Finding Affordable Health Insurance

Affordable health insurance - it seems, particularly today, those words just don't belong together in the same sentence. Health insurance monthly premiums are becoming the biggest single expense in our lives - surpassing even mortgage payments. In fact, if you have any permanent health problems, such as diabetes, or have had cancer at one time in your family history, your monthly cost could easily be more than the house and car payment combined.

Shopping for affordable health insurance can certainly be an eye-opener. If you have always had a health insurance benefit where you work - especially a state or federal employee - and now have to buy your own, you may not be able to afford the level of health insurance coverage you have become used to.

Affordable health insurance, however, is definitely available -if you know how and where to look.

When you are looking for affordable health insurance, you want the lowest cost per year that will fit your budget, of course. But, even more importantly, you want a company that has a good record for paying without fighting with you on every detail. Just as there is a car for just about any budget, there is also affordable health insurance. You may not be able to afford a "Cadillac" policy - but then you probably don't need all the frills anyway.

Shopping for health insurance on the internet is the easiest and best way to find affordable health insurance. Here are five reasons why.

1. You don't need a local agent to help you submit the claims for health insurance. The medical provider does it for you. You save money because the health insurance company saves money by not paying the agent commission. This could amount to an 8% to 12% savings to you. 2. All the top health insurance companies are at your fingertips on the internet. Most local agents can only quote you from the few companies that they represent. They may not offer you what is best for you financially or health-wise but only what they happen to have available. 3. Health insurance companies have to be extremely competitive because it is so quick and easy to compare them with their competitors on the internet today. In the past you would have had to visit physically eight to ten agents to do a similar comparison. Most folks just didn't have the time or desire for that. 4. You can change your coverage, deductibles, and payment options with just a few clicks rather than going through the paperwork delay with a local agent (and then finding out he/she made a mistake - more delay). 5. Charging to a credit card means you aren't going to forget a payment and be without insurance. Also, it gives you another 30 days before you actually have to pay. Also, many companies today give an additional discount for "auto-pay".

The key, however, to finding affordable health insurance is realizing that the purpose of any health insurance is to protect you from a major financial loss - not to protect you from spending small money on clinic visits and sliver removal. These small expenses may be cumbersome but they generally will not hurt you. It's the $100,000 heart operation that will break you. That's the financial disaster health insurance was originally designed to prevent.

Also, keep this in mind. Health insurance, as with any insurance, is a gamble. You are gambling that you will draw out more than you pay in. Your health insurance company is gambling they will pay out less. The odds are in their favor for two reasons. They have all the facts for millions of families to average out, so they know the risk in advance. Also, they get to set the rules and the prices. The higher you set your deductible, the more risk you take. This is not a bad thing at all. You will most likely be the winner in the long run.

Yes, finding affordable health insurance is much easier than most people think.

By adding more of the risk with higher deductibles, spending a little time on the internet comparing eight to ten different companies, and deleting coverage that you will not likely need (such as maternity for many people) will make it likely for you to find your own affordable health insurance.

Daniel J Lesser is the creator of HotHealthInsuranceSecrets.com. A whole world awaits those healthy enough to see it. Find out how to stay healthy at an affordable price www.hothealthinsurancesecrets.com.

Health Insurance ? Not As Straightforward As It Would Seem

Most of the seven million people covered by health insurance in the UK have a policy provided by their company. As such it is a useful benefit, but many of us assume that it will cover any kind of health issue and this is definitely not the case. The insurers exclude a wide variety of possible claims, and this article will explain those in detail.

Health insurance has a very specific purpose ? to get people suffering from short-term, curable health problems straight through to a consultant and to receive top quality private care in top speed time. Essentially, it's about jumping the lengthy NHS queues. However, there are many health problems that don't fit into this narrow band, and as such are not covered by a health insurance policy.

Be aware however that every policy is different, and only be reading your own policy documents will you be able to find out exactly what you are covered for. This article will give you the knowledge you need to understand your policy better.

Defining ? Chronic'

Illnesses and conditions etc fall into two main categories: ?acute' and ?chronic'. Short-term illnesses that can be fixed and cured are called ?acute', for example if you fell and broke your arm, this would be classed as acute. If, however, your problem is either incurable or deemed to be a long-term issue, then it will be classed as ?chronic' and subsequently you will not be able to make a claim.

What counts as ?acute' and what counts as ?chronic' is a hotly disputed issue between insurance companies and their customers. Diabetes and asthma are acknowledged as chronic, long-term conditions that cannot be cured.

The issues become more difficult with certain types of cancer. It often happens that the cancer is considered to be treatable at first, and then the diagnosis is changed at a later time to incurable. In this case, you would only be covered as long as the cancer was diagnosed curable. If the prognosis changes you will lose your cover. Insurance companies are allowed to reclassify an illness from acute to chronic at any time.

What about the long-term
If you need long-term treatment then you're out of luck. However insurers have different ideas on what constitutes long-term, you may be covered for 10 months or up to a year, but it probably won't be for any longer than that. Check your policy for details.

Does preventative medicine count?
Health insurance cannot be used to pay for preventative treatment, although that is another matter of contention. For example, a drug called ?Herceptin' can be used to help women who have ?HER2', a virulent form of breast cancer. The drug has helped reduce the risk of the cancer returning by an average of 50%. Many would call this an essential treatment, but some insurers call it preventative. Legal and General and Axa PPP will not pay for this treatment, however BUPA, Standard Life Healthcare, Norwich Union and WPA will.

Drugs not yet available on the NHS
You might think that it doesn't matter if the drug is available on the NHS, but it relates to the system of drug approval in England and Wales. Before a drug can be used in the NHS, it must be approved by The Institute for Health and Clinical Excellence. The problem is, if it's not approved, the insurance company won't allow you to be treated with it. Huge delays affect the introduction of new drugs into the NHS because The Institute for Health and Clinical Excellence must first ascertain if the benefits of the drug justify the financial costs of adding it to the NHS treatments. As a result, the drug you need may not be approved, and if so, it won't be covered.

Aware of this problem. the Financial Ombudsman issued a compromise which stipulates if the insurer won't cover ?experimental treatments', then it should cover the cost of the approved conventional treatment. The policyholder is then free to undergo the experimental treatment and pay the surplus if it's more expensive.

Pre-existing conditions

A ?pre-existing condition' describes a condition or illness that you suffered from before starting your health insurance policy. You will have to provide details of all these when you fill out your application form. That way the insurer is aware of what they can exclude from your policy. Be sure to be truthful in the application form as the insurer can easily contact your doctor to see your medical history, and they often do ? having requested your approval first. They will also sometimes ask people to undergo a medical examination.

What counts as a pre-existing condition is also a potentially sore subject. If you fell off your horse years ago and fractured an ankle, you may find in later life that it starts playing up again and you need an operation to fix the problem. The insurance company may reject a claim, saying that it's a condition that occurred before the policy began. If that happens, you either pay yourself, or go with the NHS.

Some insurance companies write a moratorium provision into their policies, which allows some respite from a potential long list of pre-existing conditions. For example, you may be covered as long as you have not suffered from the condition for two years, with the condition first taking place in the last five years. These time frames are individual to insurance companies, read the small print first to see if your policy includes a moratorium provision.

The condition or illness is excluded

Health insurance is renewable on a yearly basis and at renewal time, you may find that your policy, and your premiums, have changed ? often not for the better.

If you are undergoing treatment at time of renewal, it's possible that your condition or illness will have become ?excluded' in the renewed policy, and that you will have to cover the cost of the rest of the treatment.

Because medical research is advancing so quickly, and the number of conditions considered treatable is increasing, the goalposts are always shifting as to what is chronic and what is acute.

The insurance companies are usually trying to cover their own backs. More conditions are being classified as acute, so they have to pay out more in claims. At the same time, newly introduced treatments and drugs are often expensive, so that's more expense to the insurer. To cover their losses, the insurers increase the premiums, and introduce some more exclusions. You have to watch out for this as you may renew your policy without realising that some very important details have changed.

So if have Health Insurance, or you are considering signing up to a policy, take this article into account and read the small print so you know exactly what is and isn't covered. And the golden rule: before getting treatment, always double check with your insurer first that it is covered.

Safeguard is a uk critical illness insurance website. We provide a huge amount of information based around our products, to read more visit the critical illness information

Help! I Lost My Health Insurance!

It can literally be one of the scariest places to find yourself - without health insurance coverage. When a simple trip to the emergency room can lead to thousands of dollars in charges, the last thing you need is to not have health insurance. But what options do you have? Graduating from college can be a true rite of passage into adulthood, because this is the time when most health insurance plans drop you from your parents' plan. Even landing a job right after graduation can still mean that you will have to go through a grace period before the company's health insurance kicks in. And if you have left a job for greener pastures, well...don't get sick or injured!

But do I even have options?

Well you probably do have options for health insurance coverage, but they may not be ideal. If you have quit your job, then you will have the option of extending your health insurance benefits for up to 18 months - thanks to COBRA. The only catch is that you will have to pay for those benefits out of your own pocket. Not exactly an easy thing to do without that paycheck rolling in every week.

Is that it? Is that my only hope?

Before you panic, just relax. The solution is short-term health insurance. As the name implies, this solution offers you health insurance options for a limited period of time. Most short-term health insurance benefits are available for 30 to 180 days. Depending on where you live, you may be able to obtain these benefits for up to a year.

And short term health insurance is the same as what I had at work?

Well, if you mean that you have coverage in the event of a hospital visit or sudden illness, then yes. You also can pick your own doctors and hospitals, which is actually an advantage over some health insurance plans offered by employers. But there are definitely coverage limitations on short-term health insurance plans.

So what am I not covered for?

That really is the million dollar question, isn't it? Well, routine medical exams are not covered by a short term health insurance policy. Any kind of preventative care is also out the window with this type of coverage. Plus, you can forget about dental and optical coverage with short-term health insurance. For obvious reasons, this sort of health insurance also does not cover medical costs relating to a pregnancy nor, anything having to do with the childbirth itself.

No offense, by why should I bother with short term health insurance?

Because a simple trip to the emergency room can cost thousands of dollars, and any emergency procedure and hospital stay can cost tens of thousands of dollars. Hey, short- term health insurance is not supposed to be the long-term solution. It is just a way to make sure you are covered while you are not on any employer's health insurance plan. And it can help you avoid going into serious debt, should something happen to you when you are not otherwise covered on a health insurance plan. For that reason alone, it is definitely worth the expense.

Albert Medinas has developed and maintains the website Health Insurance Resources, which answers the most common questions people have about Health Insurance. Please visit us at http://www.healthinsuranceresources.ws today.

Online Health Insurance: The Truth About Cheap Quotes

Looking for low cost health insurance quotes? Good. You are taking that most important step of shopping around for the best price. But more importantly, you undstand that it is important to have health insurance, and perhaps, even more importantly, understand that the real purpose of health insurance, as for any insurance, is protection. That is, you do not get health insurance to act as a sort of discount off the price of doctor and hospital services. The point of insurance is protection in the event of catastrophe. Yes, health insurance costs are high and continue to rise, but do not forget that the reason you are seeking health insurance quotes online--and even offline--is to insure you get the most protection (not discount) for the best (lowest) rate.

Getting health insurance quotes is now extremely easy with the use of the Internet. Take advantage of online insurance quote availability to get an idea of the range of premium prices offered. Even if you don't want to buy online, you will have a better understanding of what the insurance agent is talking about, and when it comes time to put ink on the contract, you will be making a more informed decision. Remember, too, that quotes are free and come without obligation.

When you look for cheap health insurance quotes, online or off, you must also consider type of health care you want and what that means in terms of how your care is delivered to you. Health insurance is a much more than a matter of co-payments, co-insurance, and deductibles. When you get a health insurance quote, you are getting a quote on a certain kind of plan. Unfortunately, there is no such thing as a single "best" plan. You will find that there are some plans that will serve your needs better as an individual, and plans that will be better for both you and your family's needs. Plans will vary according to what services they offer, and you will probably have to make some hard choices as to what services are most important. No plan will pay everything; there will always be out-of-pocket costs associated with your medical services, though some plans will pay more for the services you deem most important. So, health insurance quotes are really the tip of the iceberg to a very important subject.

Cheap Health Insurance Quotes and the HMO, PPO, FFS/indemnity plan, and POS.

*HMO--An HMO is a health maintenance organization. An HMO contracts with doctors, hospitals, and other medical providers to form a sort of network. As a member of an HMO, you are required to use the providers in that network. You pay the HMO a certain amount of money per their payment arrangements in order to receive medical services.

*PPO--A PPO is a preferred provider organization. A PPO is similar to an HMO in that there is a network of medical providers that you can use. However, the PPO does not require you to use that network and allows you see doctors and go to hospitals out of network. Normally, you do not need a referral to see doctors out of network. However, in that event, you do pay more for the service. That is, the amount of coverage is less.

*POS--A POS is a point of service plan. A point of service plan is very much like an HMO except that POS doctors can refer you out of the network of providers to see a specialist. In a POS, you would not refer yourself, and if the plan does refer you out of the network, you do pay more for the service.

*FFS--A FFS or indemnity plan, is a fee for service plan. In a fee for service, you are billed by the service. You are usually not required to use a network of providers. That means you choose which doctors, hospitals, and specialists you want to see and use. Because you make the decision about who you see and where you go, there is no need for a referral to see a doctor. The only limiting factor is whether or not the provider accepts the insurance of the fee for service plan insurance.

Low Cost health insurance quotes have a lot going on behind the scenes. Seeking an online quote? Now you have a better idea of what that quote is for. When you visit an insurance agent to talk health care, be sure to look thoroughly into the options available to you. Your health insurance quote represents a package of insurance services, and it is important for you to understand the relationship between the quote and the services you may be purchasing.

Evan Davis works in Medicare customer service, and is the webmaster and owner of Instant Health Insurance. Find cheap health insurance quotes online at http://www.find-health-insurance-online.com

What to Know When Shopping for Health Insurance

What to Know When Shopping for Health Insurance

Between the rising cost of health insurance and the various types of health policies, finding a plan to fit your health needs and your budget can seem overwhelming. So how can you sort though these variables and find a policy that works for you?

Doing Your Homework

Doing a little research before you start shopping for health insurance will go a long way once you start comparing quotes and policies.

You can start by reading up on the types of policies available in your area and determining what you want and need out of your health insurance--from prescription drugs to coverage of pre-existing conditions, you'll want to identify these necessities from the outset.

To learn more about health insurance in your area, contact your state's Division of Insurance (DOI). This underutilized resource was developed to educate and protect consumers on the topic of insurance and has many guides and publications to help you make informed decisions about health insurance. And the more you know, the better decisions you'll make!

Shopping Tips

Under most state laws, health insurance policies are not regulated by the government. This means that insurers can sell different health insurance policies for very different prices. While that may seem complicated for the consumer, it's actually a benefit. This means that you can get health insurance quotes from multiple insurers and select the best health insurance policy for you.

So what exactly should you be looking at when comparing policies? Here are a few important questions to ask:

Does the policy cover all major medical expenses?
What's the monthly premium?
What are the choices for deductibles?
What percentage does the insurer pay after the deductible is met?
What coverages are included in the policy?
Does the policy cover prescription drugs?
Does the policy cover preventative care?
Are your doctors and health care facilities inside of the policy's network?
What is the cost for seeing a physician outside of the policy's network?

While you will certainly think of more questions to ask potential insurers, this list should get you started. Remember, the more you know, the better decisions you'll make!

Protecting Yourself

As with most areas of business, there are a few untrustworthy insurers out there who ruin things for the good guys. That's why it's a good idea to investigate your insurer and his or her credentials before signing a health insurance policy.

You can check your agent's credentials, as well as the company's customer satisfaction rating and financial standing through consumer-serving sites like AM Best or the Better Business Bureau. Doing a little behind the scenes work on your insurer beforehand will save you the stress and financial loss of doing business with a dodgy insurer.

You can also protect yourself by knowing your rights and privileges before signing on the dotted line. Most states now require insurers to cover certain benefits, such as mammograms and prostate exams; your local DOI will have more information on mandated benefits and other rights and privileges.

Most insurers will also offer a free-look period of 10 or so days to review your policy and make any final adjustments or decisions. If you decide you don't want the policy during that free-look period, you are entitled to a full refund and your policy will be cancelled without penalty. As a general rule, if your health policy doesn't contain a free-look period, you're probably better off purchasing health insurance from someone else.

Applying Lessons Learned

Now that you've gotten a few pointers on shopping for health insurance, you can get started and determine your needs, get the facts, shop for health insurance quotes and compare prospective insurers for price and service. Taking things one step at a time will make the task of finding cheap health insurance less daunting--and get you on the road to savings success!

About InsureMe

InsureMe, an Englewood, Colorado-based company, links agents nationwide with consumers shopping for insurance. Specializing in auto, home, life, long-term care and health insurance quotes, the InsureMe network provides thousands of agents with insurance leads every year. For more information, visit InsureMe.com.

Megan L. Mahan is a copywriter and insurance expert based in Denver, Colorado. She holds degrees in French and English from the University of Iowa and lends her writing and editing expertise in print media and Internet communications through her informative articles.

Affordable Health Insurance...

Finding affordable health insurance is possible, there are many companies that will help you to find health insurance that will meet your requirements and stay within your budget. The fact is that many people simply do not know where to look for health insurance. Connecting with a company that is capable of hunting down health insurance providers can take the hassle out of buying health insurance. For individuals who do not want to use a company to locate affordable health insurance there is the Internet.

Thousands of people in the United States simply go without health insurance because they think they cannot find affordable health insurance. This would explain why there are many individuals in the United States who choose to go without health insurance. Those who do not have health insurance will be less likely to visit a doctor. This means that a lot of times illness and other ailments are not diagnosed until they have developed.

There are numerous different things that will determine what your monthly health insurance will be. Your health insurance rates will change depending upon the kind of policy you have. For example, do you only need health insurance for yourself, or your entire family? The answer will have an impact on any quotes you receive. Are you young, or are you in your senior years? Most health insurance companies adjust your premium based upon your age. Are you self-employed, or are you receiving health insurance through your work? This will also affect the cost of your health insurance.

You never know when an accident might happen and you need a trip to hospital for stitches or a broken bone. These bills will add up quickly but if you have health insurance, you can get the help you need without the worry of receiving a huge bill. If you can't afford to pay off your medical bills, your credit rating could even suffer. If you have health insurance, you can prevent these problems from ever happening and your credit will be protected for your financial future and your health.

Another way you can make sure that your insurance rates are lowered is to increase the amount of your health insurance deductible. High deductibles equal lower monthly premiums. Anyone that has existing health problems which require extensive medical treatment may find it necessary to have a higher monthly premium.

Simply by researching health insurance options online and spending just a couple of hours searching may well save you money every month. Get a variety of quotes from insurance companies which meet your health and budget needs and you will find affordable health insurance. You may also find that purchasing health insurance online can save you money.

For family health insurance Please visit us at http://www.4insurancehere.com

Health Insurance Companies - The Good and The Bad

When you are shopping for health insurance it would be helpful to know how often health insurance companies fail to provide the service you would expect. The Arizona Department of Insurance has released a report listing fines and complaints filed against health insurance companies in the state.

The report covers 27 insurers or about 75% of the companies serving Arizona. Does the report reflect health insurance performance in other states? I can't be sure, but it does give us a peek into the workings of the health insurance industry.

United Healthcare of Arizona is one of the major insurers in the state and it had the highest number of complaints per insurance policy. Time Insurance and Mega Life And Health Insurance are smaller companies and they had even high complaint ratios.

In Arizona Humana Health Plan satisfies the appeals of its insured more than any other company. On the other hand the report shows that Mega resolves fewer appeals to the satisfaction of the insured.

When it comes to the number of fines levied in the past 5-years by the AZ Department of Insurance the Arizona arm of CGNA Healthcare garbs the top spot. They were assessed the most fines.

If you would like to read more about the performance of health insurance companies you can find the full report online if you do a search for "Report on AZ Health Insurers". Chances are the insurance department or commission in your state issues a similar report.

Another fact we can learn from this Arizona report is that your state's insurance regulatory body may be able to help you in a dispute with your insurance company. You can find state insurance regulators on the internet by doing a search for National Association of Insurance Commissioners. The NAIC has a map of the United States on their web page. Just click on your state and you'll find your state's insurance department information.

Before you buy any policy it would be sensible to learn just which health insurance companies fail to please consumers in your state.

Mark Walters helps individuals, families and travelers choose health insurance coverage at http://www.HealthInsuranceMonster.com

Health Insurance ? It's Important To Know What's Not Insured!

Around 7 million people in the UK are covered by health insurance, the majority being covered through their employers. The problem is that few have really studied their policy documents and many misunderstand what is covered. And perhaps just as important, what isn't. If you expect health insurance to pay all your health costs, you're mistaken.

Health insurance is designed to provide protection for curable, short-term health problems and allow policyholders to jump the NHS queues to see consultants, be diagnosed, receive surgery or be treated. That sounds fine, but before you buy you need to appreciate the treatments and situations that fall outside the scope of the cover.

But first a word of warning. This article does not relate to any specific policy and the terms and conditions issued by individual insurers do vary. So please ensure you also check your policy documents. After reading this article, you'll know what to look out for!

Sorry ? it's a chronic condition

If a condition can be cured and is not a long-term problem, your insurance company will classify it as acute and should meet the cost. If your problem is incurable or it's a problem that, despite appropriate treatment, will be with you for a long time, then your insurance company will classify it as chronic - and no, you won't be covered.

But drawing a firm line between what is acute and what is chronic is fraught with problems, and leads to the biggest area of conflict between insurer and policyholder.

Everyone agrees that diabetes and asthma are chronic conditions as you're likely to suffer from them for the rest of your life. So those sorts of condition are not covered.

Problems arise when the medical team initially considers a patients' illness to be curable, but the condition subsequently deteriorates and the doctors change their mind, it's now become incurable. This can happen especially in the treatment of some types of cancer.

In these circumstances, the condition is initially defined as acute and is therefore insured, but deteriorates and becomes chronic - and outside the terms of cover. This is possible as insurers retain the right to reclassify a condition from acute to chronic during treatment.

Sorry - it's too long term
The insurance company will not pay out for long term treatment. But you need to check your policy documents to see how they define ?long-term?. You can find the situation where a course of drugs extends for say 12 months, but the insurer will only pay for ten months.

Sorry ? it's preventative
Your insurance is designed to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are used to prevent an illness.

Again, the problem of definition arises. Sometimes it is arguable whether a treatment is preventative or a cure. Take the drug Herceptin for example. This drug can be used in the early stages of breast cancer. Research shows that Herceptin can halve the incidence of cancer returning for women who have a particularly virulent form of the cancer known as HER2. In this situation, is Herceptin offering a cure or is it a preventative?

Insurance companies are split on the debate. Norwich Union, WPA, BUPA and Standard Life Healthcare will pay for Herceptin for HER2 patients whereas Legal and General and Axa PPP will not.

Sorry ? the drug is not approved
Two of the main attractions for taking out health insurance are: to jump the queues at the NHS, and to get the latest treatments and drugs. But there's a rider.

Unless the drug has been approved for use by the NHS in England and Wales, by the Institute for Health and Clinical Excellence, your insurer is unlikely to approve its use. The problem is that the Institute's brief is not simply to decide whether a drug works, but to carry out a cost/benefit analysis to ensure that the benefits to the nation outweigh the financial costs of using it in the NHS. Not an easy brief - and one that has placed the Institute under scrutiny for the extended delays in drug approval.

The compromise hit on by the Financial Ombudsman is that if a health policy won't pay for the use of experimental treatments, then it should meet the cost of an approved conventional treatment with the policyholder footing the bill for the balance if the experimental treatment is more expensive.

Sorry ? it's a pre-existing condition

The basic principle is that if you are already suffering from a condition when you start a policy, then that condition ?pre-exists? the policy and any claims for its treatment are invalid.

For this reason, insurance companies insist you complete an exhaustive questionnaire before they agree to insure you. After all they need a clear picture of your medical condition before they quote. For many applications, the insurer will, with your approval, also write to your GP for specific details of your medical history. They like to have a complete picture.

So lets say some years ago you injured your knee playing football. It appeared to recover but now it turns out that you have a torn cartilage and need an operation. The insurer could argue that this is a pre-existing condition and you have to pay for its' treatment.

Some insurers try to accommodate these grey areas with a moratorium provision within your policy. These provisions typically say that so long as you have been symptom free for two years relating to any condition you've suffered from within the last 5 years, then they will pay for subsequent treatment. Not all policies have these moratorium provisions and the time periods do vary between insurers. You should carefully read your policy.

Sorry ? its not covered

Health Insurance is an annual contract ? just like your car insurance. So when it comes to renewal, your insurer is at liberty to review not only your premium but also change the conditions on which your cover is provided.

Therefore, if your policy comes up for renewal mid way through a course of treatment, it's possible to find that your new policy no longer covers that particular treatment. This means that you will have to foot the bill for the balance of the treatment.

Furthermore, with ongoing advances in medical research, more and more conditions are becoming treatable. This progress has the effect of shifting back the dividing line between chronic and acute conditions.

This hits the insurers' pocket in two ways. With more conditions being reclassified as acute, the number of claims is increasing. And there's also a trend for new treatments to cost more ? Herceptin being a good example. The net result is that the insurers are finding themselves having to pay out far more. This is inevitably passed back to you through increased renewal premiums. And in an attempt to reduce their risk exposure, insurers have a tendency to adjust their definitions and exclusions. This means that you must read your renewal notice closely before you decide to renew.

So when you are considering Health Insurance, be aware that everything is not always black and white. And if you've got insurance and need treatment, always contact your insurer without delay and get them to confirm that your treatment is indeed covered

Understanding Health Insurance

Health insurance is a necessity for everyone who wishes to maintain or improve their health. Whether you use your health insurance for regular checkups, chronic and debilitating illnesses or unexpected emergencies, you will find that carrying an insurance policy can result in a significant cost savings for you and your family. Those who carry health insurance often have a difficult time understanding what is covered under their policy and where they can go to obtain the services that they require. Without this necessary information, it is likely that many health insurance holders do not receive the maximum benefit that their insurance provides.

We all need health insurance to receive financial assistance for the maintenance and restoration of our health but we don't all receive all of the assistance that we are eligible to receive. Most of us are aware that our health insurance will cover at least a percentage of certain treatments such as office visits, hospital stays and surgeries and prescription drugs that fall under their list of covered drugs but many of us don't know what is offered beyond these basic services. Not all health insurance plans cover the same treatments so the only way to fully understand what is covered in your plan is to read your policy carefully. Some examples of inclusions that are not well known include speech classes, hearing aids, gym memberships and a variety of other features. The only way to know for sure if these items are covered is to review your policy carefully or contact your health insurance provider. You may find a variety of services or treatments that are covered under your plan that could amount to a significant financial savings.

Knowing what is covered under your health insurance plan is very important but it is equally important to understand what is not covered under your insurance plan. You should review your plan carefully to ensure that the services that you choose will be covered by your health insurance plan. Sometimes treatments that are deemed medically necessary by your doctor will not be covered by your health insurance plan. In this case it may be necessary to bear the burden of this expense in order to maintain or restore your health. If your claim is denied because your provider does not consider the treatment necessary, then you have the right to file an appeal. You should carefully review the provider's policy to ensure that you fully understand the appeal process before filing your appeal. Your claim may still be denied even if you follow proper procedure but the possibility that you will lose your appeal as a result of improper filing is greatly reduced. You should review your insurance plan carefully before undergoing preventative treatment to determine whether or not the treatment will be covered. In an emergency you may not have the opportunity to review your policy before authorizing treatment but you will have the opportunity to appeal if the treatment is not covered.

Knowing which doctors you can visit can also be confusing. Some health insurance policies allow you to visit any doctor you choose while others limit you to the participating doctors in their plan. Also, whether or not you can see a specialist is often difficult to determine. Usually, the receptionist at the doctor's office will be able to tell you whether or not they accept your health insurance policy before you schedule your appointment. You can also call your customer service representative to inquire as to whether a specific doctor will be covered.

Health insurance can literally be a life saver but understanding your policy can be a nightmare. In most cases carefully reading your policy to determine the covered treatments as well as the exclusions and limitations may help you understand your policy better. If after reading through your policy you still have general or specific questions you should contact the customer service representative for your policy. They will be able to provide you with answers that will enhance your understanding of your policy. Knowing what is covered and what is not covered are the most common misunderstandings involving health insurance. It is also important understand your provider's appeal process in case you ever incur claims that are denied. In all cases your health may necessitate treatment that is not covered and you will have to make the difficult decision of whether or not to authorize the treatment.

Ray Shelton is the editor and writer for http://www.ww-health-insurance.com

Ray Shelton is editor and writer for http://www.ww-health-insurance.com

Travel Health Insurance: Know Your Coverage Before An Emergency Occurs

(NC)Buying travel health insurance is an important step for sufficient medical coverage while outside Canada, but it is only the first step. To make your policy work, say industry regulators, there has to be a co-operative relationship between the policyholder and the company.

Indeed, the range of medical treatment around the world is so broad and varied, home-based insurance companies will provide booklets outlining what they will, and will not cover. Therefore, an equally important step at the time of purchase is for the traveller to become as familiar as possible with the basic guidelines of the policy before an emergency occurs. Decisions on the reimbursement of expenses are not likely to be the first thing on your mind in an urgent situation.

So how do we ensure financial coverage during a medical emergency? Here are a few guidelines offered by the Financial Services Commission of Ontario (FSCO). FSCO is an agency of the Ministry of Finance that regulates Ontario's insurance industry.

Obtain authorization

As soon as possible, says FSCO, call the emergency service centre telephone number provided with your policy. The service centre's role is to manage your medical care and make the claim process fast and efficient. The centre provides claim administrators, on site doctors, nurses and other medical professionals to arrange care and monitor treatment. To ensure coverage, if possible, don't proceed with any medical treatment without full authorization.

You can assist the claims process more efficiently, if you:

Supply all the facts and information accurately.

Keep a log of the contacts at both the service centre and your insurance company, including the names of people assisting you, the date of the contact, and what was discussed.

Keep a detailed record of all medical transactions. Get receipts for the medical care including tests, treatments, and prescriptions. Receipts are a must when making a claim. Also, observe the time limits of your policy.

Complete the forms supplied and enclose all original bills signed by the attending physician, plus receipts and supporting claim documentation. Be sure to include your policy identification number, health card number and date of birth. Keep copies of all documentation submitted to the company.

More information on travel health insurance is available online at www.fsco.gov.on.ca. Or, for a copy of their booklet Shopping for Travel Health Insurance phone (416) 590-7298 (Toll Free: 1-800-668-0128).

- News Canada

News Canada provides a wide selection of current, ready-to-use copyright free news stories and ideas for Television, Print, Radio, and the Web.

News Canada is a niche service in public relations, offering access to print, radio, television, and now the Internet media, with ready-to-use, editorial "fill" items. Monitoring and analysis are two more of our primary services. The service supplies access to the national media for marketers in the private, the public, and the not-for-profit sectors. Your corporate and product news, consumer tips and information are packaged in a variety of ready-to-use formats and are made available to every Canadian media organization including weekly and daily newspapers, cable and commercial television stations, radio stations, as well as the Web sites Canadians visit most often. Visit News Canada and learn more about the NC services.

Individual Health Insurance Plans

When looking for individual health insurance plans it's important to remember that generally you'll find better rates if you deal directly with the insuring company. The internet now allows individuals the chance to plug in a few personal details and obtain individual health insurance plans quotes. Some questions to consider when choosing your coverage are the following:

1) Is it important that you keep your current Doctor?

2) Is it important that you have access to alternative care such acupuncture or massage therapy?

3) How high a deductible are you comfortable with?

Individual Health Insurance Plans tailored to your needs.

Most people looking for individual health insurance plans are seeking modest insurance coverage, but they also want some of the basic essentials such as regular Doctor visits and prescription coverage. Keep in mind that your premium costs will vary depending on how high your deductible is and what kind of coverage you have. Generally the higher the deductible, the lower your monthly premiums. When choosing your coverage try to match low prices with quality coverage.

Mike Yeager

http://www.a1-healthinsurance-4u.com/

mjy610@hotmail.com

HIPAA and Email - How Does Your Practice Deal with Compliance in a Digital Age

The internet has created a new business model for the smaller medical practice, specialty clinic and medical service (e.g. dermatologist, plastic surgeon, physical therapist, psychologist, et. al). More and more, patients are looking to communicate with their healthcare providers as they do in their personal and business lives - via email.

Email as a communication solution for the smaller clinic can be a time-saving resource. It can replace the many phone calls and postal mailings, adding a financial benefit to the smaller clinic.

Does email eliminate the office visit? No nothing can replace the personal face-to-face office visit, but email can be an additional tool clinicians can implement to streamline their practice.

Some healthcare practitioners do however feel that emailing their patients equates to working for free, but some clinics have already adopted charging for email consultations.

At some practices, patients pay a flat rate from $100 to several hundred dollars per year for this type of service. Harvard professor of medicine Dr. Daniel Z Sands, a proponent to a digital clinic, stated "I think it's reasonable to assume that if lawyers and accountants charge for time, then physicians should too. (1)"

Sustainability of Health Information Technology is also on the government's radar. As part of the President's mandate to move the medical field towards a digital clinical setting within the next ten years (2). The National Coordinator for Health IT, Dr. David Brailer, noted the value-added benefit of investing in Healthcare IT:

Information technology supports treatment choices for consumers and enables better and more cost-effective care... Health IT not only adds value to the way people lead their lives, but it gets more out of our investment in healthcare overall. (3)

It is possible for clinics to shift towards a digital medical office while remaining financially solid. Rights management software tools have become a reality for the small and medium business office (4). Small Business Rights Management (SBRM) reflects a shift Rights Management software tools.

SBRM solutions provide clinics and practices of a smaller scale an equal level of user rights management and encryption previously available to larger medical organizations (e.g. state hospitals, large research facilities, university medical networks, etc.).

With any medical advance, the side affects of a solution or cure, must also be considered. While email is beneficial time-wise and financially, there are also cons to using this tool - many HIPAA related. According to the Health Privacy Project's 2005 study, 70% of Americans are concerned that personal health information (PHI) could be disclosed as a result of weak data security (5)

Currently, healthcare organizations are required to provide a disclosure statement when communication is sent to their patients. A sample of a healthcare professional's email disclosure statement may read like this:

Client information gathered by [Clinic or Organization's Name] is protected by Federal Law. If this communication contains any client information, including information which would identify a client, you are prohibited from redisclosing it to any person or organization in any manner, and you are required to maintain it as confidential. Failure to do so is punishable by civil and criminal penalties. If such information has reached you in error, please contact [Clinic or Organization's Name] contact@emailaddress.com

With the advent of phishing, malware, and spyware, the unintended recipient could possibly spread a patients PHI like a virus; using or selling data to any number of damaging sites.

Protecting a patient's PHI is an ingrained concept within the medical profession. Laws and government mandates are take this notion a step further, medical facilities not compliant to protecting their patient's PHI face stiff penalties under HIPAA. PHI includes and is not limited to:

* Patient's address, phone number
* Treating Hospital/Clinic number assigned the patient
* Patient's date of birth/ SSN
* Patients legal next of kin/guardian and their telephone number
* Patient's insurance information (pre-certification/ DSHS/ Medicare)
* Anticipated Admission date and time<

While there are some drawbacks to email, patients want the option of emailing their doctor, pharmacist, therapist or clinic. "People are often more comfortable talking to a computer than they are to a doctor," said Dr. Delbanco, a professor of medicine at the Harvard Medical School and the lead author of an article on doctors and e-mail in the New England Journal of Medicine (6).

Dealing with HIPAA compliance issues can often be frustrating to the small clinical practice. SBRM solutions bridge the gap between staying current with healthcare industry regulations and keeping a small physician practice open. Patient/client information, private communiqu? regarding diagnosis/treatment, and medical billing can stay discreet, only the intended recipient will see this information.

With SBRM solutions; clinics don't have to worry that their email content breaks the Hippocratic Oath's creed of confidentiality by revealing patient's PHI. Healthcare providers can remain both respectful and compliant under HIPAA regarding the patient privacy.

- - - - - - - - - -

End Notes:

1.) Dr. Daniel Z. Sands as quoted in Liz Kowalczyk's article "Is E-Mailing the Future of Doctor-Patient Relations?" The Boston Globe, D2, April 27, 2004, Lexis Nexus - http://www.lexisnexus.com

2.) United States Department of Health and Human Services, "Secretary Leavitt Takes New Steps to Advance Health IT," Press Release on HHS website, June 6, 2005, http://www.os.dhhs.gov/

3.) "Remarks by David Brailer, MD PhD National Coordinator for Health Information Technology HIMSS 2005" February 17, 2005, http://www.himss.org

4.) SBRM on Wikipedia - http://en.wikipedia.org/wiki/Small_Business_Rights_Management

5.) "Majority of Americans Have Privacy Concerns about Electronic Medical Record System," Health Privacy Project (www.heathprivacy.org): http://www.healthprivacy.org/info-url_nocat2303/info-url_nocat_show.htm?doc_id=263085

6.) Anahad O'Connor, "Take Two Aspirin, E-Mail Me Tomorrow," The New York Times, Section F; Column 5; Health & Fitness; 7., 30 September 2005, Lexis Nexis - http://www.lexisnexus.comMs. Veniegas is an alumni of the University of Washington Marilee joined the Marketing team at Essential Security Software, Inc. in 2005. She also serves as one of the ESS site editors for "I Want My ESS!

Are you HIPAA Compliant?Matt Sears

By - Matt Sears, Senior Vice President
Athens Benefits Insurance Services, Inc.
A division of The Jenkins Athens Group

HIPAA. Perhaps one of the most significant laws in recent memory; certainly one of the most complex. While this short article won't make anyone an expert, it will, hopefully, demystify this wide ranging set of laws and put you on the path towards compliance.

First, let's answer the question; "What is HIPAA?" HIPAA stands for the Health Insurance Portability and Protection Act of 1996. Although it purports to regulate health insurance, HIPAA provisions extend far beyond insurance. HIPAA introduced broad disclosure and privacy requirements. It also established civil and criminal penalties for each violation (up to $25,000 per person per year in civil penalties and up to $250,000 in criminal fines - along with imprisonment).

Title I of HIPAA deals with portability and special enrollment rights for health plans. Those conditions must have been incorporated into your plans by now (original compliance date was 1997). Title II of HIPAA governs a wide ranging set of conditions called, "Administrative Simplification". For those charged with compliance, the notion that HIPAA simplifies anything qualifies as "dark humor". Administrative simplification attempts to create a uniform system for processing and retention of health information and ensuring the security of that information.

For the purposes of this article, we're only concerned with those portions of the law impacting most employers...privacy. Notably the privacy of personal data defined by HIPAA as "Protected Health Information" or "PHI" - information that is personally identifiable. In the broadest summary possible, key components of HIPAA privacy requirements for a plan sponsor are fairly straightforward:

Generally, the employer (Plan Sponsor) is not a HIPAA "Covered Entity" - the Health Plan is. For fully insured plans, this typically means the health insurer, HMO, EAP provider, etc.
As the Covered Entities, health plans bear the brunt of compliance requirements (your responsibilities become exponentially larger as the quantity of data you receive increases)
Meet with every service provider, or ensure that your broker or consultant has reviewed compliance requirements with each
Use protected health information only for needed administration of the benefit programs (HIPAAspeak: "Treatment, Payment and Health Care Operations)
Collect (and release) only the minimum data required to "do the job" (e.g. enroll an employee, file claims, etc.)
Restrict the data to those persons who absolutely must use it
Establish "firewalls" and safeguards to protect the data (separate locked files, restricted access, password protect systems)
Appoint a Privacy Official (not required for fully insured plans that never receive PHI)
Create a Privacy Policy and distribute a Privacy Notice to participants
"Scrub" personally identifiable data from communications pieces, ID Cards, etc.

HIPAA, like COBRA before it, will continually change as new rules and regulations are released (for example, the U.S. Dept. of HHS has yet to release enforcement rules for HIPAA). Ongoing compliance will require vigilance in remaining up to date on the changing laws. It's vital your broker/consultant proactively work with your organization to review plans, identify problems and provide ongoing education to maximize the performance of your benefit plans.
By - Matt Sears, Senior Vice President
Athens Benefits Insurance Services, Inc.
A division of The Jenkins Athens Group

HIPAA. Perhaps one of the most significant laws in recent memory; certainly one of the most complex. While this short article won't make anyone an expert, it will, hopefully, demystify this wide ranging set of laws and put you on the path towards compliance.

First, let's answer the question; "What is HIPAA?" HIPAA stands for the Health Insurance Portability and Protection Act of 1996. Although it purports to regulate health insurance, HIPAA provisions extend far beyond insurance. HIPAA introduced broad disclosure and privacy requirements. It also established civil and criminal penalties for each violation (up to $25,000 per person per year in civil penalties and up to $250,000 in criminal fines - along with imprisonment).

Title I of HIPAA deals with portability and special enrollment rights for health plans. Those conditions must have been incorporated into your plans by now (original compliance date was 1997). Title II of HIPAA governs a wide ranging set of conditions called, "Administrative Simplification". For those charged with compliance, the notion that HIPAA simplifies anything qualifies as "dark humor". Administrative simplification attempts to create a uniform system for processing and retention of health information and ensuring the security of that information.

For the purposes of this article, we're only concerned with those portions of the law impacting most employers...privacy. Notably the privacy of personal data defined by HIPAA as "Protected Health Information" or "PHI" - information that is personally identifiable. In the broadest summary possible, key components of HIPAA privacy requirements for a plan sponsor are fairly straightforward:

Generally, the employer (Plan Sponsor) is not a HIPAA "Covered Entity" - the Health Plan is. For fully insured plans, this typically means the health insurer, HMO, EAP provider, etc.
As the Covered Entities, health plans bear the brunt of compliance requirements (your responsibilities become exponentially larger as the quantity of data you receive increases)
Meet with every service provider, or ensure that your broker or consultant has reviewed compliance requirements with each
Use protected health information only for needed administration of the benefit programs (HIPAAspeak: "Treatment, Payment and Health Care Operations)
Collect (and release) only the minimum data required to "do the job" (e.g. enroll an employee, file claims, etc.)
Restrict the data to those persons who absolutely must use it
Establish "firewalls" and safeguards to protect the data (separate locked files, restricted access, password protect systems)
Appoint a Privacy Official (not required for fully insured plans that never receive PHI)
Create a Privacy Policy and distribute a Privacy Notice to participants
"Scrub" personally identifiable data from communications pieces, ID Cards, etc.

HIPAA, like COBRA before it, will continually change as new rules and regulations are released (for example, the U.S. Dept. of HHS has yet to release enforcement rules for HIPAA). Ongoing compliance will require vigilance in remaining up to date on the changing laws. It's vital your broker/consultant proactively work with your organization to review plans, identify problems and provide ongoing education to maximize the performance of your benefit plans. Setting-up Your New Computer: How To Move Your Old Files to Your New ComputerSteven PresarYou've got a new computer for your office. It's cleaner, better, faster and you can't wait to start to use it!

However, your satisfaction of making a fresh start with a new computer is tempered by the fact that all of your "stuff" is still on your old computer. Everything that made your old computer YOUR computer: your personal settings, your business files, your company spreadsheets are still loaded on your old computer.

You find yourself with a new computer that's not so great without a whole lot of the useful file information that is still stored on your old computer. How are you going to get all of that information onto your new computer?

The process is called "data migration" and it can be a tedious and time-consuming task for you and your business.

Here are some suggestions to make this data migration go a little easier for you.

CDs

One option is to copy ("burn") everything to recordable CDs.

Blank CDs are cheap, at about $1 apiece, and can hold more than 600 megabytes each. That much storage space should be enough for most small businessess to transfer old data files from one hard drive to a new.

Two drawbacks to the CD method of data transfer are that:

~ It may take a while to burn each CD and
~ That you may not have a recordable CD drive on your old PC.

Recordable CD units are standard on newer PCs but if older computers have a CD unit, it was insatlled as later add-on hardware feature. Thus, depending on the age of your older computer, it may not have a recordable CD drive installed at all. To install a recordable CD drive on your older computer now, may be more of a time-consuming effort when compared with other alternatives to moving your data files.

Portable Drives

Iomega has a pre-packaged solution designed to bridge the gap between old and new computers. They offer a software "moving kit" for individuals who have recently bought a new computer with Microsoft's Windows XP.

The software works with Iomega Zip, Jaz and Peerless drives. It allows individuals to "pack" the files they have on their old computer onto a portable high-capacity disks and then "unpack" the same files onto your new computer.

The transfer software uses Microsoft's "files & settings transfer wizard," a feature included in Windows XP.

After connecting a high-capacity drive to your old computer, you need to download the transfer tool, which primes a disk to prompt you to begin the transfer process the next time it is inserted into a drive. Setting up the disk also requires a CD with the Windows XP operating system.

Keep in mind, software moving kits, have the ability to move everything. Thus, if you are not aware of what files that you are transferring, you may be transferring unneeded problem or virus files to your new computer.

Link Transfers

There are other options if you do not want to shuffle CDs or portable drives.

With the link transfer software option your computers are linked through a serial cable or USB cable. After the software program has been installed on both of your computers (the "source" the old computer and "target" the new computer), you click through a question-and-answer wizard to describe what files you want to transfer. And for transfers on the fly, you can drag and drop folders or files between the two panes in the program representing each computer.

Some link transfer software packages that work with Microsoft's Windows are: PCsync, IntelliMover, PC Relocator, and PC Upgrade Commander.

In each case, the software must be installed on both your old and new computers. The software scans your old computer hard drive, to inventory the folders, subfolder, and files and then you select the data files that you would like to transfer to your new computer.

It sounds like a fairly simple way to handle your data transfer. However, be aware:

~ Generally, these programs want to move all the contents of your old computer to your new computer. That's OK for your data files but moving the program files that run your applications may cause problems because older applications may not be supported by your new computer operating system. Transferring a Windows 95-era program to a computer preloaded with the Windows XP operating system could be a problem because many of those programs haven't been upgraded to run under Windows XP.

~ When you move the full contents of a computer system, everything moves over, including those obscure files that had your old computer running sluggish in its final days.

~ Moving data through a USB cable isn't fast, but it is faster than data transfer through a parallel port.

Choosing a Data Migration Software Package

~ Does the software allow you to pick and choose which files are moved, or does it move EVERYTHING -- even the junk files?

~ How is the data transferred? A wireless network is faster than a USB cable, which is faster than a USB cable, which is faster than a parallel cable. Are you prepared to wait hours or even days for this transfer to take place?

~ If you're using the Internet as a holding place for your data, check your connection and upload speeds. It could take hours to move those files.

~ Consider investing in a high-capacity external hard drive, a plug-and-play device that you'll simply connect to your new computer. The drive, though more expensive, will get far more use than one-time migration software.

Getting Ready for Your Data Migration

~ Get rid of all of your old files. Fill your recycle bin on your old computer with as much as you can. There's nothing worse than bringing useless data to the new computer.

~ Make a software checklist. Is your versions of current program applications compatible with Windows XP? Look on the Web for free Windows XP upgrades to new versions of the programs you need, such as your Palm desktop software.

~ Does your new computer have preloaded software on it? Chances are good the latest Internet browser is already pre-load on your new computer and thus you do not have to transfer the older browser version.

~ Make a list of user names and passwords that are stored in files on your old computer and automatically appear when you visit Web sites. They could be lost in the move, denying you access on your new computer.

Steven Presar is a recognized small business technology coach, Internet publisher, author, speaker, and trainer. He provides personal, home, and computer security solutions at www.ProtectionConnect.com. He provides business software reviews at www.OnlineSoftwareGuide.com. In addition, he publishes articles for starting and running a small business at www.Agora-Business-Center.com. Be sure to sign-up for the SOHO newsletter at the site.

 

7 Steps To NPI For HIPAA-Compliant Electronic Medical Billing Software And Service

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 wo

   rk 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 Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

HIPAA in a "Nutshell" - Guidelines for EMR and Paper Medical Records Compliance

 

HIPAA in a “nutshell”

There are two HIPAA rules requirements; privacy (2003) and security (2005). Both rules require:

-Identifying possible threats,
-Assessing specific vulnerabilities,
-Determining appropriate and reasonable safeguards and
-Implementing the necessary defense mechanisms and policies.

Using an EMR (electronic medical record) has no absolute right and wrongs in either computer equipment or software for HIPAA compliance. Usually there are four areas to examine:

-Physical Security – can your computers with patient data be stolen?
-User Security - can anybody log on to the patient database?
-System Security – what happens on a hard drive crash?
-Network Security – can unauthorized persons outside your facility access patient data?

Using paper medical records begs similar questions:

-Physical Security – how secure are the files from fire and theft?
-User Security - what access controls and logging is there?
-System Security – what happens in a fire or flood?
-Storage Access – are the files in a locked, secure area?

There are HIPAA penalties

The civil monetary penalty is up to $100 per person record per violation and up to $25,000 per year total for the same type of violation. There is 30 days to correct the problem if it is not through willful neglect.

The criminal penalties are for “misuse” and for obtaining or using health information by “false pretenses” or with the intent to sell, transfer or use it for commercial advantage, personal gain or malicious harm. These penalties are up to $250,000 and five years in jail.

Currently there is no real effective enforcement body.

HIPAA compliance "thumb rules"

With an EMR most of the requirements are common sense and providers do not need to be overly concerned but do require some basic steps like:

-Put your computer server in a secure room, locked,
-Use an EMR with user management and permissions,
-Make regular back-ups and store them in a secure place and
-Employ a computer specialist.

Most medical practices and clinics using paper records need to make physical changes to be HIPPA compliant. If you continue to use paper then there are a myriad of physical complexities to consider:

-How to monitor staff access,
-Fire and flood protection (insurance is not enough)
-A disaster plan (that has been documented and practiced.)

Finally, if there is a legal case brought forward a provider to protect themselves should have a trail of how the patient's individual information was accessed. For paper records this means at a minimum a monitored sign out sheet and for an EMR user logging of patient file access.

Michael Milne is the CEO of BrunMed, Inc. (http://www.brunmed.com), the developer of Medscribbler, the first handwriting embedded EMR for the Tablet PC. Visit http://www.medscribbler.com for more information on a handwriting enabled EMR.