- 1. Insurance & Athletic Training AND HIPPA and FERPA KIN
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2. FERPA
- The Family Education Rights and Privacy Act of 1974, commonly
known as FERPA
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- FERPA is a federal law that protects the privacy of student
education records.
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- Students have specific, protected rights regarding the release
of such records and FERPA requires that institutions adhere
strictly to these guidelines.
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- 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:
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- Written documents; (including student advising folders)
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- Microfilm and microfiche;
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- Video or audio tapes or CDs;
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
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- Records Not Considered As Educational Records
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- The following items are not considered educational records
under FERPA:
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- Private notes of individual staff or faculty; (NOT kept in
student advising folders)
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- Statistical data compilations that contain no mention of
personally identifiable information about any specific
student.
8. HIPAA
9. HIPAA Guidelines
- Reactions to these sorts of abuses,
- as well as a general concern about health privacy, led to the
passage of HIPAA
- 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
- 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
- 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, Im 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
- Dont let other see your computer screen
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- Dont share your access code
- Dont 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
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- HMO - fixed fee for services rendered
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- PPO - similar to HMO but allow greater choice in health care
providersPay on fee for service rather than capitation (per person
system)
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- Government Sponsored Medicare, Medicaid, CHAMPUS
17. Insurance Systems
- Health Insurance - more comprehensive
- Athlete accident insurance - used to supplement students 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
policyholders insurance company for services rendered
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- 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
- 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
- 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
24. Other Issues
- NATA views having an NPI number like having a state license:
its 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 NPIs, 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)
andTaxonomy 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.
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- The research will favorably affect decisions by:
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- workers compensation organizations
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- Federal and state legislators and regulators
- U.S. health care delivery system
- Reach 100 reporting sites (currently at 29), and 1800 data
sets.