Tag Archives: California Department of Workers Compensation

How to Use HIPAA to Obtain Timely Medical Records

Are you hip to HIPAA?

August 27, 2018 by 

Members of the claims management team obtain medical records on a frequent basis when investigating workers’ compensation claims. It is important they do this promptly given the many constraints of workers’ compensation laws. Given the nature of these requests, state and federal privacy laws come into play. Failure to understand these laws and their requirements can lead to delay and problems down the road. Now is the time to better understand these laws and how to incorporate them into your team’s best practices.

It All Starts with HIPAA

HIPAA logo for article, How to Use HIPAA to Obtain Timely Medical RecordsThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) serves as the basis for healthcare privacy and the dissemination of medical records in the United States. The law was enacted in 1996 to address the many issues medical providers were facing and to protect the privacy of all individuals. In essence, it serves as the baseline for standards enacted at the state level for all covered entities.

Understanding the Basics of HIPAA

To understand the law, it is important to understand when it applies and whom it protects. HIPAA applies to all “covered entities,” which are defined under 45 C.F.R. §160.103, as:

Health care providers who transmit “protected health information;”

Entities that process personal health information (healthcare clearinghouses);

Health plans such as Group Health Plans; and

Any business partner of a “covered entity.”

It is also important to note that the federal law applies to “protected health information,” otherwise known as PHI. This is information defined under 45 C.F.R. §164.501, which is individually identifiable health information maintained or transmitted in any form, whether electronically, on paper or orally.

Exceptions to HIPAA in Work Comp

Employees at healthcare providers are required to know and understand HIPAA and have a duty to protect a patient’s PHI. Continue reading How to Use HIPAA to Obtain Timely Medical Records

What Will Workers’ Compensation Look Like in 20 Years?

Dept. of Workers' Comp crystal ballBy Safety National

At the 67th Annual SAWCA Convention, Frank Neuhauser, Executive Director of the Center for the Study of Social Insurance (CSSI) at University of California at Berkeley, opened this keynote session by discussing the future of workers’ compensation.

Workers’ Compensation’s Inefficient Delivery

He noted that the current system does not efficiently address the issues that employers and employees face today. In 1915, the system was primarily created to support a heavily industrialized workforce, which is no longer the case.

The organizational costs associated with administering $1.00 of medical treatment under workers’ compensation is estimated to be $1.25 versus .14 cents to administer at this same level of service under a group health plan.

In addition, the use of workers’ compensation Medicare set asides (MSA) create a loss between 25-40% to Medicare and the MSA process has exposures related to it that are inefficient and have the potential to become costly.

Neuhauser recommends that a more-streamlined approach needs to be designed by the states to limit the duration of employers’ liability of two years and then assess insurers and self-insurers “fair” payment to a Medicare Trust Fund.

Improvement Needed on Controlling Non-Traumatic Claims Costs

Non-traumatic injuries make up 67% of claims and 75% of claim dollars. So where do these injuries frequently occur? An employee is four times more likely to suffer a fatal injury away from the workplace and 75% of workers are in occupations that are low hazard.


Top 10 Excuses For Not Reducing Work Comp Costs

  1. Too costly, something that in reality is a misperception, referring to the cost containment process;Top 10 illustration
  2. The business is decentralized and its operating units are in fact autonomous;
  3. The company is centralized, thereby making it unable to have any sort of influence on the operating units’ decision-making;
  4. The business is unionized, therefore the union will forbid it from making the necessary changes (in most cases, this is simply false);
  5. A business that is too large (one with an abundant amount of silos, regulation and inflexibility) or too small (too few resources) can’t decrease costs;
  6. The business simply believes it is unable to have a return to work program;
  7. The company believes it is unable to produce modified or transitional positionsin its environment;
  8. The company’s management does not back them (bad take in order to achieve commitment);
  9. In fact, the claimant’s (plaintiff) attorneys are the root of the problem, making it imepossible for the company to improve;
  10.  Those businesses based in other countries with U.S. operations claim there is too much litigation in America.By