Jbentz

I think the the family EOB can still be used as long as it is stated in your Notice of Privacy Practices (NPP). They can always request a restriction and then the plan can decide whether to honor the request.

Yes, answer the questionaire truthfully and any insurance coverage that you have had in the past 12 months needs to be asked to send you a copy of your Certificate of Coverage. Do not worry about the pregnancy pre-ex, under the HIPAA portability laws they cannot inpose a pre-ex on pregnancy.

I understand that she needs to be consistent, but you have to be realistic also. I have had many plans that are "paperless" for the insurer and do not send EOBs. I have a plan like that now. I only recieve a letter if a request for coverage has been denied. In fact, i don't think i have recieved an EOB from my medical insurance carrier in over 10 years.

If you are talking about a BAA for the HIPAA standards, there was one actually created by HHS in the proposed regs in March. You can also try hipaadvisory.com, ahima.org, indianahipaa.org, snip-wedi.org.

I agree with Steve72. It sounds like it would be an easy out, but as cumbersome as some of the regs are, i don't see how a TPA could administer them for a covered entity. It involves access, security, physical storage of records, policy and procedures, BA agreements, etc... Plus since you would have a business associate agreement with them, it is kind of like putting the fox in charge of the hen house. I would be very wary of any company who states they can make you "HIPAA compliant." I would be more concerned with what the TPA was doing to ensure that they could meet the standards of their BA agreement.

If I understand correctly, the employer has not paid ANY premiums for any of their employees, right? So they are trying to reinstate the entire plan? After 60 days, this will not be an easy task, and the company might be stringing you along, knowing they have really screwed up. If this is the case, if they do not pay, they cannot continue your COBRA since their is no plan. This is a bigger concern to you and your son due to the HIPAA pre-x laws regarding the 63 day gap in coverage with any future coverage you might have. I would call the company and go to the top. Also contact the Department of Insurance in your state (Indiana?) and ask for an application for the state uninsureds risk pool. You also need to file a formal complaint to them. I would contact a lawyer today and get the ball rolling.

Remember that the regs say "MAY" obtain a consent. i would be very careful about this, becauase if you get it for one, you MUST get if for all. If not, you must abide by what the consent says and the fact that a handful did not sign it.

You also have to be aware that if the employer is going to process their own claims with Protected Health Information (PHI), that might lead to HIPAA complications.

Any software that you are currently looking into should include HIPAA guidelines. i would be wary of any company using the phrase "HIPAA compliant" (i hate that!), but be aware of the need and the ramifications. Negotiate the upgrades to be included. I am finding that many providers and health plans are having extra fees tacked on.

Can I ask what the benefits are in waiting until they return to work? Also, will the carriers accept the changes?

i have dealt with these on both the employer side and the insurance side and it is the insurance side that handles them. I would forward it to carrier. They will (should) research it and see if they did the pay the bill incorrectly as the secondary rather than the primary. If the money is not owed (the person is not covered at DOS, etc....) they can send the documentation to them.

Some over the counter drugs are prescription based depending on strength and other factors. I am not familiar with this strength of aspirin, but do not assume that it is OTC. Either call a pharmacy and ask or look it up in a PDR. It tells you if a drug is prescription or OTC.

My two cents: We (the clinic) can refuse to treat a patient, and we have for many reasons. We have also had restraining orders against patients, for the safetly of our doctors and our staff. You can also share PHI (Protected Health Information) when the doctor thinks the patient is at risk or others are in danger. We have also pressed charges. In the situation you have, if it were my employer, i would advise our clinic to do all of the above. Check into your state laws for confidentiality and law enforcement guidelines. On the COBRA issue, you have to provide the opportunity for coverage, but that is separate from where he receives treatment. Separate the the HR side of the clinic and the business side of it. For the HR side, smile, and provide the COBRA. On the clinic side, treat him like any other patient who is a threat to the work environment.

I think a big concern for the upcoming year would center around the new HIPAA regs and how prepared the companies are, not just with the transactions, but with the privacy piece. I am very wary of the "Of course, we are HIPAA compliant!" answer. If you want any more specific info, let me know. i will be happy to give you my two cents (with the stock market, maybe my one and half cents!!!)

This is a hard question to answer, but i can tell you my experience. One of my past employers was closed (by our state Department of Insurance) and shut down and i had several reimbursements out for about 5 employees (tuition reimbursment, mileage, etc...). We were allowed to let them go through and the employees were reimbursed. Ours was a very difficult situation because we were also the health insurance company, which means no COBRA could be issued. Our outstanding health claims had to go through the bankruptcy court, like all the others. I would hope in your case that the judge would allow the money to go back to the employees, but technically, i think it is an asset and any outstanding claims would be liabilities.

My expertise is in the Privacy Rule, but I believe what you may be looking for is under the Transactions and Code Set piece of HIPAA. I copied this from the the HIPAAdvisory.com website: HIPAA defines EDI healthcare transactions as: Health claims or similar encounter information Health care payment & remittance advice Coordination of Benefits Health claim status Enrollment & dis-enrollment in a health plan Eligibility for a health plan Health plan premium payments Referral certification & authorization First report of injury (will not be included in Final Rule) Health claims attachments (will not be included in Final Rule) I believe you may be under the second one "Remittance Advice" and the third one "COB", depending if you are using an electronic format. I know i have heard a lot of talk about EOB's and the codes used. You can see the regs at www.hipaadvisory.com. This is a great website, lots of information about all the HIPAA regs. Hope this helps!

In the case you gave, i agree with maverick and mroberts with the exception being if the claim was accompanied by a script from a provider, even if it was off the tv or a drugstore. My reasoning is that if he can find the exact same item cheaper and it is at his own expense, he should have the freedom to purchase it where he wants to.

Okay, i am going to take a stab at this one. You have several issues because the employee and spouse had two qualifying events so close together: Since they did not notify you (does your initial notice say that it has to be written documentation?) or they have no proof that they notified you, i do not think you have to offer the spouse the 18 extension. Be aware that since the divorce and the termination happened close to the same time, since one of the them claims that a call was made, when the COBRA notice was received, they may have thought it was for the divorce or for both. I don't think you can deny the spouse COBRA becasue you have a signed document in your hand. It is clear that their INTENT was to have COBRA for the both of them. Also, how is your form worded? Could they BOTH have signed up SEPARATELY on the form or are the choices employee, employee and spouse, and employee and family? Anyone else?

I agree with Mike and Mary: gently move up the ladder and get your hands on the plan document. It sounds like you have a rep who is trying to save the company money or is not trained well on spending accounts. I would also be questioning your COBRA rights under the plan. If you have a deficit, the company has to offer you continuation. Mary, Mike, am i correct on this? You would not be saving on taxes on the premium you would pay out after the termination date, but it would allow you additional visits with the orthordontist to recoup your money. It sounds like you set the plan up specically for the orthodontia, but don't forget you can use it for any medical expenses. I would suggest going through your receipts for the year and claiming any other expenses you have. The little things add up to big money sometimes.

You might want to look at the qualifications under FMLA, if the employee qualifies. It is possible that you cannot lay them off until they are able to return, so you would be paying them out anyway.

All tuition reimbursement policies that i have had nominal compensation ($1000.00 per calendar year) and have not required that. The only policies that i have dealt that do require a stay of employment was based on the company paying the complete tuition. this is done with CMA's RN's, etc... those were always special educational programs aside from the normal tuition reimbursement benefit. It was also only for the most sought after positions as a way to recruit. Hope this helps.

I agree with Mary C, we always look for a trend and lreviewing by the quarter is a good way to ensure you are being consistent and fair. It is relatively easy and saves many man hours by not making it weekly or monthly. We put them on warning the first quarter then gave them 45 days to pull their hours up. We also did the reverse and looked at supplemental (casual) employees' hours to ensure that they are not working enough hours to be benefit eligible. We then would talk to the supervisor and if needed, go through the steps to make it a full time position.

I have not heard that changing a DC provider is a qualifiying reason to change the DC election. Papogi, can you tell me more? Where in the regs is it, etc...? I am curious. Thank you for your insight.

You are so right, papogi, my apologies. I should have used "spouse".

If you have a pre-ex clause, I believe that HIPAA regs regard the federal program he is under as credible coverage and that would change any pre-existing time period.