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Insurance

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  • 1. Insurance & Athletic Training AND HIPPA and FERPA KIN 193
  • 2. FERPA
    • The Family Education Rights and Privacy Act of 1974, commonly known as FERPA
      • FERPA is a federal law that protects the privacy of student education records.
      • Students have specific, protected rights regarding the release of such records and FERPA requires that institutions adhere strictly to these guidelines.
      • Therefore, it is imperative that the faculty and staff have a working knowledge of FERPA guidelines before releasing educational records.
  • 3. FERPA Educational Records
    • Educational records are defined by FERPA as:
    • Records that are kept in the sole possession of the [institution] , are used only as a memory aid, and are not accessible or revealed to any other person except a temporary substitute for the maker of the record.
  • 4. FERPA – Educational Record
    • Educational records are directly related to the student and are either maintained by the school or by a party or organization acting on behalf of the school. Such records may include:
      • Written documents; (including student advising folders)
      • Computer media;
      • Microfilm and microfiche;
      • Video or audio tapes or CDs;
      • Film;
      • Photographs.
  • 5. FERPA - Educational Records
    • FERPA gives students the following rights regarding educational records:
    • The right to access educational records kept by the school;
    • The right to demand educational records be disclosed only with student consent;
    • The right to amend educational records;
    • The right to file complaints against the school for disclosing educational records in violation of FERPA.
  • 6. FERPA – Educational Records
    • Students have a right to know about the purpose, content, and location of information kept as a part of their educational records. They also have a right to expect that information in their educational records will be kept confidential unless they give permission to the school to disclose such information.
  • 7. FERPA
      • Records Not Considered As Educational Records
      • The following items are not considered educational records under FERPA:
      • Private notes of individual staff or faculty; (NOT kept in student advising folders)
      • Campus police records;
      • Medical records;
      • Statistical data compilations that contain no mention of personally identifiable information about any specific student.
  • 8. HIPAA
    • H Health
    • I Insurance
    • P Portability
    • A Accountability
    • A Act
  • 9. HIPAA Guidelines
    • Reactions to these sorts of abuses,
    • as well as a general concern about health privacy, led to the passage of HIPAA
    • In Tampa Florida…….
    • A county health department worker copied lists of HIV patients, distributed the information to his friends and sent the information to a local newspaper.
  • 10. HIPAA
    • In Missoula Montana
    • A hospital posted the psychiatric records of dozens of children on its public web site, where they remained for weeks until discovered by a newspaper reporter
  • 11. HIPAA
    • In Minneapolis
    • A university health facility sent emails to transplant recipients that revealed the names of hundreds of donors to whom confidentiality had been promised.
  • 12.
    • The visitor who passes a computer screen, the housekeeper who cleans your hospital room or employees talking in an elevator should not learn anything about your health information because it is private. It must be protected – and it is called protected health information (PHI).
  • 13.
    • Only those who must know information to provide care or do the work necessary to complete business responsibilities are legally and ethically allowed to know and use the information.
    • They must make sure they guard the information so it does not become known or used by anyone else. It must be kept confidential.
  • 14. Confidentiality Protection
    • DO NOT give any information about a patient to anyone who is not directly involved in the care of the patient unless the patient gives an official consent or unless the law requires it.
    • This means you should say, “I’m sorry, that information is confidential and we cannot share that info” to:
    • ANYONE YOU KNOW DOES NOT HAVE A LEGAL REASON TO KNOW ABOUTTHE PATIENT.
  • 15. HIPAA Recommendations
    • Don’t let other see your computer screen
      • Log off when done
      • Don’t share your access code
    • Don’t talk to persons in public about medical record issues
    • Do not leave messages on e-mail or voice mail
    • Use only a land line – cell phones can be captured
    • Make sure fax numbers are correct
  • 16. Medical Insurance
    • Contract between policy holder and insurance company for reimbursement a percentage of the cost of medical benefits
      • HMO - fixed fee for services rendered
      • PPO - similar to HMO but allow greater choice in health care providers Pay on fee for service rather than capitation (per person system)
      • Government Sponsored Medicare, Medicaid, CHAMPUS
  • 17. Insurance Systems
    • Health Insurance - more comprehensive
    • Athlete accident insurance - used to supplement student’s family insurance
    • Exclusions - accident insurance policies usually exclude overuse injuries
  • 18. Insurance Systems Cont.
    • Riders - accident insurance companies use to include overuse injuries (cost extra), may be necessary if setting is responsible financially for athlete
    • Catastrophic Insurance - takes effect after 1st $25,000
    • Experimental treatments - usually excluded (if at research setting need to look into rider)
  • 19. Types of Athletic Insurance
    • Self Insured - university decided to self-insure (create own insurance policy)
    • Primary Coverage Medical/accident insurance that begins to pay for medical expenses after deductible - parental insurance is not a source of payment
    • Secondary Coverage (Excess insurance) - policy tat pays for medical expenses only after all other insurance policies have reached their limit.
  • 20. Third Party Reimbursement
    • The process where health care practitioners are reimbursed by a policyholder’s insurance company for services rendered
      • Depends on state licensure
    • Legal requirement - all patients must sign patient release of medical records (confidentiality of medical records)
  • 21. Filing Claims
    • Quickly - usually a time limit
    • Insurance Claim registry
    • Explanation of benefits -for secondary insurance coverage - need this form from patient primary insurance to process secondary insurance
    • Speak with insurance carrier they may allow you to incorporate your record keeping forms (prevent double work)
  • 22. Purchasing Insurance
    • Provide suggestions and needs
    • Provide timely service in event of claim
    • Bid for insurance
    • Run through a claim with company prior to purchase (this will review contact people and find rough spots early)
  • 23. Other Issues
    • May need to help/tell student to switch primary care to area (with secondary insurance policy)
    • May need to call for prior authorization with some policies
    • There is always a way to work the system
    • BE NICE!!
  • 24. Other Issues
    • “ NATA views having an NPI number like having a state license: it’s a professional requirement and adds credibility to both the individual and the profession,”
    • The National Provider Identifier is the result of the mandate in the 1996 Health Insurance Portability and Accountability Act (HIPPA) that the Secretary of HHS establish a standard national provider identifier.  Though all healthcare providers will be eligible to receive NPI’s, covered healthcare entities will be mandated to use the NPI as the sole provider identifier on all HIPAA electronic transactions. The 10 digit number will be assigned by a CMS-funded NPI “Enumerator” through the NPPES (National Provider and Plan Enumeration System).
  • 25. NPI
    • The NPI is a numeric 10 digit identifier, consisting of 9 numbers plus a check-digit in the 10th position.  It is accommodated in all standard transactions and contains no embedded information about the healthcare provider that it identifies.
    • When filling out your application use: Provider Code 22 (Respiratory, Rehabilitative & Restorative Service Providers) and Taxonomy Code 2255A2300X (Athletic Trainer)
    • To Apply go to: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
  • 26. Other Issues
    • National Outcomes Research Analysis: Goals
    • NORA will provide scientific outcomes research to demonstrate the clinical value, cost effectiveness and improved outcomes provided by athletic trainers to patients.
        • The research will favorably affect decisions by:
        • third-party payers
        • workers compensation organizations
        • corporate employers
        • Federal and state legislators and regulators
    • U.S. health care delivery system
    • Reach 100 reporting sites (currently at 29), and 1800 data sets.