Cutting Health Insurance Costs

Surveys of self-employed individuals consistently show that one of their major concerns is the ability to buy affordable health insurance. One in 4 self-employed persons has no health insurance today even tough more than 70% of these people could afford to buy high quality health insurance if they had an effective buying strategy.

1. Have a budget and set realistic expectations. Realize that the purpose of insurance is to cover unexpected and otherwise unmanageable expenses. Most good plans cover "ordinary and necessary medical expenses" but not your health club membership. Look for coverage that provides protection but avoid being drawn in by the marketing sizzle. Do not buy health insurance with the primary intention of picking up the cost of your existing ordinary medical expenses like prescriptions, routine dental care and annual check-ups. Health plans exist for almost every budget. Remember that no one is excluded from receiving medical care for an acute condition because of the type of their health insurance plan, but rather medical treatment may be denied because they dont have any insurance coverage at all.

2. Realize that there are trade-offs in every health plan. The lowest priced high quality health insurance plans excluded coverage for pre-existing medical conditions and require periodic re-enrollment. It is often better to take the less expensive insurance any pay for small uncovered expenses yourself. But if you need to find full takeover coverage, then you cannot expect to be offered the insurers lowest rating.

3. Think short term. Most individual health insurance policies for self-employed persons actually stay in force less than a year. Buy the plan that offers you the best deal right now and do not worry about whether it will be available in a year. In 12 months, a whole new generation of health plans will be available. It would not be smart to keep the same plan for more than two years because new plans are evolving rapidly. A plan that you bought more than 2 years old would not likely represent the best value for you today.

4. Use student medical plans and foreign travel plans if you qualify. These plans offer better deals than traditional coverage.

5. Choose a higher deductible. By taking a $1000 deductible, you will save more than $1000 in premium payments over a year's time. This should be an easy decision from a mathematical viewpoint, but still many people buy policies with a low deductible. It makes no financial sense to pay an insurance company $1000 in premiums for medical care that you could buy for $600 cash.

6. Choose indemnity type coverage and avoid HMOs. This lets you and the doctor that you choose maintain control of your own medical care. This saves money in the long run by allowing the best course of treatment from the outset of any medical condition.

7. Use the Internet. Technology now allow for online pricing and enrollment with policies issued within 24 hours. Savings have resulted in lower premium prices. Some plans offer premiums as low as $25 per month for catastrophic coverage for young people.

8. Avoid the scams. Unfortunately, self-employed individuals are a prime target market of numerous health plan marketing scams. State insurance departments continuously shut down disreputable plans, but new ones sprout up just as quickly. Well-established and reputable health plans are obtained from well-established and reputable distributors. Good health plans do not use multi-level marketing schemes. All individuals handling your health plans enrollment should be licensed, bonded and insured. Beware of individuals who claim that they do not need an insurance license in your state or can not provide evidence of errors and omission coverage or a bond issued by an insurance company. Remember the old adage if it sounds too good to be true. This certainly applies when shopping for health insurance.

1. Have a budget and set realistic expectations. Realize that the purpose of insurance is to cover unexpected and otherwise unmanageable expenses. Most good plans cover "ordinary and necessary medical expenses" but not your health club membership. Look for coverage that provides protection but avoid being drawn in by the marketing sizzle. Do not buy health insurance with the primary intention of picking up the cost of your existing ordinary medical expenses like prescriptions, routine dental care and annual check-ups. Health plans exist for almost every budget. Remember that no one is excluded from receiving medical care for an acute condition because of the type of their health insurance plan, but rather medical treatment may be denied because they dont have any insurance coverage at all.

2. Realize that there are trade-offs in every health plan. The lowest priced high quality health insurance plans excluded coverage for pre-existing medical conditions and require periodic re-enrollment. It is often better to take the less expensive insurance any pay for small uncovered expenses yourself. But if you need to find full takeover coverage, then you cannot expect to be offered the insurers lowest rating.

3. Think short term. Most individual health insurance policies for self-employed persons actually stay in force less than a year. Buy the plan that offers you the best deal right now and do not worry about whether it will be available in a year. In 12 months, a whole new generation of health plans will be available. It would not be smart to keep the same plan for more than two years because new plans are evolving rapidly. A plan that you bought more than 2 years old would not likely represent the best value for you today.

4. Use student medical plans and foreign travel plans if you qualify. These plans offer better deals than traditional coverage.

5. Choose a higher deductible. By taking a $1000 deductible, you will save more than $1000 in premium payments over a year's time. This should be an easy decision from a mathematical viewpoint, but still many people buy policies with a low deductible. It makes no financial sense to pay an insurance company $1000 in premiums for medical care that you could buy for $600 cash.

6. Choose indemnity type coverage and avoid HMOs. This lets you and the doctor that you choose maintain control of your own medical care. This saves money in the long run by allowing the best course of treatment from the outset of any medical condition.

7. Use the Internet. Technology now allow for online pricing and enrollment with policies issued within 24 hours. Savings have resulted in lower premium prices. Some plans offer premiums as low as $25 per month for catastrophic coverage for young people.

8. Avoid the scams. Unfortunately, self-employed individuals are a prime target market of numerous health plan marketing scams. State insurance departments continuously shut down disreputable plans, but new ones sprout up just as quickly. Well-established and reputable health plans are obtained from well-established and reputable distributors. Good health plans do not use multi-level marketing schemes. All individuals handling your health plans enrollment should be licensed, bonded and insured. Beware of individuals who claim that they do not need an insurance license in your state or can not provide evidence of errors and omission coverage or a bond issued by an insurance company. Remember the old adage if it sounds too good to be true. This certainly applies when shopping for health insurance.

Tony Novak, MBA, MT is a writer and financial adviser in Narberth, PA. His businesses MedSave.com and Freedom Benefits Association provide online benefits enrollment to individuals and businesses in 47 states

Health Insurance for the Self-Employed - Protecting Your Business's Greatest Asset

Health Insurance for the Self-Employed - Protecting Your Business's Greatest Asset

2002 Elena Fawkner

"I've been considering quitting my full-time job and getting a part-time job that would pay the bills [so I can start a home business] ... The one biggie my full-time job provides me now is health insurance. If I was to get a part-time job, I'd probably have to pay for my own health insurance and I know that can be expensive."

Like Jason, who sent me the above email this week, many a dissatisfied employee would chuck in their full-time J.O.B. (just over broke) for their part-time home-based business in a heartbeat if not for one thing. Employer-provided health benefits. It's a biggie, no doubt about it.

Undeniably, employer-paid or -subsidized health benefits are one of the few real perks of working for someone else. In fact, surveys have shown that, for employees (especially those with families), paid benefits are hands down the most important element of their compensation packages.

And there's no shortage of people already running their own home businesses with no health or disability coverage at all. Scary. After all, if you're dependent upon your home business as your sole source of income and you lose your health, you lose your livelihood as well.

Bottom line? If you run a home-based business you can't afford not to have health coverage of one form or another. Here's how to make it happen, whatever your circumstances.

BASIC OPTIONS FOR THE EMPLOYER OF ONE (YOU)

You have three basic options when it comes to health and disability insurance.

=> Spouse Coverage

If your spouse has health coverage from his or her employer, as a general rule, use that. It probably provides better and less expensive coverage than you could get on your own.

=> Group Health Insurance

The main advantage of group health insurance plans is that they can't turn you away because of health problems. The good news for the solo entrepreneur is that an increasing number of companies are offering group health plans for "groups" of one. This varies by state though so you'll need to do your homework to find one.

=> Individual Health Insurance

These plans are fine if you don't have any pre-existing medical conditions. (If you do, try your best to find a group plan that will cover a group of one.) They're subject to medical underwriting so your state of health will be a factor the insurance company takes into account in determining whether to accept your application.

Of course, the mere fact that you're able to get into a good plan is one thing. Doing so affordably is quite another.

REDUCING THE HIGH COST OF HEALTH INSURANCE

There are several ways of minimizing the cost of health insurance. Your tolerance for risk will determine which, if any, you are comfortable with.

=> Reduce the Level of Coverage

Do you really need to have every doctor's visit and prescription covered? If you only go to the doctor once a year for an annual examination, have no health conditions, don't need regular expensive prescription medications and are generally healthy, consider cutting out coverage for office visits and prescriptions.

=> Higher Deductible

Similarly, if you're reasonably healthy, don't visit the doctor very often and don't need to use expensive medications, consider switching to a higher deductible to save on premium costs. By increasing your deductible from $100 to $2,000, you can cut your premium payment in half.

=> Annual Premium Payments

If you can afford to do so, pay your premiums annually rather than monthly or quarterly to avoid service fees and to take advantage of prepayment discounts where available.

=> Join Associations

Just because you're going it alone in your business doesn't mean you can't take advantage of the group buying power that being a member of an association offers. Check out your local chamber of commerce, various trade and professional groups and small and home business associations for member benefits. Many offer access to discounted health insurance.

Here are a few small/home business association links to get you started (you'll need to cut and paste some of these links if they wrap to the next line):

National Association for the Self-Employed http://www.nase.org/nase_benefits/health_benefits.asp American Association of Home-Based Businesses http://www.aahbb.org/benefits.htm Home Office Association of America http://www.hoaa.com/allbenefitsnew.htm National Business Association http://www.nationalbusiness.org/NBAWEB/Directory/Internal_Pages/Member_Benefits/Health.htm

Don't forget to check out local associations in your area or associations relevant to your particular profession.

=> Shop Online

Being able to offer insurance products online means insurance companies save on broker and agent fees. Often, this translates into premium savings for policies purchased over the Internet. So, when your fingers do the walking, make sure they do so on a keyboard and not the Yellow Pages.

=> Medical Savings Accounts

Under the Health Insurance Portability and Accountability Act (HIPAA), if you're self-employed you may be eligible to use a medical savings account, or MSA.

MSAs work in conjunction with higher deductible health insurance policies to reduce premiums and allow you to use pre-tax dollars to pay for your medical expenses up to the limit of the deductible on your insurance policy.

Basically, you reduce your premium by replacing a low- deductible policy with high-deductible policy and use the premium saving to make fully tax-deductible contributions to your MSA. You can contribute up to 65% of the deductible each year into your MSA (75% for families). The money goes into a tax-deferred account or trust and you pay your medical expenses (until you reach the deductible) by drawing from the account. Once you hit the deductible, of course, the insurance policy kicks in.

If you spend less than you contributed, the surplus stays in the account and earns interest. Not only that, the funds can be invested in high-return vehicles such as mutual funds and stocks.

As the balance can be carried forward, an MSA can be used to accumulate a pretty healthy nest egg for retirement. In fact, a Journal of Financial Planning analysis calculated that if you contribute $1,500 per year into an MSA for 25 years, assuming a 12% rate of return, you'll end up with almost $1.5 million. That's assuming you don't draw from it to pay for medical costs, of course.

There are some limitations though. First, the range of deductibles is limited to $1,500 - $2,250 for individuals and $3,000 - $4,500 for a family. Second, as we saw above, you can contribute only 65% of the deductible as an individual or 75% for a family.

So, if you're an individual and you choose a policy with a $2,000 deductible, you'll be able to contribute 1,300 pre-tax dollars into an MSA each year. In other words, Uncle Sam pays for part of your health insurance/retirement fund. How fitting.

The money in the MSA can be used to pay any medical expenses incurred before the deductible is reached, as well as other eligible costs such as contact lenses and dental work. If you use the money for anything else, you must not only pay tax on the amount withdrawn, but a 15% penalty on the top. (If you're over 65 when you make the withdrawal the penalty is not applied but you'll still have to pay the tax.)

(By the way, MSAs are also available to you if you work for a business with fewer than 50 employees.)

In short then, MSAs offer a very tax-effective and potentially lucrative way to self-fund part of your health care costs while dramatically reducing your premiums. If luck is on your side and you remain healthy, by the time you reach retirement age, your MSA could well fund your retirement.

Pretty neat.

=> Self-Employed Health Insurance Deduction

Finally, the self-employed can write off 70% of their health insurance premiums in 2002. This increases to 100% in 2003. That's only so long as the total doesn't exceed the net profit from your Schedule C minus deductions for one half of the self- employment tax and Keogh, SEP and Simple contributions though.

Also, the deduction can only be claimed for months when you weren't eligible to participate in a subsidized health plan from another employer (including your spouse's employer).

Self-employed workers who qualify for both the self-employed health deduction and the itemized medical deduction can write off the other 30% this year on Schedule A. (Medical expenses are deductible on Schedule A only to the extent they exceed 7.5% of adjusted gross income.)

WHAT TO DO IF YOU'RE UNINSURABLE

The foregoing is all well and good if you're able to get health insurance in the first place. But what if you have a pre- existing condition that disqualifies you from an individual health plan and you can't get into a group plan? In other words, you can't get insurance at any price.

=> HIPAA

Although beyond the scope of this article, the Health Insurance Portability and Accountability Act (HIPAA) may offer you some protections. For more information about how HIPAA may help you obtain health insurance even if you have a pre-existing condition, visit http://www.hcfa.gov/medicaid/hipaa/content/hipsteps.asp .

=> Risk Pools

High-risk health insurance plans, also known as risk pools, are state-funded plans and are an important safety net for individuals who are denied health insurance because of a medical condition. They're available only in 29 states though.

To be eligible, you must be a resident of the state from which you seek coverage (unless there's reciprocity between that state and the state you reside in) and you must be able to prove at least one of the following:

1. that you've been rejected for similar health insurance coverage by at least one insurer; or

2. you're presently insured with a higher premium; or

3. you're presently insured with a rider or rated policy.

You will not be eligible for participation in a risk pool if:

1. you're not a resident of the state from which you seek coverage (again subject to reciprocity between states); or

2. you're eligible for Medicare or Medicaid; or

3. you've terminated previous coverage in the plan unless at least 132 months have since elapsed; or

4. you're an inmate of a public institution.

For more information on risk pools in your state, contact your state health insurance department, the national association "Communicating for Agriculture and the Self- Employed" (1-800-432-3276) or visit http://www.selfemployedcountry.org .

Coverage via the safety-net protections of the HIPAA may end up being "risk-pool" coverage.

=> Healthcare Savings Programs

Healthcare savings programs are patient advocacy programs that minimize out-of-pocket healthcare expenses.

They're not insurance policies but rather programs that allow you to access networks of healthcare providers for the same negotiated rates that large insurance companies enjoy. Savings range from 20% to 50%.

Not ideal but better than nothing. Also, since they're not insurance policies, all pre-existing conditions are accepted.

A modest monthly fee is usually required to participate. See, for example, Care Entree at http://www.careentree.com for $20 per month.

Although health insurance may seem like a luxury you just can't afford if your finances are already stretched to breaking point thanks to your home-based business, you never know what's around the corner. Quite simply, you and your business can't afford not to have health (and disability) insurance.

You are your business's greatest asset. Protect it.

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** Reprinting of this article is welcome! ** This article may be freely reproduced provided that: (1) you include the following resource box; and (2) you only mail to a 100% opt-in list.
Here's the resource box to use if reprinting this article:

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Elena Fawkner is editor of A Home-Based Business Online ... practical business ideas, opportunities and solutions for the work-from-home entrepreneur. http://www.ahbbo.com
Also, visit Elena's newest site, Web Work From Home http://www.web-work-from-home.com

Elena Fawkner is editor of A Home-Based Business Online ... practical business ideas, opportunities and solutions for the work-from-home entrepreneur. http://www.ahbbo.com
Also, visit Elena's newest site, Web Work From Home http://www.web-work-from-home.com

Health Insurance for Seniors on the Web

Health Insurance For
Seniors On The Net

When a good friend of mine inquired where he could obtain information about medical insurance for his out-of-state, elderly mother, I told him to try the Internet.

He reported back to me about a week later, in desperation: "I am giving up, I am too confused." He had taken on an overwhelming project with his widowed mother, living in another state. As the only child, and following the sudden death of his father, it was his responsibility to care for his mother.

In this world of technology, the family unit is often living in different geographical areas and the family members are usually quite involved with their own lives, careers, and families. In addition, when both parents are alive, often one or both parents are quite independent and do not require a lot of assistance. As time goes on things, of course, change, and sometimes change very suddenly. There can be a crisis, with regard to the health care needs of one or both aging parents.

With our baby boomers facing this problem in ever increasing numbers, and with the information highway in full bloom, there is a definite need for planning.

Protecting your parent's assets and health is a huge and daunting undertaking, which requires a tremendous amount of education and practical application. Our seniors face many diverse responsibilities upon reaching age 65. To name just a few: Estate planning, taxation, Medicare, social security, wills, insurance, and various other legal and financial matters. All of these different areas require expertise from accountants, lawyers, estate planners, insurance agents, home brokers, financial advisors, and others.

The Internet is a good starting point for most people to find resources for questions and solutions for your problems. There is, however, no replacement for good solid intelligent advice from an expert.

Twenty years ago, insurance for elders was sold by "senior insurance specialists", with just a handful of companies in each state. The programs were most often Medi-gap or Medicare supplemental policies, which covered the expenses not covered by Medicare, including hospital and doctor deductibles, durable medical devices, and non-approved Medicare costs. Ironically these specialists did not sell a lot of nursing care policies, even though Medicare paid a national average of less than 2% of these expenses. With the advent of "financial and estate planning" and more insurance companies entering this market, a more broad and diversified product line became available to agents, brokers, planners, and seniors.

Part of this new diversification was the "home health care plan", sold by itself, and in conjunction with senior health insurance products. The appeal of the "home health care policy" was that a senior could stay at home and still receive medical and custodial benefits, allowing a person to recuperate in the comfort of their own home.

This was the answer to a huge problem. The last place an older person wanted to go was a "retirement home", or "rest home", or, God forbid, the "nursing home." It appeared that seniors could now rely on this new innovation without worry of having to move out of their home environment in the event of a health problem.

As with most things," if it is too good to be true".... The home health care policy is no exception. The problem is, there is not enough coverage for a lengthy illness or recuperation time. The fact is, the new trend is toward an "all in one" type facility, allowing for a variety of levels of care all in one location. In other words a senior could start off with little or no health care concerns in an independent, less expensive area, and then go to an assisted living, or nursing care facility, all within the same compound.

A "nursing home" requires a nurse on the premises 24 hours per day, assisted living is just eight hours. The advantages to this are financial. The patient or senior is only charged according to the care level required during the time he or she is admitted to that facility. Another benefit is it alleviates a lot of planning because the care is delivered, as it is needed. The medical attention is available to all residents regardless of their current health.

Some people are offered a lifetime package, which covers their care for the rest of their life, regardless of their current age. It also allows for social outlets to an otherwise somewhat isolated group. On-line shopping services have become a huge business. It is definitely here to stay and many insurance policies are purchased from Internet quotes and on-line applications.

There are literally hundreds of thousands of insurance agents and brokers advertising on the Internet. Most of them will provide instant on-line quotes and even applications for the potential insured. I highly discourage a layperson to purchase insurance in this fashion. A little knowledge can be dangerous.

The federal government has mandated to all states through legislation, the standardized senior health insurance policy guidelines, which are governed and regulated by each state insurance department.

There are plans for almost every level of health. Some are designed and priced for a less than healthy individual. Others are for a person with minimal health concerns. . The whole concept of insurance is to provide protection for "unanticipated" sickness or injury, especially catastrophic expenses, which would devastate a person's net worth. The more small expenses a person is willing or able to pay (self-insure), the lower the rate. I recommend this strategy when evaluating your insurance options.

Another consideration when reviewing various insurance plans is to look at the company itself. How long has the company been selling this type of insurance? Do they have a lot of complaints filed with the local department of insurance? Are the rates stable? Does it pay claims on time? Service? Most agents talk about the rating. These ratings are as follows: A+, A, A-, B+, B, B-, C+, C, C-, or "not rated".

Do not be fooled by rating alone. It is good to have a high rating, but it is far better to have a company that has longevity, stability, innovation, service, and expertise. The problem is that some companies enter into a market and quickly leave without explanation. This does not give security to the policyholder.

The most important consideration should be a review of the profit/loss ratio for that product. This will establish stability, and longevity in the market. An insurance company with a moderate profit in a particular line of business will remain in that market. On the other hand, a company with losses will make changes and possibly even withdraw. This is information not normally available to Internet users.

Before entering into an insurance contract, the senior person, the family, and other advisors must be realistic, and a careful evaluation of the entire picture must be examined. The age, the health of the senior, the financial resources, the personality and attitude of the senior, and most importantly the desires of the senior, should all be considered.

Early planning is important, as qualification becomes increasingly more difficult as the applicant's health declines. The senior health care market is complex. I will offer some words of advice to attempt to alleviate potential pitfalls. *Choose a well-informed, seasoned, and service oriented agent or broker to assist your decision making process. The professional can offer invaluable information, but do not be afraid to ask a lot of questions and even get a second opinion. *Do not wait until your parent or loved one is sick, or injured. Plan ahead and take the time needed to cover all the options. *Choose an experienced insurance company. A Company that has been in the marketplace for a significant time and has maintained a balance of rates and benefits and sound risk selection with moderate rate increases over time is your best bet. *The plan should be flexible, with a broad range of options and benefit selections to the insured. There should be no tricks, or complicated language for the coverage. An incredibly low rate is a red flag for trouble in the future. *Do not rush or be rushed by an over aggressive sales person.

This policy will not be inexpensive and will need to be read and reviewed for a clear understanding of the contents. This is one advantage to the Internet. You are allowed to read indefinitely before you act.

A long-term care program, with or without insurance coverage, will only work if the senior has input into the care selection process. If there are any questions about the accreditation of a facility please call the "Continuing Care Accreditation Commission at 202-783-7286.

As I have mentioned in my article, the best way to avoid potential problems are to plan ahead. I have found a company, that I highly reccommend as they are professional senior care specialist's and offer sound, practicle, individualized, advice
for caregivers, family members, seniors, and guardians. They will advise on tax, legal, financial, health care, and other family issues, and are available nationwide.

author: William H. Pritchett Jr.

Mr. Pritchett is a certified estate planner with over 25 years of experience in long term care, medicare, and custodial care health insurance products. Mr. Pritchett was a pioneer in this market and developed the first "Home Health Care" insurance plan available in the United States in 1983. He has written many articles, is a national public speaker on the subject and sits on the board of directors for several large corporations.

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

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

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

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

HCFA Timetable

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

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

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

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

HIPAA Made Easy

HIPAA made easy

In 1996, a major legislative act was passed affecting health care administration called the Health Insurance Portability & Accountability Act or HIPAA. Whenever the legislature writes new laws it's up to the rest of society to understand the legal jargon and find how what the new law is all about. That's the aim of this article- to help simplify and state the main concepts of HIPAA.

There are two main parts to HIPAA that need to be understood. * The first part of HIPAA amended the Internal Revenue Service Code of 1986. * The second part is directed at streamlining and standardizing some of the administrative aspects of health care administration and information systems.

The second role of HIPAA is what will be focused and discussed as this is the part which mostly affects health care providers. Again the purpose of HIPAA was to simplify health care administration. There are deadlines for compliance; HIPAA does provide penalties and legal action for noncompliance. There are four parts to HIPAA: * Standards for Electronic Transactions * Unique Identifiers Standards * Security Rule * Privacy Rule Before HIPAA there really wasn't much standardization among health care providers regarding filing claims and identification. This created a lot of problems, headaches and extra work. HIPAA aims at saving time and making the process more efficient. It affects how health care providers file and process claims and conduct other business electronically. HIPAA also makes provisions for how health care providers are identified. There was no standardized way of identifying health care providers in: (1) being identified to Medicare and other government health organizations and (2) in being identified with other health care providers. The security and privacy rules were created to ensure secure transmission of electronic data and to protect individuals' personal medical information.

Many health care providers use electronic means for filing, billing and claim work. There has yet to be any adopted standards for this, with each individual provider using whichever forms they like. This led to complications in filing claims with Medicare and in transferring information from provider to provider. HIPAA has changed that though making electronic filing forms standardized. When filing electronic claims or when sending an electronic medical record providers will now be using the same forms. Medicare will require that all providers use the same form when filing an electronic claim with them. Providers who do not file or process claims electronically will not be affected by HIPAA. Also a standardized set of codes must be used on records in relation to physical conditions, diseases, health, etc. Most providers and institutions already use this practice. There will be enforcement of compliance; HIPAA has set deadlines for when providers must be using the approved forms.

Also new with HIPAA is how providers will be identified. Health care providers, doctors, hospitals and health plans are required to have a unique identifier and current they are using either tax-id numbers or employer identification number.

The security and privacy rules contain provisions to ensure that people's personal records and information will be protected and kept confidential. Along with all other privacy laws there will be penalties for non compliance, HIPAA provides for fines up to $250,000 and possible jail time for severe enough violations. But don't be worried about too many places avoiding compliance, HIPAA was created to make the massive process of health care administration easier.

Rick Lorenzen writes for 10x Marketing. To learn more about HIPAA compliance, electronic claim software and electronic medical record software visit www.AdvancedMD.com.

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.