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HIPPA and medical bills? UPDATE
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<blockquote data-quote="bigblueagain" data-source="post: 4316" data-attributes="member: 909"><p>I know you all get tired of me probably in taking the other side to these issues.....BUT once again I need to give the other side of the issues since I work the other side, and have for many many years. HIPAA was developed and made law by lawmakers... lay people, not medical or people with previous billing experience. It was initially a good idea....to allow employees to have continued coverage when either laid off, fired or changing jobs.(Health portability Act (HPA) It was also good from the stand point that if those employees could show continuous coverage when they applied for new or different coverage they could no longer be denied coverage for things which were once considered PRE-EXISTING. (Which I admit most insurers could explain everything at one time or another as pre-exisiting and did....ESPECIALLY mental health issues.). Then the lawmakers due to consumer urging decided to tack on the information privatization part. In large part I believe to slow the claims paying process down in order to make insurers pay for treatment whether it was medically necessary or not...this was after the HMO's came into play and required precertification prior to most everything. Instead of allowing them to get info on the front end, as there were things being denied that truly did NOT meet medical necessity and that made the ever wanting American public crazy, it is now difficult to get that much needed information, even on the back end once treatment has already been rendered. As with most public policy the HIPAA law is cumbersome and undefinable. (Ever see the Medicare REgs???)</p><p>It has caused most insurers to add personnel just to try to figure out what it means. Most insurers have had to add a HIPAA compliance officer. Most insurers have also had to consult out to computer, risk management and security firms just to mention a few to come into compliance, although every time we call for clarification to the very entities that are supposed to know and understand the law, it is a different answer each and every time. It is bogged down under state law as well, which means additional staff is needed to keep abreast of the local law. This has added cost to your employers premiums, which folks is being passed on to you and me. Also as pointed out, a lot of the problems lie in the fact that most physician offices now have hired billing practices to bill and collect their payments. Folks, you don't even want to know what we see from those folks. They can get their training over the internet, and many do. Many do it from their homes, which may not be the most undistracted environments to start with. </p><p>All I can say is that of ALLL the different types of insurance companies, third party administrators and ppo's I've worked for really do try. However when you get government involved in no matter what the situation (and I believe this with the NO Child Left Behind laws as well) and you don't include the very people who work the system it is going to bog down. You just have to be patient and do a paper trail just like with the school systems. </p><p>BLUE</p></blockquote><p></p>
[QUOTE="bigblueagain, post: 4316, member: 909"] I know you all get tired of me probably in taking the other side to these issues.....BUT once again I need to give the other side of the issues since I work the other side, and have for many many years. HIPAA was developed and made law by lawmakers... lay people, not medical or people with previous billing experience. It was initially a good idea....to allow employees to have continued coverage when either laid off, fired or changing jobs.(Health portability Act (HPA) It was also good from the stand point that if those employees could show continuous coverage when they applied for new or different coverage they could no longer be denied coverage for things which were once considered PRE-EXISTING. (Which I admit most insurers could explain everything at one time or another as pre-exisiting and did....ESPECIALLY mental health issues.). Then the lawmakers due to consumer urging decided to tack on the information privatization part. In large part I believe to slow the claims paying process down in order to make insurers pay for treatment whether it was medically necessary or not...this was after the HMO's came into play and required precertification prior to most everything. Instead of allowing them to get info on the front end, as there were things being denied that truly did NOT meet medical necessity and that made the ever wanting American public crazy, it is now difficult to get that much needed information, even on the back end once treatment has already been rendered. As with most public policy the HIPAA law is cumbersome and undefinable. (Ever see the Medicare REgs???) It has caused most insurers to add personnel just to try to figure out what it means. Most insurers have had to add a HIPAA compliance officer. Most insurers have also had to consult out to computer, risk management and security firms just to mention a few to come into compliance, although every time we call for clarification to the very entities that are supposed to know and understand the law, it is a different answer each and every time. It is bogged down under state law as well, which means additional staff is needed to keep abreast of the local law. This has added cost to your employers premiums, which folks is being passed on to you and me. Also as pointed out, a lot of the problems lie in the fact that most physician offices now have hired billing practices to bill and collect their payments. Folks, you don't even want to know what we see from those folks. They can get their training over the internet, and many do. Many do it from their homes, which may not be the most undistracted environments to start with. All I can say is that of ALLL the different types of insurance companies, third party administrators and ppo's I've worked for really do try. However when you get government involved in no matter what the situation (and I believe this with the NO Child Left Behind laws as well) and you don't include the very people who work the system it is going to bog down. You just have to be patient and do a paper trail just like with the school systems. BLUE [/QUOTE]
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