How HIPAA Trained Employees Can Help In Safeguarding Patient Information

The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 with the primary objective of protecting confidential patient information. There are various circumstances due to which this protected information is accessed by employees in hospitals, clinics and insurance companies. There is always a danger that this protected information could be used for commercial reasons. This is one of the primary reasons as to why it needs to be protected from unauthorized access.

There are also restrictions on the number of times that confidential information of individual patients can be accessed and it is important that people who access it are aware about it. Employees who work in "covered entities" as specified in the Health Insurance Portability and Accountability Act need to be properly trained so that they are able to access this confidential information carefully. The regulations of HIPAA are quite stringent and any unintentional or intentional violation attracts many penalties. The penalties could include fines or imprisonment depending on the nature and extent of the violation.

What Are The 5 Issues That You Need To Be Aware About In HIPAA Training?

It is important that all employers of health care service providers (covered entities) arrange for a HIPAA training session for their employees so that they become aware of the various rules and regulations that are stipulated by the Act. The HIPAA training can be done by just a section of the employees who handle this protected information or all employees of the covered entities. The training sessions can usually last for a couple of hours and employees should be encouraged to ask questions so that they are able to get a better understanding of HIPAA and its various rules and regulations. The training will also provide information to employees about the various penalties for non compliance of Health Insurance Portability and Accountability Act. The penalties can be civil and criminal depending on the extent of the violation. The training will also ensure that all provisions of the Act are complied with and there are minimum unintentional violations. There are various physical and technical safeguards that need to be implemented to keep the protected information safe and secure and the training will provide employees with the guidelines to do so. This will also help prevent any unauthorized access to the protected information of the patient. After the training period is completed, employees will need to take a test to check whether they have understood all the concepts of HIPAA clearly. Employees who have successfully completed the test will be awarded a certification. The certification would mean that these employees are proficient in the privacy and security rules of Health Insurance Portability and Accountability Act.

There have been several modifications made in HIPAA since its introduction in 1996. The training should be a continuous process for employees as Health Insurance Portability and Accountability Act can get updated at regular intervals. The covered entities can have specific policies that are related to HIPAA and this should be in compliance with the overall act.

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How to File a Health Insurance Claim

There are two methods for getting a claim under a health insurance policy in India:

1. Cashless Hospitalization

2. Non-cashless Hospitalization

In case of Cashless/planned Hospitalization

1. In case of planned hospitalization inform the Third Party Administrator/insurance company about the date of admission in the hospital quoting your policy number and health ID card at least 4-5 days in advance.

2. The form for intimation to Third Party Administrator and obtaining previous authorization for cashless claims services is available with the admission counter of the hospitals.

3. The patient must fill up the form carefully as any incorrect information may lead to rejection of previous authorization.

4. The medical condition of the patient or the requirement of any surgical procedure is filled up by the doctor attending the patient. Be sure that the doctor is briefed correctly about the patient's history, otherwise it may again lead to rejection of previous authorization by Third Party Administrator.

5. In case of new policies all previous existing diseases are excluded. At the time of signing previous authorization form check that doctor has not mentioned anything about condition which may lead to assume it for existing previously.

6. The filled up form is then sent by the hospital authorities to the respective Third Party Administrator of the company for granting of previous authorization of amount for hospitalization.

7. The Third Party Administrator carefully scrutinizes all the details such as policy number, validity of policy, Sum assured, waiting period, preexisting diseases etc and after being satisfied sends the authorization of amount directly to the hospital.

8. After satisfying itself the Third Party Administrator will issue a previous authorization letter/ guarantee of payment letter to the hospital/nursing home mentioning the sum guaranteed as payable and also the ailment for which the person is seeking to be admitted as a patient.

9. The Third Party Administrator has the right to deny the previous authorization if he is not satisfied with the documentation.

10. Unless the Third Party Administrator gives the previous authorization letter to hospital, the hospital will not treat it as cashless claim. So the insured must vigorously follow-up with the Third Party Administrator for giving the authorization letter.

11. If the letter from Third Party Administrator is not received or if they deny then the insured must first pay for the expenses from his pocket and then lodge a claim to the Third Party Administrator/insurance company.

12. In case of planned hospitalization it is easier to get previous authorization since the insured has ample time to followup with the Third Party Administrator. The problem comes in emergency hospitalization.

Here time is of essence. The hospital will not start treatment unless he receives authorization from Third Party Administrator or cash from the insured.

13. This creates a panic situation and many times the insured are forced to pay from their

pocket and thereafter claim the amount from Third Party Administrator/Insurance Company in normal course due to emergency. In many cases it has been seen that Third Party Administrator's delay the process of authorization so that the customer pays from his pocket and then claims reimbursement.

14. Generally the Third Party Administrator's grant authorization for a particular amount. If the cost of treatment exceeds that amount the patient must give it from his own pocket and then claim reimbursement from the Insurance company if it is within the policy limits.

In case of Non-Cashless Hospitalization/Emergency Hospitalization:

In case of Non cashless Hospitalization the insured must give preliminary intimation about the claim within 7 days of hospitalization (The intimation period may vary from company to company) to the Third Party Administrator/Insurance Company.

The notice would include the following:-

1. Particulars of Policy number

2. Health ID card number and copy

3. Name of Insured Person

4. Address

5. Name of attending doctor

6. Name of Hospital

7. Nature of illness/injury

After the insured is discharged the final claim must be submitted to the company within 30 days from the date of discharge. The period of intimation may vary in insurance companies.

The following documents must be attached along with the prescribed claim form of the company:-

1. Original prescription of Doctor

2. Prescription of doctor advising for hospitalization/tests.

3. Original reports of all diagnostic tests along with the original bills like X-rays, ECG, Scan, MRI, Pathology etc.,

4. Detailed itemized bill from the hospital for bed charges, OT charges, medicines, and details of any other charges that the hospitals have levied.

5. Surgeons certificate stating nature of operation along with bill.

6. All bills for medicine purchased during the previous 30 days before hospitalization and

after discharge.

7. Hospital Receipts / bills / cash memos in Original (Copies of charge slips if payment is made by credit card) duly stamped.

8. Discharge certificate from hospital

9. Certificate from the doctor that the patient is fully cured and is able to resume his work

10. In case of domiciliary hospitalization a report from qualified nurse who attended the patient in his residence supported by a certificate from medical practitioner.

11.Copy of current insurance policy and previous policy.

12. F.I.R. in the case of accidental injury and English translation of the same, if in any other language.

13. The claim form must be filled correctly and there should not be any overlapping of information otherwise it may lead to rejection of claim.

14. Since all the original documents are submitted along with the claim form the policyholder must keep a copy of the claim form and all the original documents submitted along with the claim form. At the time of submitting the claim form he must obtain an acknowledgment from the insurance company about the receipt of the documents to serve as a proof of submission.

15. The policyholder must followup with the insurance company about the status of the claim after some time as the insurance company may require some other documents or clarifications from the hospital about the charges.

16. The insurance company if finds everything in order shall make payment for the claim. Many times it deducts some amounts from the bill which are not authorized under the policy or which may seem to be in excess.

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How Does Medicare Work? Understanding Medicare

Medicare is a federal program open to seniors 65 years or older or to certain disabled Americans. It has various component programs that cover a number of people.

Generally speaking, Medicare recipients are in the low middle income to low income levels. Because they have limited means, these recipients often find it hard to pay for all their medications so they will either skip taking the medicine or skip on groceries or other life's essentials.

To help alleviate this particular problem, the federal government has several resources available to Medicare recipients. For example, the Social Security Administration says,

"Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia."

There are links at the end of this article you can use to read the full details about this program. Take advantage of all the information they provide.

Believe it or not, the federal government wants each recipient to get all the benefits they deserve. They encourage people to find and enroll in federal, state, local and private programs that help pay for prescription drugs, utility bills, meals, health care and other needs.

For example, people who need help paying for food can enroll if the Supplemental Nutrition Assistance Program (SNAP). The federal government has renamed the former federal Food Stamp Program. SNAP helps low-income individuals and families buy the food they need to maintain good health.

Their opening paragraph sums up their mission this way:

"There are programs that help millions of people with Medicare save money each year. States have programs for people with limited income and resources that pay some or all of Medicare's premiums and may pay Medicare deductibles and co-insurance."

Visit this site and click on your home state and see what is available to you. Hopefully, you hit the jackpot and get all the aid you deserve.

Simply because you are a low income or poverty level income individual doesn't mean you are without means or resources. The above programs are in place to benefit you and hopefully make your life a bit easier.

Another excellent resource is on Medicare.gov, the official US Government site for Medicare. The specific program is called Medicare Savings Program (MSPs). Its web address is:

http://www.medicare.gov/contacts/staticpages/msps.aspx

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Value Your Own Loved Ones' Wellness By Getting Health Insurance Plans

Probably one of the most essential things folks just ignore is health and wellness. As we say, health is wealth. On the other hand, they just recognize its relevance should they become ill and need to pay a large amount on their medical costs. This is exactly what injures your bank account the most. Whenever you are unwell, you have to spend unexpectedly something you must have well prepared for at the start.

That is why it is essential to make health a high priority. Keeping yourself healthy makes it possible to steer clear of forking over big medical costs and other related expenditures. On the other hand, accidents could happen out of nowhere. That is why you'll want to stay one step ahead of the game. Each time unanticipated situations have an impact on you and your loved ones, you have to be equipped for the inevitable. For this purpose alone, family health insurance plans undoubtedly are a must.

These days, most people find getting health insurance plans the best way for you to cope with any kind of health issue or accident. To make the best from obtaining one, you ought to select the right family health insurance plans. Here are some elements you need to know prior to getting started.

First thing will be to understand the medical expenses needed. You will need the best idea of what form of medical expenditures you own family must have. Since members differ in age and gender, it's always best to generate a comprehensive plan for every one. The listing should also contain all planned expenses and also the ones that may possibly occur at any time.

Immediately after figuring out the coverage essential, the next thing is to find a reputable health insurance organization which may offer this. It is important to pick a company that's legitimate and offers top quality service. It will be helpful when you speak with friends or relatives to get some kind of idea. Doing your search on the internet will also help save your time. Visit sites of the insurance agencies and look at testimonials. Ensure that you go over your choices cautiously prior to making any kind of selection.

One more thing to take into consideration is price. Choose amongst major medical insurance plans which come on this category. When you search on the internet, always evaluate the costs. While doing this, you must be mindful too. A few sites offer unbelievably affordable costs which are fraudulent so you should always be mindful all the time. Don't end up being easily blinded by these unusually low rates and add-on special discounts. Being nitpicky helps you save from making the wrong choices.

Family health insurance plans help you provide protection for your family. Being a concerned loved one, you need to spend much focus on this. Being equipped will let you handle unpredicted instances that involve their health. Most importantly, owning insurance coverage will give you peace of mind.

There are lots of plans offered. All you have to do is choose the one which matches your requirement.

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Make Sure You're Covered Before It's Too Late

It's been a few years since you've had your last physical and you have this insurance plan through work that takes a monthly sum out of your paycheck-so what the heck, why not get a check up? You find a doctor in your insurance provider's network, make an appointment, and check that task off your things-to-do list.

If this is all you've done to make a doctor's appointment, you haven't adequately protected yourself against a surprise bill from the doctor's officer following your visit. Just because a doctor is in your insurance provider's network does not mean that same doctor is covered under your plan. The previous hypothetical is one of several ways ordinary people get hit with big medical bills due to a lack of due diligence on their part and a false sense of security that they're covered. Ensure that you're fully covered before seeing a doctor or specialist by asking yourself the following questions.

Is the doctor or nurse familiar with my plan?

Doctors and nurses want to make sure that you're covered just as much as you do. They're much more comfortable getting paid by your insurance provider rather than by you. That being said, don't hesitate to ask in a straightforward manner whether your policy covers a specific doctor or procedure. Additionally, to be absolutely certain that your visit is covered speak with an insurance claims manager in the officer either in person or by phone. These managers will work hand-in-hand with you to make sure you understand what is covered and what is not. Insurance claim managers are often Certified Medical Assistants (CMA) so they have a wealth of knowledge about health insurance. The more questions you ask them, the better off you'll be.

Is the doctor covered under my plan, not just in the insurance provider's network?

Similar, to the hypothetical, don't be fooled into thinking that a doctor is covered under your plan just because that doctor is in the insurance provider's network. It's common for plans to not include all the network doctors.

Is my name on the claim the same as it appears on my insurance card?

Avoid any unnecessary headaches by confirming the correct spelling of your name on the claim and your insurance card. Insurance providers will deny or reject a claim for such an administrative error. Sure, you can probably appeal the denial or rejection and get it reversed, but why bother going through red tape that could take months to resolve?

Is this medical bill accurate?

After doing your homework you still may receive a medical bill if a procedure was only partially covered or you went into a procedure knowing that it was not covered. That doesn't mean you should not closely look at the bill. Believe or not, medical providers and insurance companies make mistakes. Be sure the charges are accurate and if you're not sure about a few charges contact the appropriate entity for clarification.

Remember the adage, it's better to be safe than sorry. That applies when finding a doctor under your insurance provider. Save yourself time and money by asking yourself, your insurance provider, and healthcare providers the right questions.

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Concerned Over Gaps in Medicare Plans? Choose Suitable Medical Supplements

Obviously, health comes first. If you are not in good state of mental and physical health, your work, leisure, productivity, relations...all of the things get affected.

As individuals are careful about their well-being, so is the government. This is the reason many health insurance plans are run by governments of different countries. Here I am going to discuss about one such plan... Medicare plans.

This is a plan administered by U.S. Government for people over 65 years of age. Younger ones but affected from any disability are also covered under it. If you are in search of health insurance plans, Medicare well deserves your attention but you also need to know about Medicare supplement plans as Medicare doesn't cover everything.

For the things not under its purview, you can opt for Medicare supplements health insurance.

Here are some aspects you need to consider while selecting Medicare supplemental

• An estimation of medical cost is the first and foremost thing. Make a list of any regular checkup, test you are undergoing, doctor's visit and similar other things. However, this may become difficult as all Medicare plans A,B,C provide different coverage. Also, don't forget to include the premium of Medicare policies while making n estimation.

• Check state insurance departments to know about the companies providing supplement health insurance legally. Not all policies are offered by all companies. So, if you skip this step, you may end up in wasting time as your selected insurance coverage may not be applicable in your state.

• Similarly, not all companies are operating legitimately. So, while finalizing the insurance company, Its better to take guidance from friends, family other sources as well.

• Once you are through with company selection, start comparing their plans and policies. You can narrow down your choices by restricting to your needs. Don't look for unnecessary coverage. Stick to only what you require. It will help you out in making good selection.

• If you are a travel freak, make sure that the plan includes nationwide coverage because all policies don't include the same.

• Don't forget to inquire about the customer service of the company. However good it is, if customers are not satisfied; it's of no use. You can visit the website of the company and read customer's testimonials. Personally contacting them will also solve your purpose. By any means, make sure to get convinced by the services before taking a final decision.

• If you enroll for supplement plans within 6 months of enrollment in Medicare part B, it will be best for you as you will grab comprehensive coverage. The more time you take, the higher will be the premium.

So, these were some of the points you need to take care of while opting for supplement plans!

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