health of your pet.

Most health insurance policies for animals start around the 6-8 week range, but when the policies end depend on a variety of factors, mostly decided by the health insurance company. Some have age limits, and some dont.

And just like with humans, some health insurance companies will only accept your pet on their plan if they are healthy; others will accept them only if they have had a stable condition for more than six months in a row.

Currently, deductibles stand around $100 for pet health insurance. Policy costs vary as much as human health insurance does, unfortunately. Some depend on what types and kind of coverage is desired, and yet others are just blanket coverage catch-alls. Some may only cover accidents and illnesses. And more pets usually means a reduced health insurance rate for subsequent animals.

But what if you decide that an health insurance policy is not right for you, and your pet? There are other options, of course!

First, discuss your situation with your Veterinarian. Some animal hospitals offer packages that arent quite health insurance, but can offer a rate deal of some sorts on more mundane medical procedures (spaying/neutering, vaccinations, etc.), or packages for your aging animal.

Secondly, research plans that offer discounts on animal health services. PetAssure is one of these companies, but there are a myriad of not-for-profits that may offer this as a side benefit when you join. Or, these same animal not-for-profits may offer financial assistance for pet owners whose health costs are beyond their means a sort of emergency fund, if you will.

All in all, it depends on you, and your pet(s), whether or not pet health insurance is the right choice. Hopefully, with the help of this article, your choice will be an informed one.

For more more information about pet health insurance please visit http://www.1health-center.com/articles/The-Important-of-Health-Insurance.php

Dog Health Insurance

Should you seriously consider buying a dog health insurance policy? Yes, you should. Here's why health insurance for dogs is a good idea:

Dog health insurance saves you money. As with just about all other costs, veterinary expenses have increased rapidly in recent years. Without dog medical insurance (or more accurately, veterinary insurance), you are responsible for paying for everything: routine checkups, preventive procedures, emergency care and disease treatments. That will run into hundreds of dollars. Why not get some help?
Dog Health Insurance: Quick Cost Facts

* Health insurance for your dog, like health insurance for yourself, has annual premiums and deductibles.
* Pet insurance premiums depend on the breed of your dog and the type of policy you decide upon. If you have more than one dog, there is usually a reduced rate after the first policy. Dog health insurance deductibles can vary as well. The average annual deductible is about $100.
* You may choose among different coverage plans which are based on your dogs age, breed, and pre-existing medical conditions. Some policies even consider the dogs lifestyle; for instance, whether your dog is purely a pet or a watchdog, too.

Health Insurance for Dogs: Quick Coverage Facts

* Dog insurance healthcare plans can vary greatly. Some canine health plans are quite comprehensive, covering annual checkups, routine care, vaccinations and other preventive medications, and spaying/neutering, as well as illnesses and accidents. Others only cover unexpected sickness or injuries.
* Dog insurance coverage for emergencies begins immediately on most new dog health plans, with a 30-day waiting period for illness and other claims.
* Your dogs age can affect your dog's health insurance coverage. Typically, policies begin veterinary healthcare coverage when the dog is 6 to 8 weeks old, although some will start when the dog is younger. Similarly, some dog health insurance companies only will cover dogs under 8 years old unless the animal was already insured with them before turning 8.
* Many dog health insurers will not cover your pet if she has a preexisting condition or a terminal illness. Some will insure the dog only if the condition is controlled or stable, usually for 6 months.

With all these options, it is important you check out the various dog health insurance companies, their pet insurance policies and corresponding dog healthcare plans.

In short, if you care about your dog, you should care about his health. If you care about your wallet, you should care about your dog's health insurance coverage, too.

You can read more of Joel Walsh's articles on dog issues such as Dog Health Insurance at: http://www.i-love-dogs.com

How to Shop for Individual Health Insurance

Thompson

If you find yourself in the position of shopping for an individual health insurance policy, there are certain things you'll want to keep in mind. Whether you are coming out of a job that covered you before, or are at the end of your COBRA benefits, or simply have never had coverage before there are things you can do to get coverage on yourself and your loved ones.

The basic thing to know is that if you have a shot a group health insurance, whether through a job or an association you're a member of, that is usually much more affordable than buying individual health insurance on your own. First you need to figure out your health insurance goals; in other words, what are you after? If you're young, healthy as a horse, no dependents and not attempting Mt. Everest next week, you may want to opt for a policy that covers only the catastrophes, and cover the rest out-of-pocket. On the flip side of that, if you're the sole bread winner with a family to support, the scenario is different.

The basic choices you'll have are Fee-for-Service, Managed Care Plans, and Association-based health insurance. Fee-for-service is the traditional indemnity plan, harder to acquire, more expensive, but usually great coverage. Managed care plans include most HMO's and PPO's. These offer lower costs but your choices are somewhat limited. Another way to get insured is through a group or association you may already be a member of, such as professional, religious or trade organizations. Often they may offer health insurance. It's worth checking out, as sometimes you can strike gold in this vein.

Things to consider when you're looking for any policy are what's covered on this plan, how much are the monthly premiums, what is the yearly out-of-pocket, what is the deductible, how much are office visits, does it cover preventative medicine, vision, dental? And I'm sure you can come up with many of your own. Sit down before you go shopping and make a list of your needs and wants, and decide in advance what you're willing to give to get. Be aware that once you start getting quotes they can vary as much as 50% for the same person! Remember, you're shopping, and nobody's making you do anything. If one insurer isn't cutting it, move on to another. If you're coming at this cold and have no good recommendations it may be wise to use a broker who represents several companies, as he or she wil be more likely to find the best policy for you, as opposed to selling the company they work for.

Shopping for individual health insurance can be frustrating and time-consuming, but if you come armed with facts you'll be able to navigate this highly competitive and ever-changing field.

Keith Thompson is the webmaster at http://www.health-insurance.giftsforbiz.com,a site geared toward helping you find great individual health insurance!

Canadas Aging Baby Boomers: Planning Health Insurance for the Future

The first of Canadas aging baby boomers are poised to turn 65, and with this milestone birthday comes a variety of new health care concerns. In response to these changing medical needs, the Canadian health care system is preparing to handle some 10 million boomers whose reasons for visiting the hospital will range from hearing loss to long-term care. The aging of this Canadian demographic is inevitable, but falling into financial debt in order to pay for these services can be avoided. By thinking ahead to what medical services may be required, individuals are able to customize their health insurance accordingly.

Living in a country like Canada where health care is provided for all is an undeniable luxury. Yet, despite the many benefits of Canadian health care, there are gaps that exist in coverage. These gaps dictate the need for supplementary health insurance. Sadly, there are many instances where people have met with unexpected illness, but there are also many health issues that can be planned for. Aging is one such issue.

Some of the most common services required by seniors include: x-rays for weakening bones, a visit to the podiatrist for any number of foot related issues and testing and fitting hearing aids for hearing loss. Each of these services may be an inevitability for the aging individual, but they may not all be covered by the Canadian government. Provincial health plans vary from province to province with certain provinces offering a proscribed amount of money yearly for various necessities, such as a trip to the podiatrist. A visit to a specialized doctor or the purchase of a hearing aid can be very costly, and with little to no coverage, people are often left with a substantial financial burden. Supplemental health insurance is the best way for seniors to plan for and minimize these costs.

Opting for supplemental health insurance allows you to customize your plan to suit your individual needs. For many seniors, the prospect of spending time in a hospital is not a pleasant one, but with supplemental coverage, a private room in a health care facility can make the stay more comfortable. Not only does health insurance ease the worry that individuals may have concerning their own personal welfare, but it also helps to assuage the fears of family members on whom the burden of long-term care would fall.

As ten million Canadians begin to approach the time in their life when retiring is imminent, it becomes a necessity to plan for whatever eventualities the future might hold. Thinking ahead to answer the various demands of aging helps guarantee a peace of mind for yourself and your family and ensures that you are ready to face the challenge of lifes milestones.

Anna Dorbyk is the editor for Canada Health Insurance and is a graduate student in Communication Studies at Concordia University. For more information on health insurance for Canadians please visit http://www.canada-health-insurance.com/.

Health Insurance and health care

Health insurance is something that everyone needs today. The rising cost of visiting a health care provider or a hospital stay makes it imperative that everyone have some type of health care coverage. Government statistics estimate that over 40 million people in America are not covered by any type of health insurance on any given day. That's an enormous number of people who really are taking a financial risk.


Even if you're on a tight, limited budget, it's very important that you pick up some kind of affordable health insurance. Even if you only have a plan that covers unexpected hospitalization, your peace of mind will be greatly enhanced. Keep in mind that a catastrophic health insurance policy can come with a high deductible before their coverage kicks in. They don't pick up the cost of preventive physician visits or emergency room visits to get a few stitches.


Some questions to ask when considering affordable health insurance.

1) Can your and/or your family afford to pay ALL your medical expenses if you're sick or injured?

2) How much is the deductible?

3) How much are the premiums?


With a little searching and comparison shopping you find the best rate for your personal affordable health insurance.

Mike Yeager
Author/Publisher
http://www.a1-healthinsurance-4u.com/

What to look for in good Health Insurance

Health insurance is a kind of protection that provides payment of benefits for covered sickness or injury. Included in health insurance are various types of insurance such as accident insurance, disability income insurance, medical expense insurance, and accidental death and dismemberment insurance.

Before sign the health insurance policy make sure that you have read thoroughly the benefits section. Take note of any health care service that is not covered by your health insurance policy. Also, pay specific attention to how the health insurance policy is worded. Sometimes, health insurance companies hide the health insurance coverage exclusions within the definitions of words.

For instance, a health insurance company may define the term emergency as anything that is life threatening condition that cannot be reasonably treated by a primary care physician. Whereas, your definition of emergency may be anything that requires quick medical attention.

Clearly, there is conflict for the two definitions. If you find yourself in an emergency situation where you incur a broker arm, for instance, your insurance company may deny coverage for emergency room treatment of a broken arm for the reason that the broken arm does not fall under the life threatening category.

Therefore, you should read over carefully the health insurance policy definitions, paying close attention to the seven key words:

medical emergency
medically necessary
accidental injury
experimental or investigational
pre certification
pre-existing condition, and
reasonable and customary


These words and any words that are open to interpretation should be regarded with wariness. Find out how your health insurance company defines each of these.

Finally, find the section describing the procedures you must follow in order for your insurance company to reimburse you. These policy conditions or prerequisites are typically worded in a positive tone. Read through each condition carefully, make notes and call your health insurance company with any questions.

You should also compare health insurance contracts before you sign one. In order to compare exclusions, take two policy contracts and find the exclusions sections. If you want to compare a number of health insurance contracts then you could use an online service.

After you obtain your free quote for the health coverage you desire, apply for it online, and you'll obtain all the information that you'll need to compare exclusions of each health insurance policy (though sometimes this will require more research.)

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Mike Spencer recently became unemployed and moved into self employment. He was forced to find his own health insurance plan to protect his family. It wasn't as easy as he first thought. Here he shares the pitfalls of various plans and what you need to look out for when picking a good plan for you:http://www.1st-for-health-insurance.com/articles/what-is-health-insurance.html

Natural Health Insurance: 3 Proven Immune Boosters

As important as it is to make sure you have 'normal' health coverage, it's even more important to increase the amount of 'natural' health insurance you have. After all, if you protect your body now you won't need to worry about paying a big doctor's bill later! One of the best ways to do this is by boosting your immune system and helping your body to fight off disease.

The following tips are some of the most effective methods for boosting your immune system naturally. Each one is absolutely proven to help protect you from a wide array of diseases, including heart disease and cancer. Incorporating them into your lifestyle is one of the easiest ways to 'buy' natural health insurance!

Eat Colorful Vegetables & Fruits

These extremely healthy foods should be the basis of your diet. Eating colorful veggies and fruits is a must if you want to stay healthy for life. They are packed with essential vitamins, minerals, fiber, and phytochemicals that keep your body -- and your immune system -- strong and ready to fight off disease. Choose things like leafy greens, bright red tomatoes, orange grapefruits, yellow peppers, and plump blueberries. Remember, the more colorful your plate is the healthier you're going to be.

Get 8 Hours of Sleep

There is no longer any doubt that lack of sleep affects the immune system and leads to health problems. Several recent studies have shown that getting a good night's sleep can dramatically boost your immune response, while even one night of poor sleep can significantly suppress immune function. The immune system is constantly working, so when we sleep the body is able to 'reinforce' and strengthen it, most likely by producing powerful hormones. Most people need about 8 hours of sleep per night for optimal health so that's a good number to shoot for.

Exercise 6 Days a Week

Exercise is a powerful immune booster, not to mention a very important component of good overall health. Regular, moderate exercise has been shown to lower an individual's likelihood of getting sick. It also boosts natural energy levels while relieving stress at the same time. To top it all off, regular exercise makes it much easier to sleep at night! Just don't overdo it. Too much exercise can actually suppress the immune system. Try to get about 30 to 40 minutes of moderate exercise most days of the week, leaving one day for rest and recovery.

Well, there you go -- 3 powerful and proven ways to boost your immune system and stay healthy. Each of the above are healthy habits which, over time, will provide you with an abundance of natural health insurance. If combined, you'll enjoy great health and wellbeing for a very long time!

Ryan Wilson is a writer for Natural-Health-Insurance.com, a guide to useful news & information about staying healthy. You can learn more at: http://www.natural-health-insurance.com/.

Note to web site owners: Feel free to use this article on your site or newsletter. Just be sure it includes a 'live' link back to Natural-Health-Insurance.com

How To Save Money On Health Insurance Premiums Using HSA's

Opening a health savings account (HSA) can save you hundreds on your health insurance premium and help pay for out of pocket expenses and deductibles. Anyone younger than age 65 who buys a qualified health insurance policy with a deductible of at least $1,000 for individuals, $2,000 for families, can open an HSA. An HSA lets you set aside pretax money up to the amount of the deductible (with an annual maximum of $2,600 for singles; $5,150 for families). You can use the money tax-free for medical expenses, and anything left over grows tax-deferred. You can use the money for anything after age 65 without penalty, but you will owe income taxes on any money that isn't used for medical expenses.

In many cases, the cost savings from buying a high-deductible policy make up for the higher out-of-pocket medical expenses you'll have to pay -- not to mention the tax benefits.

The HSA Insider Web site (http://www.hsainsider.com) has a comprehensive list of insurers offering HSA-eligible policies and financial institutions providing the investment accounts. You can also search for a quality high deductible health insurance plan to complement your HSA at Best Insurance Deals (http://www.Best-Insurance-Deals.net).

Charles White has authored several informational articles related to saving money on insurance. He is the owner of Best Insurance Deals, a website offering several sources of free insurance quotes saving you hundreds on Auto, Life, Health, Long Term Care and RV insurance. You can visit the website at http://www.best-insurance-deals.net and save money today.

How to Get NPI - National Provider Number for HIPAA-Compliant Medical Billing in 7 Steps

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers, as well as the adoption of standard unique identifiers for health plans. They become mandatory on May 23, 2007.

The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers.

CMS has contracted with Fox Systems, Inc. to serve as the NPI Enumerator. The NPI Enumerator is responsible for dealing with health plans and providers on issues relating to unique identification.

HCFA Timetable

Changes in the HCFA 1500 form to accommodate the NPI number took place January 1, 2007. Until March 30, 2007, using NPI number on the HCFA form is optional but as of April 2, 2007, using NPI becomes mandatory.

Getting an NPI is free - Not Having One Can Be Costly: If you delay applying for your NPI, you risk your cash flow.

1. Enumerate: Enumeration is mandatory for both individual providers and organizations and subparts. When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI.
2. Update: Make sure to upgrade your software, HIPAA Transactions, CMS1500, UB04, and/or Dental claim form changes.
3. Communicate: Notify your payers once you have obtained your NPI number. As outlined in the Federal Regulation (The Health Insurance Portability and Accountability Act of 1996 (HIPAA)) you must also share your NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes -- including designation of ordering or referring physician.
4. Collaborate: Check the readiness of your payment partners (such as health plans, TPAs, clearinghouses, etc...)? Not all payers are ready to accept the NPI number at this time. Use both your existing (legacy) number and the NPI number when submitting electronic claims.
5. Test: Test transactions well before the deadline. Make sure to test HIPAA Transactions, e.g., 837 Claims, 835 Remittance Advice, and, if you submit paper claims, verify that the data is printed in the correct fields. The new HCFA form has new fields for identifier numbers on lines 17b, 32a and 33a.
6. Educate: Focus on staff working on insurance verification of eligibility and claim denial or underpayment follow up.
7. Implement: Once you obtain your NPI, it might take about 120 days to do the remaining work to use it. This includes working on your internal billing systems, coordinating with billing services, vendors, and clearinghouses, testing with payers.

Yuval Lirov, PhD, author of "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial intelligence and Computer Security, and CEO of Vericle.net Billing Technologies and Services. Vericle? unites hundreds of billing services across the nation. Its electronic medical billing software tracks payer performance from a single point of control and shares compliance rules globally. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

No Living Will & Power Of Attorney?: HIPAA Law Shuts You Out

What do you mean I can't find out about my husband's accident injuries? Why can't we move my mother to the nice nursing-home down the street? The Health Insurance Portability and Accountability Act or HIPAA caused two of my clients to live through these very situations.

A husband and wife were involved in a terrible automobile accident. The husband was seriously injured. His wife wanted to make certain that the needed medical attention was given to her husband. The wife could not get any medical information from her doctor. Even though she was the wife, the new HIPAA law and regulations prevents her from receiving medical information without specific written authorization!

In another case, an elderly widow lady became incapacitated. Her two children wanted to place her in a nursing home so that she would receive adequate care. Even though they had a living will and health-care power of attorney for their mother, they were required to go to court and be appointed her guardians so that they could place their mother in the health care facility.

What is the HIPAA Law all about?

The HIPAA Law in a Nutshell

HIPAA took effect on April 14, 2003.

This legislation applies to virtually every physician, nurse, pharmacist, dentist, and health care provider in the nation. It impacts everyone's access to health care information.

What does this privacy act mean? The regulations stress that health care providers must limit health information to those who are intended to receive it. This means health care information cannot be released to any unauthorized person. This may mean you may not be able to receive medical records for your spouse or parent.

HIPAA Violation Penalties

The penalties for health care providers are staggering. For each disclosure violation, there is a $100 fine. If the violation is knowing, there are criminal penalties of a $50,000 fine and up to one year in prison. If information is provided or obtained under false pretenses, there is $100,000 fine and up to five years in prison. If the wrongful sale, transfer or use of the information was for commercial advantage, there is a $250,000 fine and up to 10 years in prison.

How does this affect you? To ensure an easy transition, you must have the appropriate medical release language to comply with HIPAA in three of your estate planning documents.

Documents to Update

The documents which need to be updated are:

• Your Living Will and Health Care Power of Attorney
• Your Living Trust
• Your Durable Power of Attorney

What if I do nothing?

You may be forced to sign the doctor's or hospitals forms in a stressful emergency situation. These documents may not reflect your choices and may contain confusing legal and/or medical terminology. Or you may be unable to sign anything and may repeat one of the above scenarios.

If your documents were created before 2003 and have not been amended since, have your attorney review them for HIPAA compliant language. Are you missing some or all of these documents? Make an appointment today!

Visit http://www.stevenallen.com for tips and tools on Wealth Preservation. You can also subscribe to his monthly newsletter Secrets To Wealth Preservation. Steven W. Allen has been an Estate Planning attorney for over 30 years. He is a member of the Arizona Bar Association, National Lawyers Association, National Academy of Elder Law Attorneys and National Speakers Association. He is the author of four books including the most recent You Can?t Take It With You...So How Will You Leave It Behind?. Go to http://www.EstatePlanningDr.com for your 3 free chapters.

HIPAA and Document Imaging

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 and has made quite an impression on the world of digital document imaging and forms processing. Any company as a covered entity of HIPAA needs to take certain precautions when outsourcing any aspect of their operations that deal with personnel health information (PHI.) There are two main components to HIPAA that deal directly with the outsourcing of document imaging and claims processing. Privacy issues and Administrative Simplification are of the utmost importance to HIPAA.

If you have been to doctor?s office the last few years, you probably have been asked to sign all kinds of new forms; these forms are HIPAA privacy forms. It does not end with privacy and disclosure forms, people handling medical information must take special precautions when handling private medical information. This information includes but is not limited claims, patient history files, and enrollment files.

Whenever dealing with a Document Imaging Service provider you should always ask them about their HIPAA policies and procedures. Every one of their employees needs to sign an agreement stating they are aware they are handling people?s PHI. The company should have a zero tolerance policy on distributing or reading anyone?s PHI. Every care and precaution must be taken to ensure PHI remains private.

Under the privacy rule of HIPAA there is a security rule which has three parts:

1. Administrative Safeguards ? are policies and procedures designed to clearly show how an organization will comply with the HIPAA act.
2. Physical Safeguards - Physical access to PHI must be restricted and controlled to guard against inappropriate access to such data.
3. Technical Safeguards ? Any organization engaged in the handling of PHI must control access to computer systems and protect communications containing PHI. These communications must be protected against interception.

The primary goal of the Administrative Simplification portion of HIPAA is to simplify and streamline the administration of health care. Essentially, standards are created to facilitate various types of health care electronic transactions. No one insurer can ask any claims submitter to file in any other electronic formats other than those mandated by HIPAA.

A little bit of work up front will pay off in time. If you use an experienced service bureau or clearinghouse to process your claims, they will be able to convert your paper claims according to the standards set fourth by HIPAA with little effort. Once you successfully submit claims in the HIPAA standard ANSI 837 format, submitting to another insurer will be a piece of cake.

Under the old system, one health care provider could require all claims submissions to be in a HL7 format while another could require a custom text string. There were about 400 different ways to submit an electronic claim before HIPAA. Now there is one way, HIPAA's Way.

• Less setup for new claims submitters (One size fits all)
• Easier training for new staff
• Faster payments

If you feel the company you are doing business with is not serious about HIPAA, find another company to do business with. In the end you are responsible for the actions of your contracted vendors. Any vendor dealing with PHI is also considered a covered entity of HIPAA and therefore legally bound by the act.

We are a NY document imaging company dedicated to finding you the right solution for all your digital data needs. We believe in providing you with all the necessary information and expertise to help you make a sound decision regarding your data processing projects. For more information visit our website at http://www.paper-scanning-services.com

HIPAA And How It Will Affect Your Office

This information is designed to help you better understand HIPAA and to assist your office in becoming HIPAA compliant. The information was obtained from a variety of sources and is not intended to be legal advice. If you are having difficulty understanding any portion of the HIPAA regulations you should consult your legal counsel. First, there are no HIPAA police. No one is going to come into your office to inspect you to see if you are HIPAA compliant. A complaint must be filed in order for any action to be taken.

What is HIPAA?

HIPAA stands for The Health Insurance Portability And Accountability Act. It was enacted by the federal government in 1996 as part of a healthcare reform effort. HIPAA is intended to ensure confidentiality of all patient related health care information. It also intends to simplify the administrative processes of health care, thereby reducing the costs and administrative burdens of health care.

One thing to remember is that the HIPAA Act uses the word ?reasonable? several times. You and your office staff must do whatever reasonable to protect your patient?s privacy. For instance, smaller medical offices do not have to take the same privacy measures as large hospitals do. That would not be reasonable.

Also, there are no ?privacy police.? No one is going to come in and inspect your office randomly. Someone must file a complaint first. The complaints will be handled by the Office of Civil Rights. If someone puts in a complaint, then it will be investigated. The fines are very high, so you will want to be sure that your office has good privacy practices and that they are followed all of the time.

Another thing to keep in mind is that the type of your practice may determine the level of privacy that you need to acquire. For example, patient?s in an optometrist?s office may not be as concerned about people knowing they are there, as opposed to patient?s in a mental health office. There are several different components of HIPAA, each one having its own implementation date.

Section 2: The Privacy Component : implementation date: April 2002

1. You must do everything within reason to protect your patient's privacy.

2. Patient's files and information should be kept in a secure section of your office, a section that is not accessible by other patients.

3. Charts should not be left lying around, open where someone can read it.

4. If you are making a phone call about a patient or to a patient, you need to do it from an area where you cannot be overheard if you will be giving out personal information. For example, if you are calling their insurance company, and you will be saying the patient's first and last name, date of birth, ID#, and/or a diagnosis, then you do not want to do it where others, perhaps in a waiting room, can hear you.

5. If patient's charts are ever removed from the office you need to have a policy in place. For example, you should have a sign out sheet which states the patient's name, date taken, by whom, and then signed back in when the chart is returned.

6. If charts are removed , they should be carried in a case that is marked ?confidential - medical records.? If you were ever involved in an accident, or separated from the bag for any reason, either authorities or medical personel would secure the information for you. Or you would have at least done whatever reasonable to protect that information.

7. If computer screens are in a position that patients can view them, you may want to move them, or get a screen cover. A screen cover makes it so that the computer screen can only be read when directly in front of it. The above are just some things that you will need to consider when becoming HIPAA compliant. Each office will have it?s own areas that need to be reviewed. The above are many of the common areas.

Section 3: Administrative Simplification: compliance date: October 2002

This component requires the standardization of data transmissions, or EDI, and procedure/diagnosis codes.

As for the standardization of procedure/diagnosis codes, this just means that you must use CPT-4 codes for procedure codes and ICD-9 codes for diagnosis codes.

As for the standardization of EDI, that refers to your electronic billing. In order to submit your claims electronically, you must do so in a HIPAA compliant format.

Section 4: Security Component: no implementation date set yet

This component requires that health care professionals, Billing Services, and clearing houses take appropriate security measures to assure that health information pertaining to an individual remains secure and is not accessible by others.

Things to consider:

Where is your fax machine? Is it in a place where only office staff can access incoming faxes? Is it on 24 hours a day? When you are not in the office (after office hours) can anyone else access your fax machine? Whenever you fax personal information about a patient you should use a fax cover sheet with a confidentiality statement. The statement should explain that the following fax contains personal medical information and that if the fax is received by anyone other than the intended party, that the fax should be destroyed and they should notify you that it was received in error.

Do you hire a cleaning person/crew? Are they in the office when you are not? Do they have access to the patient?s personal information? You may want to ask them to sign a confidentiality statement.

Do you rent office space? If yes, does your landlord have access to your office? Do they ever enter your office without you being present? If they do, you may want to ask them to sign a confidentiality statement.

By asking people who have access to your office to sign a confidentiality statement, you are making a reasonable attempt to protect your patient?s privacy. It is not always reasonable to never allow anyone access to areas that contain private information. If those people sign an agreement and then breech that agreement, you would not be held responsible.

If you do any business by email, you will need to use an encryption service. This will ensure that if anyone were to intercept your emails, they would not be able to read them.

Section 5: Privacy Officer

All offices must designate a mandated ?privacy officer.? This person would be responsible for making sure all staff are HIPAA trained and that privacy policies are typed up and followed. They would also be the person that staff members or patients could go to with any concerns or questions about HIPAA compliance. Even if you are a very small practice, you MUST have someone designated as the privacy officer. It may even be the Doctor themself.

Section 6: Release of Patient Information/Consent

You need to have the patient?s written consent in order to release any of their records/information.

(Exception: If request is due to immediate/urgent care of patient.)

You should review your current consent and authorization forms to make sure they are HIPAA compliant. HIPAA requires you to obtain consent for the use and disclosure of information from each of your patients. You may refuse to treat patients who will not sign the consent form.

Section 7: Unique Identifiers: No implementation date set yet

HIPAA will mandate the use of unique identifiers. More to come on this component. Most likely you will have one national provider number, instead of a different provider number for each insurance company.

Section 8: Policies and Procedures Required by HIPAA

1. Identify people on your staff who require access to protected health information.

2. Prevent access to protected health information by unauthorized persons.

3. Ensure that the ?minimum necessary? amount of information is released for routine disclosures (only release information pertaining to what is requested, not the patient?s entire file.)

4. Verify the identity of the requestor of information.

5. Provide patients access to their records, the opportunity to request corrections, and access to and accounting of disclosures.

6. Every office must have written policies regarding privacy practices.

Summary

Evaluate your physical office for potential privacy and security risks. One of the best things that you can do to become ?ready? for HIPAA is to walk through (better yet - have someone else walk through) your office as if you are a patient. Look around at EVERYTHING. What do you see? Do you see any personal patient information, charts in full view? Start right from the front door, and go through every room in your office, especially the rooms that patients have access to. Then continue to do periodic checks to ensure ongoing compliance.

Make sure that you have written policies regarding any privacy practices, such as removing charts from the office, faxing patient information, reviewing any complaints from patients, etc. Also, make sure you designate a ?privacy officer.?

Make sure all staff members are trained regarding HIPAA policies. Remember to train any/all new employees regarding HIPAA policies. You should also review your current HIPAA policies regularly.
Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor?s degree in Computer Information Science and is responsible for the medical billing for over 50 providers. For more information on medical billing and HIPAA visit her website at http://www.solutions-medical-billing.com

The Modern Medical Office: Balancing Success, Technology, and HIPAA

The medical field has always depended on technology for improving patient care. Thanks to advances in technology, administrative functions of healthcare offices have greatly increased their efficiency and customer relations. For example, there is technology that allows doctors to share information with offices across street or across the nation instantly with just a few clicks of the mouse. These advances not only free up hours of paperwork, but also quickly provides information vital to patient?s care.

The Electronic Medical Office & HIPAA A clinic can in the end be more profitable by offering these innovative services. Nearly half of the people interviewed in a Forrester Research study said they would be willing to pay more for online features; such email access to their doctors. (1)

While technology can be tremendously beneficial there are serious cautions that must be heeded. In 2003, the privacy rule of HIPAA was enacted and the rules governing protected health information (PHI) of patients became far more stringent. The rule governs the way in which information is handled. It requires every level of communication and storage of the PHI to be secure and private.(2) Examples of the ways violations occur are:

• Computer screens visible from waiting room
• Files left out around the office
• PHI not disposed of properly, such as securely shredded
• Records sent to the wrong home or email address

Due to these changes all modes of communication have a heavier burden of responsibility placed upon them since the inclusion of the privacy rule, but none more than electronic transmissions. Keeping the information protected when sending emails, which can be intercepted, can in itself be a daunting task.

HIPAA?s Penalties If an action taken by any employee, whether intentional, unintentional, or simply neglectful leads to improper recipient of PHI, the practice involved could face serious consequences.

• The civil penalties range from "$100 per incident, up to $25,000 per person, per year, per standard that is violated."(3)
• The criminal penalties range in three main groups. The first is up to $50,000 and 1 year in prison, moving up to $100,000 and 5 years, or $250,000 and 10 years in prison.

Each tier of the criminal penalties has different qualifications leading up to the knowingly disclosing PHI with the intent for malicious harm. (3)

Keeping Your Practice HIPAA Compliant
It?s important for today?s electronic medical office to have several layers of digital protection. This ensures PHI or any other private information cannot go outside the confines of the practices? systems without the proper digital rights. These rights can be controlled by moderators or even the sender and have the ability to dictate what permissions the receiver may have.

One large step is to protect your practice from accidentally sending information into the wrong hands. This can be done through email anti-theft solutions which encrypts the data sent via email. By using these types of programs, the sender may control not only the security of the file but also subsequent actions that may be carried out by the file?s recipient(s).

email anti-theft programs allow the user to establish who can view, edit, print and forwarding these important health records. Permissions set with email anti-theft software stays with the documents once they?ve left the clinic?s computer.

What Happens if My Practice?s Computer is Stolen?
Email anti-theft software can also protect the data on the computer if the machine is ever misplaced or stolen. This can be done through remote laptop security. All the victim of theft has to do is log into the program and there remotely block access to all protected files on the missing laptop. Without improvement in the means of securing and transmitting their files many practices will continue to commit violations of HIPAA, losing money and patients along the way.

HIPAA Compliance & Patient Trust
It is obvious that one must comply with HIPAA because of the financial penalties that go with noncompliance. There are however, far better reasons for compliance than avoiding punishment.

HIPAA Violations can break the trust between doctors and patients, but compliance along with new technology can strengthen relationships. When patients have new services such as the ability to ask questions to doctors via email the doctors can enhance their trust levels. This is especially important for small practices as interpersonal relationships play key roles for the retention of patients.

The advantages of technology will continue to provide new ways of serving patients. As the digital age comes the computer will increasingly become the focus of record keeping. With an industries like medical & healthcare so dependent on keeping detailed yet secure records, it is going to be ever important to stay current with strong security programs to encrypt and protect files.

1. Bradford J. Holmes, Eric G. Brown, Elizabeth W. Boehm, Lynne Bishop, "Trends In Healthcare Consumer Technology Adoption" Forrester Research, 15 July 2004.
2. Title 45 Code of Federal Regulations, Pt 164.
3. United States Department of Health and Human Services. Protecting the Privacy of Patients' Health Information Summary of the Final Regulation. 2005. http://aspe.hhs.gov/admnsimp/final/pvcfact1.htm
   Michael David is a member of the marketing team at Essential Security Software (ESS), the leading provider of email anti-theft software for small business. He is a regular contributor to http://www.Iwantmyess.com.

Medical Billing, HIPAA Compliance, and Role Based Access Control

HIPAA compliance requires special focus and effort as failure to comply carries significant risk of damage and penalties. A practice with multiple separate systems for patient scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. This article presents an integrated approach to HIPAA compliance and outlines key HIPAA terminology, principles, and requirements to help the practice owner to ensure HIPAA compliance by medical billing service and software vendors.

The last decade of the previous century witnessed accelerating proliferation of digital technology in health care, which, along with reduced costs and greater service quality, introduced new and greater risks for accidental disclosure of personal health information.

The Health insurance Portability and Accountability Act (HIPAA) was passed in 1996 by Congress to establish national standards for privacy and security of personal health data. The Privacy Rule, written by the US Department of Health and Human Services took effect on April 14, 2003.

Failure to comply with HIPAA risks accreditation and reputation damage, lawsuits by federal government, financial penalties, ranging from $100 to $250,000, and imprisonment, ranging from one year to ten years.

Protected Health Information (PHI)

The key term of HIPAA is Protected Health Information (PHI), which includes anything that can be used to identify an individual and any information shared with other health care providers or clearinghouses in any media (digital, verbal, recorded voice, faxed, printed, or written). Information that can be used to identify an individual includes:

1. Name
2. Dates (except year)
3. Zip code of more than 3 digits, telephone and fax numbers, email
4. Social security numbers
5. Medical record numbers
6. Health plan numbers
7. License numbers
8. Photographs

Information shared with other healthcare providers or clearinghouses

1. Nursing and physician notes
2. Billing and other treatment records

Principles of HIPAA

HIPAA intends to allow smooth flow of PHI for healthcare operations subject to patient's consent but prohibit any flow of unauthorized PHI for any other purposes. Healthcare operations include treatment, payment, care quality assessment, competence review training, accreditation, insurance rating, auditing, and legal procedures.

HIPAA promotes fair information practices and requires those with access to PHI to safeguard it. Fair information practices means that a subject must be allowed

1. Access to PHI,
2. Correction for errors and completeness, and
3. Knowledge of others who use PHI

Safeguarding of PHI means that the persons that hold PHI must

1. Be accountable for own use and disclosure
2. Have a legal recourse to combat violations

HIPAA Implementation Process

HIPAA implementation begins upon making assumptions about PHI disclosure threat model. The implementation includes both pre-emptive and retroactive controls and involves process, technology, and personnel aspects.

A threat model helps understanding the purpose of HIPAA implementation process. It includes assumptions about

1. Threat nature (Accidental disclosure by insiders? Access for profit? ),
2. Source of threat (outsider or insider?),
3. Means of potential threat (break in, physical intrusion, computer hack, virus?),
4. Specific kind of data at risk (patient identification, financials, medical?), and
5. Scale (how many patient records threatened?).

HIPAA process must include clearly stated policy, educational materials and events, clear enforcement means, a schedule for testing of HIPAA compliance, and means for continued transparency about HIPAA compliance. Stated policy typically includes a statement of least privilege data access to complete the job, definition of PHI and incident monitoring and reporting procedures. Educational materials may include case studies, control questions, and a schedule of review seminars for personnel.

Technology Requirements for HIPAA Compliance

Technology implementation of HIPAA proceeds in stages from logical data definition to physical data center to network.

1. To assure physical data center security, the manager must
   1. Lock data center
   2. Manage access list
   3. Track data center access with closed circuit TV cameras to monitor both internal and external building activities
   4. Protect access to data center with 24 x 7 onsite security
   5. Protect backup data
   6. Test recovery procedure

2. For network security, the data center must have special facilities for
   1. Secure networking - firewall protection, encrypted data transfer only
   2. Network access monitoring and report auditing

3. For data security, the manager must have
   1. Individual authentication - individual logins and passwords
   2. Role Based Access Control (see below)
   3. Audit trails - all access to all data fields tracked and recorded
   4. Data discipline - Limited ability to download data

Role Based Access Control (RBAC)

RBAC improves convenience and flexibility of systems management. Greater convenience helps reducing the errors of commission and omission in granting access privileges to users. Greater flexibility helps implement the policy of least privilege, where the users are granted only as much privileges as required for completing their job.

RBAC promotes economies of scale, because the frequency of changes of role definition for a single user is higher than the frequency of changes of role definitions across entire organization. Thus, to make a massive change of privileges for a large number of users with same set of privileges, the administrator only makes changes to the role definition.

Hierarchical RBAC further promotes economies of scale and reduces the likelihood of errors. It allows redefining roles by inheriting privileges assigned to roles in the higher hierarchical level.

RBAC is based on establishing a set of user profiles or roles according to responsibilities. Each role has a predefined set of privileges. The user acquires privileges by receiving membership in the role or assignment of a profile by the administrator.

Every time when the definition of the role changes along with the set of privileges that is required to complete the job associated with the role, the administrator needs only to redefine the privileges of the role. The privileges of all of the users that have this role get redefined automatically.

Similarly, if the role of a single user is changed, the only operation that needs to be performed is the reassignment of the user profile, which will redefine user's access privileges automatically according to the new profile.

Summary

HIPAA compliance requires special practice management attention. A practice with multiple separate systems for scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. An integrated system reduces the complexity of HIPAA implementation. By outsourcing technology to a HIPAA-compliant vendor of vericle-like technology solution on an ASP or SaaS basis, HIPAA management overhead can be eliminated (see companion papers on ASP and SaaS for medical billing).

Yuval Lirov, PhD, author of "Mission Critical Systems Management" (Prentice Hall) , inventor of multiple patents in artificial intelligence and computer security, and CEO of Vericle.com Billing Technologies. Vericle delivers comprehensive practice workflow engine that integrates patient scheduling, electronic medical records (EMR), billing, transcription, and compliance management. By consolidating technology for hundreds of separate billing services, Vericle? tracks payer performance from a single point of control, shares compliance rules globally, and creates massive economies of scale. Yuval invites you to share your knowledge of medical billing and compliance at BillingWiki.com and register to the next webinar on audit risk at ChiroAudit.com.

HIPAA Compliant FTP Hosting

FTP Hosting ? an overview

?File Transfer Protocol?, commonly known as FTP, is a reliable protocol to exchange large volume of digital information from one computer to another. FTP hosting technique has simplified file transfer process over the Internet. FTP hosting comes with two components ? FTP Server and FTP Client. Moreover, each FTP user will get a unique FTP account with user name and password. Irrespective of file type and file size, FTP account holders can upload the files in FTP Server through their FTP account. Similarly, FTP account holders can download copies of the uploaded files from FTP Server.

FTP hosting services provides complete security in file exchange process. Only authorized FTP account holders can view and access the files. Further, you can restrict a FTP account holder to access other FTP accounts. Irrespective of business volume, companies require to transfer files over the Internet. Though it is true that Hyper Text Transfer Protocol (HTTP) provides the facility to share information over the Internet but due to its limitations, FTP became popular across the globe.

FTP Hosting for Health Care Services

In Medical Transcription or other Health Care Services, medical reports are stored and exchanged in digital format. The growing necessity of exchanging large volume of medical reports and files over the Internet allows the Health care Service providers to use File Transfer Protocol as an alternative of Hyper Text Transfer Protocol. After the introduction of Health Insurance Portability & Accountability Act of 1996, extra guidelines are drawn for FTP hosting. All types of Health Care Services, who store and exchange medical files and reports over the Internet will fall under this Act and have to follow HIPAA regulation throughout the business process to ensure quality service and security of digital medical files and reports.

HIPAA

Health Insurance Portability & Accountability Act, commonly known as HIPAA, is a set rule to protect health related electronic information. The effect of HIPAA rules is applied to all types of health care organizations and support services. According to Health Insurance Portability & Accountability Act, all the health care organizations and support services should maintain necessary security measures to protect personal health information.

Medical institutes and support services prepares and stores health information of the patients in digital format. Based on the requirement, these digital reports are exchanged from one computer to another over the Internet. Health Insurance Portability & Accountability Act ensures complete security of digital health information that includes ? secure storage system and secure transmission of digital information over the Internet.

HIPAA Compliant FTP Hosting

The growing importance of Health Insurance Portability & Accountability Act in health care sector has given the birth of HIPAA compliance FTP hosting services. The objective of HIPAA compliance FTP hosting services is to protect unauthorized people from accessing digital heal information or medical report.

Following are some general features of HIPAA compliance FTP hosting service:

• HIPAA compliance FTP servers are considered as highly secured data centers.
• The system will automatically generate and run several threads during transferring digital medical files from one location to another. This is known as Multi-thread File Transfer and makes the process faster than normal File Transfer Protocol.
• HIPAA compliance FTP hosting service comes with 128-bit transfer encryption. Digital files are transferred in the encrypted form. There is also another process ? symmetric or secret key encryption, which encrypt files and upload them in the server with a unique ?key?. The system will store the encrypted data in HIPAA compliance FTP server. Only the authorized person, who has that ?key?, can download the encrypted digital medical report from the server.
• Like general FTP hosting services, the methods of uploading and downloading digital medical files are user friendly.
• HIPAA compliance FTP hosting services allow the users to apply FTP services with existing firewalls.
• Unique user name and password for HIPAA compliance FTP account holders.
• HIPAA compliance FTP hosting services restrict anonymous FTP account holder from accessing the server.
• Some HIPAA compliance FTP hosting services provides ultimate security by using ?Intrusion Detection System? and other security tools, which are compatible with all types of operating systems.

Advantages of HIPAA compliance FTP Hosting

The main advantage of HIPAA compliance FTP hosting services is data encryption. HIPAA compliance FTP hosting services will encrypt each data files in separate pieces of data, which are known as ?key?. You have to use the software xTyFTP during the process of uploading medical records in the FTP server. The software will encrypt the digital file in the computer and provide the ?key? to the authorized user decrypt.

HIPAA compliance hosting services will store the encrypted file in the server. However, if any unauthorized user accesses the file from the FTP server, he/she will get the encrypted form and the content will remain hidden without the right ?key?.

Apart from data encryption, which is considered as the core feature of HIPAA regulation, HIPAA compliance FTP hosting service requires secure procedure in data handling and serious maintenance of necessary policies, e.g., restricting unauthorized users from damaging digital information.

Adam is a Network Engineer with "InstantFTPsites.com". You can learn more about "FTP Hosting" services online at http://www.InstantFTPsites.com.

? 2006 InstantFTPsites http://www.InstantFTPsites.com You may reprint this article online and in print provided the links remain live and the content remains unaltered (including the "Author Biography").

Will HIPAA Sabotage Your Estate Plan

You may have recently noticed that your doctor, other health care providers and pharmacy now ask you to sign a receipt for their "Notice of Privacy Practices".

The reason for this is a new law - - one intended to protect your personal information from identity theft or public disclosure - - which, unfortunately, also dramatically impairs your estate plan in several unforeseen and unintended ways.

The Health Insurance Portability and Accountability Act ("HIPAA") was passed by Congress to provide a secure way for health information to be passed from one health provider to another, or from health providers to insurance companies and to individuals (including the person whose information is involved).

HIPAA strictly limits the disclosure of your medical information by virtually every physician, dentist, psychiatrist, nurse, other health care provider and pharmacist, and imposes fines of up to $250,000 as well as jail time for up to 10 years, in the event any health information is wrongfully disclosed.

Why HIPAA Affects Your Estate Plan

Statistically, there?s better than a 50% chance you?ll someday suffer a serious accident or illness and become unable to handle your financial and medical decisions. In that event, your estate plan documents provide for a successor to take over for you. Your Living Trust and/or your Durable Power of Attorney for Property ("Estate and Personal Planning Uses") take care of your financial decisions. Your "Durable Power of Attorney for Health Care takes care of your health care and treatment decisions.

Your successor decision makers named in your Living Trust or Power of Attorney cannot step in and make decisions for you unless they first have knowledge of your inability to make decisions yourself. If your successor can?t get a confirmation of your condition, he or she may instead have to go to court to declare you "incompetent" - - in what can be an expensive, lengthy and embarrassing conservatorship proceeding. Furthermore, your health care decision makers will urgently need access to your medical information in order to make critical health decisions for you!

Clearly, you would prefer for your successors to have immediate, hassle-free access to your medical records so they may obtain information from your doctor regarding your situation in order to handle your important matters right away. Unfortunately, HIPAA can prevent your successors from getting the medical records and doctor letters they need and force them to go into court!

Sorting out this new law and figuring out how to respond to it has been a huge process for health providers and for us. That?s why you haven?t heard from us, even though the new law became effective in April of 2003. Over the past two years, we have attended numerous continuing education programs, and spent a lot of time doing legal research! Fortunately, the health care providers are only now starting to seriously implement HIPAA, so we haven?t run into any significant problem in getting a client?s medical information so far ? but it will be a real problem in the immediate future!

Isn?t an Authorization to Release Medical

Information Sufficient?

Our policy has always been to thoroughly research new laws and develop practical solutions we feel confident are going to work, rather than to immediately jump in and recommend estate plan changes. For example, we have already seen numerous estate planners advise their clients to merely sign an ?Authorization to Release Medical Information? and tell their clients that?s all they need to take care of the problem ? but that?s wrong!

First of all, HIPAA does not provide one standard ?form? for such authorization. And relying on an authorization form provided by a specific health care provider, a government authority or agency, or even one attorney speaking at a continuing education program may be a big mistake! We have critically examined the exact wording of the law, and almost all forms we?ve see are inadequate!

Many planners creating HIPAA authorizations fail to include certain required disclosures to the signing party and fail to refer to specific terminology of the Act, thereby threatening the validity and acceptance of the authorization by third parties holding your medical information. Worse yet, many authorizations are overly broad and may give others access to your medical information when it?s not yet necessary or appropriate!

Most importantly, very few planners have considered the impact of HIPAA on your other estate plan documents. Your Living Trust, Durable Power of Attorney for Property and Advance Health Care Directive all should be updated to include provisions that will permit your successor trustee or agent to sign a valid authorization on your behalf if you become disabled and your authorization is invalid due to changes in the law, or because it?s too old or simple can?t be located.

These documents also need to provide a set of alternate or back-up procedures if your authorization or the one signed by your successor trustee or agent can?t be properly implemented, even thought it may be valid. For example, your doctor might refuse to honor your authorization because he may question your legal capacity at the time it was signed or he narrowly interprets the kind of information permitted to be released and decides to withhold some important item. Or, because he?s scared off by all the severe penalties, he may refuse to write a letter stating you are incapacitated. If you don?t have a back-up procedure in your estate plan documents to cover these kinds of events, then you may be forced into a court conservatorship!

As if all of this isn?t complicated enough, we also have to consider what may happen if you?re disabled or deceased and one of your successor trustees or agents then becomes incapacitated. How will your documents permit the next named successor to step in immediately if they don?t have a proper Authorization to Release Medical Information from the first successor who can no longer act? We have come up with a practical mechanism to deal with this issue so, again, you can avoid going to court.

You must get all of your documents upgraded, so that your estate plan continues to function smoothly, as intended, should your or one of your successor trustees or agents ever become incapacitated because of illness or accident. This package includes an Authorization to Release Medical Information, an Amendment to your Living Trust for those of you who have a Revocable Living Trust estate plan, a new Power of Attorney for Property and a new Advance Health Care Directive. If you have a Will Package only, you need to have it updated also with a new Authorization to Release Medical Information, Power or Attorney for Property and Health Care Power of Attorney.

Carolina Senior.Com offers South Carolina baby boomers, seniors and retirees, retirement information on investing, financial protection, legal protection, long term care options and more. Perry Fields is a writer for Carolina Senior.com and focuses her writing on South Carolina retirement information.