Individual Medical Insurance

Written by Admin
Posted March 25, 2009 at 7:07 pm

Milfuegos: Insurance Industry is Simply a Parasite Feeding on the …
They also actively interfere in the delivery of quality medical care, as anyone who has had to battle with some “nurse” on the phone at an insurance company to get required pre-authorization for needed procedure can attest. … Now we hear that two big insurance trade groups, the Blue Cross and Blue Shield Association and America’s Health Insurance Plans, have offered to “phase out the practice of varying premiums based on health status in the individual market” in the … read more…

Regulating Health Insurance: Can a state Cafeteria Plan mandate …
This may mean that an employer that sets up a cafeteria plan for its employees so that they can purchase health insurance in the individual market may be subject to COBRA’s requirements for its employees’ health insurance, even thought … read more…

Employer-sponsored Health Insurance Is Vital For Part-timers …
Employer-sponsored health insurance can be much more inexpensive than trying to get insurance as an individual, and employees can often benefit from a larger range of quality medical services as well. In order for employers to offer … read more…

From Google Blog Search

SAV INCOME TAX BEYOND SEC 80C
Thinking beyond Section 80C for saving taxes ??
Individuals, who need to save more to save their tax money more than what section 80C allows for, can opt for other options:

a. Home loan: Interest… read more…

Credit history and car insurance rates
You are definitely aware of the fact that banks examine your credit rating when deciding on whether to extend your current credit or not. But the banks are not the only institutions that use your cred… read more…

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Locating the right property and casualty insurance cover might not come very high up on your list of priorities and, alongside investment and estate planning decisions, questions concerning the langua… read more…

From GoArticles.com

Open Question: URGENT!! HELP!!! concerning 300 point essay!?
i have to write a 6 page paper on how HIPAA has impacted Health Care. it’s due tomorrow Monday March 23 and i am having trouble. i am not good at putting stuff into my own words. this paper is worth 300 points. i have to do good on this paper in order to pass. will you proof read it for me and maybe re write it for me or something so it doesn’t look like i cheated too much by copying and pasting? i did put some of my own words in but not enough. please keep it 6 pages!
HELP!
here is my paper…

The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996 and became effective July 1, 1997. This act is a grouping of regulations that work to fight fraud and abuse in health care delivery and health insurance. The intention of the HIPAA is also to improve the effectiveness and efficiency of the health care system, portability and continuity of health insurance coverage as well as the ability to provide consequences to those that do not apply with the regulations explicitly stated within the Act.
The Health Insurance Portability and Accountability Act protects health insurance coverage for workers and their families when they change or lose their jobs. The HIPAA also promotes the use of medical savings accounts, improving access to long-term care services and coverage as well as simplifying the administration of health insurance. As federal law, it limits pre-existing condition exclusions and permits special enrollment when certain life or work events occur. The HIPAA prohibits discrimination against employees and dependents based on their health status. It guarantees the availability and renewability of health coverage to certain employees and individuals in general terms allowing the portability for group coverage from one carrier to another group carrier.
The regulations require guaranteed issue and renewal of insurance coverage, prohibiting plans from charging individuals higher premiums, co-payments, and/or deductibles based on health status. Pre-existing conditions may not be imposed if group coverage was effective for 12 months and not longer than 63 days elapsed between coverage. If such coverage was for less than 12 months, than pre-existing conditions may be imposed for only that portion of the 12 months that were not covered. The Health Insurance Portability and Accountability Act establishes a maximum of 12 months may be imposed for a pre-existing condition, meaning individuals will not be punished for seeking care for chronic and life long illnesses in the past.
The Act’s Administrative Simplification provisions required the establishment of national standards. These standards were set forth for electronic health care transactions, national identifiers for providers, health insurance plans, as well as employers. The Administrative Simplification process also addresses the security and privacy of health data to improve the efficiency and effectiveness of the nation’s health care system, encouraging the widespread use of electronic data interchange in health care. The regulations were expanded in 2002 to provide protection for individual medical records. With the new revisions in place, medical records may not be disclosed without written permission of the patient. It is also required that medical records be kept under lock and key and available only on a need-to-know-basis.
Key privacy provisions establish that patients must be able to access their records and correct errors, in addition to being informed of how their personal information will be used. Patient information can only be shared to treat the patient and cannot be used for marketing purposes without their consent. Patients can ask their health insurers and providers to take reasonable steps to ensure that their communications with the patient are confidential, and file formal privacy-related complaints to the Department of Health and Human Services (HHS) Office for Civil Rights. Health insurers and providers must document their privacy procedures so that patients and staff are aware of the policy that will be followed to give the patients the confidentiality that they expect from medical professionals.
HIPAA has increased patient privacy, even though it may not always feel as though this has happened. The original intentions of this legislation were to standardize and simplify information transmissions and cost savings. As we moved from the paper-based medical record to the electronic health record, there was an expectation of cost savings. Initiatives to protect privacy became front and center of everyone’s attention and implementation of these initiatives escalated costs. Rather than reducing costs there have been increased administrative costs and complexities for clinical practice. Money has been spent for educational sessions; the development of pamphlets, booklets, and handouts explaining HIPAA; new consent forms; and the salaries for those who were hired to implement the Pri
Privacy Rule. Fundraising has also been affected because patients can no longer be contacted unless the patient has signed a separate authorization. Ultimately, the HIPAA goals of simplification and reduced costs will be realized, as the electronic health record becomes the norm in health care.
As we increase the ability to share patient information, we increase our responsibility to protect that information. Not only must patients be informed about the practices for use and disclosure of their information, they must give written consent to use and disclose the information for treatment, payment, and healthcare operations. HIPPA has also given patients the right to access their health information and to amend this information.
HIPAA obligates the employers to educate the staff, and it obligates all of us to inform patients about privacy. The quicker we can educate our patients, the quicker we can move into a better cycle of privacy protection being an integral part of our culture. Wh
Whatever teaching is done, we as health care professionals must avoid lying to patients. For example, a statement such as, “You must sign this or your insurance company won’t pay the bill,” would be a dishonest, threatening, and inappropriate claim; and it would do nothing to help the patient understand when they should or should not grant access to PHI. It is important to obtain the patients’ signatures, and in so doing to use this opportunity to inform them of their rights. HIPAA forms and documentation cannot be viewed as just another insurance form or we will lose sight of the value. Nurses know best that the one-time educational interventions do not sustain the test of time. Diabetic patients cannot meet with the nurse once and then understand what they need to do. A nurse cannot attend one educational session about HIPAA and know all there is to know about informing patients of the implication. It is important to encourage employers to continue upgrading all employees’ HIPAA know
knowledge and expertise. It takes time to learn new procedures and to adjust the processes at work. Someday HIPAA will be an integral part of clinical practice and will not be such a struggle.
HIPAA’s fraud and abuse provisions are based upon the False Claims Act. Passed during the Civil War, The False Claims Act was intended to protect the Union army from fraudulent suppliers who sold faulty war material to the government. HIPAA expands the False Claims Act. HIPAA removes the concept of intentional from civil fraud, preserving it only for criminal acts. Under HIPAA, to be guilty of fraud you need only to have engaged in a pattern or practice of presenting claims that you knew or should have known will lead to greater payments than appropriate. (Hellerstein, David)
HIPAA increased fines to triple the overcharged amount plus up to $10,000 per violation. It increased the percent of the award that could be paid to whistleblowers, it returned the fines collected back into the Fraud and
Abuse Control Program which funds the investigations, and it created the Medicare Integrity Program, which contracts out the investigative work to the private sector. HIPAA set up a funding mechanism, increasing the amount available for fraud and abuse investigations every year through 2003. Funding will exceed $2.5 billion over the next 5 years. As a result, fraud and abuse activities are increasing. 4,000 civil fraud cases were filed in 1997, compared to 2,500 in 1996, and the Office of the Inspector General (OIG) workforce will grow from 960 healthcare auditors in 1996 to 1,920 by 2002. Overpayments estimated at $23.2 billion in 1996 dropped to $20.3 billion in 1997 and $12.6 billion in 1998. The Inspector General cites HCFA’s fraud and abuse initiatives as contributing to this improvement.(Hellerstein, David)
The department of justice reported $1.2 billion in civil settlements and judgements in 1997 from its activities in healthcare fraud alone. The OIG declared savings of $11.6 b
of $11.6 billion in fiscal 1998 compared with $7.6 billion the previous year, and recovers between $11 and $23 for every $1 spent, depending upon the program. (Hellerstein, David)
Congress, OIG and the General Accounting Office (GAO) are not pleased with these successes. In 1996, the OIG reports that Medicare overpaid physicians $1.1 billion because of incorrect coding alone. This increased to $1.7 billion in 1997, dropping to $1.5 billion in 1998, but is stilled viewed as unacceptable. (Hellerstein, David)

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