HIPAA Law



             


Monday, March 17, 2008

Student Health Insurance

Students often wonder if they really need health insurance. It seems like a reasonable question when you are young and healthy and seemingly invincible. After all, almost everyone who knows how to access the health care system is provided with basic health care services and acute care (like emergency care) in the United States, regardless of whether or not they have health insurance. Young adults tend to use health care services less often than any other group. The odds are that a young adult will go more than 12 months without any need for health care. Even among those who need health care, the likelihood of exceeding $1000 annual healthcare expenses is very small. So it is reasonable to wonder whether a young adult really needs health insurance at all.

But the situation changes when we consider the more extensive and more costly types of health care. The ability of a patient to obtain top quality medical care for the most serious types of health care - things like transplants, extended hospital care, physical rehabilitation, and long term outpatient care - depend more on whether the patient has adequate health insurance than any other factor. A simple attack of appendicitis could easily wind up costing more than $25,000. Even an affluent family will have difficulty arranging adequate medical care without insurance coverage. Unfortunately, if you wait until you need this type of care it will be difficult or impossible to buy health insurance that covers these items.

Often the most immediate insurance concern for young people is the fact that most colleges, trade schools, internship programs, sports teams, community-sponsored travel opportunities and many other activities require health insurance as an admission requirement. Without health insurance, you do not pass "go". So there is usually no question about it - most young people with ambitions to advance their education need to have some type of health insurance.

Coverage Options
There are many types of health insurance plans available to young adults. The most popular plans are listed below.
Parent's Policy - Most students continue to be covered under a parent's policy. If this option is available, it is almost always the best option. But most health plans require that proof of full-time enrollment be provided. Be aware of the maximum age for this benefit. In many cases this coverage will expire when the student reaches age 23 (or at another age as stated in the insurance policy).

Employer Group Coverage - Most employers provide health insurance to their full time employees and pay for most of the cost of this employee benefit. This is called group health coverage. This benefit is completely under the control of the employer. Many people do not realize that there is no requirement for an employer to provide this benefit. Most group health plans require that new employees wait a few months before becoming eligible for coverage.

School-Sponsored Coverage These are usually uninsured managed care arrangements to provide care to students in the local area of the college or university.

Student Medical Policies These are privately insured major medical policies designed specifically for students. These are portable and offer coverage to the student in any location in the U.S. These plans also cover graduate students, and are available regardless of age or health. In most parts of the U.S., students can buy a high quality health insurance plan for less than $70 per month at www.medsave.com.

Short Term Medical Policies - Interim or gap insurance policies are available to cover from one to 12 months. This coverage is inexpensive and easy to obtain online in most states. The quality of the coverage is excellent except that it does not cover pre-existing conditions. These provide coverage in the U.S. only.

Individual Medical Policies - Permanent policies that you buy directly from an insurance company offer excellent coverage, strongest financial guarantees, and the most stability. These often provide worldwide coverage. But all this comes at a higher price and coverage is issued for a minimum of 12 months.

Travel Coverage / International Policies - Students planning overseas travel should purchase a separate medical insurance plan for the time that they are traveling, since most student health plans do not cover charges incurred outside of the U.S. These policies are specifically designed to pay for medical expenses and deal with the other international complications (language, currency and business issues) typically incurred while obtaining medical treatment overseas.

Terms to Know
Deductible or Co-payment - this is the portion of the bill that you pay before the insurance comes into play. These help reduce the cost of the insurance.
HMO - stands for "health maintenance organization". The HMO may pay to keep you healthy, rather than only cover problems hen things go wrong. HMOs tend to be popular among young healthy people, but criticized by people receiving more serious medical care. Private physicians tend to feel that they lose control over the quality of a pateint's care when an HMO is involved.
Indemnity plan - means that the policy reimburses you for any ordinary and necessary medical expenses. This is the least restrictive type of coverage but also the most expensive.
Managed Care - this means that the insurer has some authority to influence the type of health care you are provided. This cuts healthcare costs but may also limit your treatment.
Pre-existing condition - a medical situation that started before your insurance policy that may not be covered by the health insurance policy.
Premium - the cost of the policy, usually ranging from $25 to over $200 monthly.
Tax-deductible - reduces your taxable income and thereby reduces your total tax due at the end of the year. Most health insurance is not tax deductible by individuals.
Tax-free - the benefit provided by health insurance is usually tax-free. This means the value of the coverage received as well as any cash benefit paid as the result of a claim.
Underwritten - this means that not everyone will be accepted because acceptance is based on individual medical history. The insurance company reviews each application and selects the healthiest applicants for enrollment. Premium rates are lower for those accepted, but these plans offer no solution for people with pre-existing health conditions.

But the situation changes when we consider the more extensive and more costly types of health care. The ability of a patient to obtain top quality medical care for the most serious types of health care - things like transplants, extended hospital care, physical rehabilitation, and long term outpatient care - depend more on whether the patient has adequate health insurance than any other factor. A simple attack of appendicitis could easily wind up costing more than $25,000. Even an affluent family will have difficulty arranging adequate medical care without insurance coverage. Unfortunately, if you wait until you need this type of care it will be difficult or impossible to buy health insurance that covers these items.

Often the most immediate insurance concern for young people is the fact that most colleges, trade schools, internship programs, sports teams, community-sponsored travel opportunities and many other activities require health insurance as an admission requirement. Without health insurance, you do not pass "go". So there is usually no question about it - most young people with ambitions to advance their education need to have some type of health insurance.

Coverage Options
There are many types of health insurance plans available to young adults. The most popular plans are listed below.
Parent's Policy - Most students continue to be covered under a parent's policy. If this option is available, it is almost always the best option. But most health plans require that proof of full-time enrollment be provided. Be aware of the maximum age for this benefit. In many cases this coverage will expire when the student reaches age 23 (or at another age as stated in the insurance policy).

Employer Group Coverage - Most employers provide health insurance to their full time employees and pay for most of the cost of this employee benefit. This is called group health coverage. This benefit is completely under the control of the employer. Many people do not realize that there is no requirement for an employer to provide this benefit. Most group health plans require that new employees wait a few months before becoming eligible for coverage.

School-Sponsored Coverage These are usually uninsured managed care arrangements to provide care to students in the local area of the college or university.

Student Medical Policies These are privately insured major medical policies designed specifically for students. These are portable and offer coverage to the student in any location in the U.S. These plans also cover graduate students, and are available regardless of age or health. In most parts of the U.S., students can buy a high quality health insurance plan for less than $70 per month at www.medsave.com.

Short Term Medical Policies - Interim or gap insurance policies are available to cover from one to 12 months. This coverage is inexpensive and easy to obtain online in most states. The quality of the coverage is excellent except that it does not cover pre-existing conditions. These provide coverage in the U.S. only.

Individual Medical Policies - Permanent policies that you buy directly from an insurance company offer excellent coverage, strongest financial guarantees, and the most stability. These often provide worldwide coverage. But all this comes at a higher price and coverage is issued for a minimum of 12 months.

Travel Coverage / International Policies - Students planning overseas travel should purchase a separate medical insurance plan for the time that they are traveling, since most student health plans do not cover charges incurred outside of the U.S. These policies are specifically designed to pay for medical expenses and deal with the other international complications (language, currency and business issues) typically incurred while obtaining medical treatment overseas.

Terms to Know
Deductible or Co-payment - this is the portion of the bill that you pay before the insurance comes into play. These help reduce the cost of the insurance.
HMO - stands for "health maintenance organization". The HMO may pay to keep you healthy, rather than only cover problems hen things go wrong. HMOs tend to be popular among young healthy people, but criticized by people receiving more serious medical care. Private physicians tend to feel that they lose control over the quality of a pateint's care when an HMO is involved.
Indemnity plan - means that the policy reimburses you for any ordinary and necessary medical expenses. This is the least restrictive type of coverage but also the most expensive.
Managed Care - this means that the insurer has some authority to influence the type of health care you are provided. This cuts healthcare costs but may also limit your treatment.
Pre-existing condition - a medical situation that started before your insurance policy that may not be covered by the health insurance policy.
Premium - the cost of the policy, usually ranging from $25 to over $200 monthly.
Tax-deductible - reduces your taxable income and thereby reduces your total tax due at the end of the year. Most health insurance is not tax deductible by individuals.
Tax-free - the benefit provided by health insurance is usually tax-free. This means the value of the coverage received as well as any cash benefit paid as the result of a claim.
Underwritten - this means that not everyone will be accepted because acceptance is based on individual medical history. The insurance company reviews each application and selects the healthiest applicants for enrollment. Premium rates are lower for those accepted, but these plans offer no solution for people with pre-existing health conditions.


Tony Novak, MBA, MT is a writer and financial adviser in Narberth, PA focusing on tax and employee benefit issues. His businesses www.MedSave.com and Freedom Benefits Association provide online benefits enrollment for thousands of individuals and businesses nationwide

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Wednesday, February 13, 2008

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

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Wednesday, February 6, 2008

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

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Thursday, November 29, 2007

The Need for HIPAA Complaint Medical Billing Software

 

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes seven sets of rules that will affect your practice. The Department of Health and Human Services, or DHHS, issues these in the form of the ""Notice of Proposed Rule Making"" or NPRM. Every practice, regardless of size, must comply with HIPAA privacy, security and transactional regulations. Moreover, adherence to all subsequent regulations is also required. This covers most everything in your practice, including your medical billing software.

When you are shopping for medical billing software, ask how and for whom the system was designed, and whether the data will be safe and secure on backed-up, protected, HIPAA-compliant servers accessible only to authorized persons. Look for companies who provide free updates to ensure continued efficiency and HIPAA compliance. The new HIPAA standards require huge changes to how healthcare organizations deal with their patient information, including coding, security, patient record management, reimbursement and care management. HIPAA‘s provisions include stringent codes for the unvarying transfer of electronic data, including routine alterations and billing.

Clearly your approach to HIPAA medical billing software must include a serious investigation of software security. Most computer experts will agree that there is no such thing as absolute computer or software security, so working closely with your HIPAA software providers to help determine data deficiencies is a good idea. HIPAA Complaint Medical Billing Software can be easily expanded to meet future needs, and can be targeted directly to the size and complexity of your practice. Options for new HIPAA compliant software have never been better, as there is unlimited scalability, a wide range of customization choices, and a large selection of useful features that will prevent the patients' privacy from being compromised.

Innovations in the technology of medical billing software have created a new criterion for digital precision. Make certain that the HIPAA compliant medical software packager you chose includes all finalized aspects of HIPAA to guarantee full compliance with HIPAA standards as they relate to the electronic transfer of protected health information. The regulations themselves took effect in February 2003, and affect every medical practice in the United States. Effective April 2005, HIPAA mandates security measures to physically and electronically secure electronic protected health information (PHI) against unauthorized retrieval, reliably store the electronic data, and provide for emergency access to the data.

Since most medical billing software packages are now designed to be HIPAA compliant, it is just a matter of choosing the right software for your practice, and your medical billing software will run as smoothly and efficiently as ever.

Medical Billing Software Info provides comprehensive information about medical insurance billing software, HIPAA compliant medical billing software, easy and free medical billing software, and medical billing software prices and reviews. Medical Billing Software Info is the sister site of Medical Billing Web.

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