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Individual covered entities can evaluate their own situation and determine the best way to implement addressable specifications. Some privacy advocates have argued that this "flexibility" may provide too much latitude to covered entities. [60] Software tools have been developed to assist covered entities in the risk analysis and remediation ...
Additionally, all clinics located off-site of the parent hospital, regardless of whether those clinics are in the same building, must register with HRSA as outpatient facilities of the parent 340B-eligible hospital if the covered entity purchases and/or provides 340B drugs to patients of those facilities. [19]
Step 2: Determining Financial Responsibility [4] Once the patient is registered, the next step is to identify which treatments or services their insurance plan will cover. Insurance policies often include specific guidelines regarding covered procedures and exclusions, and these rules can change annually.
Covered Entities often use third parties to provide certain health and business services. If they need to share PHI with those third parties, it is the responsibility of the Covered Entity to put in place a Business Associate Agreement that holds the third party to the same standards of privacy and confidentiality as the Covered Entity. [6]
Shock loss is the direct loss that is borne by a self-funding entity; if a self-funding entity has purchased stop-loss, amounts of shock loss that rise above an amount known as the specific deductible are covered by the applicable stop-loss policy. Under the captive model, the parent companies do not themselves offer health plans.
Like an HMO, an ACO is "an entity that will be 'held accountable' for providing comprehensive health services to a population." [ 3 ] The model builds on the Medicare Physician Group [ 4 ] [ 5 ] Practice Demonstration and the Medicare Health Care Quality Demonstration, [ 6 ] [ 7 ] established by the 2003 Medicare Prescription Drug, Improvement ...
CMS subsequently announced that as of May 23, 2008, CMS will not impose penalties on covered entities that deploy contingency plans to facilitate the compliance of their trading partners (e.g., those healthcare providers who bill them). The posted guidance document can be used by covered entities to design and implement a contingency plan.
Medicare Levy Surcharge: People whose taxable income is greater than a specified amount (in the 2011/12 financial year $80,000 for singles and $168,000 for couples [16]) and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the people in this ...