...The TRICARE Provider Handbook provides important information about TRICARE, while emphasizing key operational aspects of the program and program options (Bryant & Stratton, 2012, p. 1). The information that I think would be most important to me to keep as a quick reference would be the information on how to submit claims. There are certain requirements when submitting electronic and paper claims. Electronic claims can be broken down into different categories. For example, one can submit a claim as an Xpress claim, eZ TRICARE Claim, Claims clearinghouse, and Electronic Data Interchange Gateway (Bryant & Stratton, 2012). According to Bryant & Stratton TRICARE provider handbook (2012), Xpress claims are claims that are submitted and the payments are received by the providers instantly. Providers are also able to print a summary receipt with this type of submission. There is no cost to use this service by providers. EZ TRICARE claims allow providers to upload groups of claims directly from their practice management system. There is no software to install, no data entry, and no cost to file TRICARE claims. EZ TRICARE claims can accept a variety of claims formats. This is a no cost service to providers as well. Paper claims are sent via mail. Although these are more seldom used, they do still circulate. There are more chances that a claim will be denied when using paper claims. The person that is filing the claim must ensure the CPT codes are correct as well as making...
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...Contracting and Ethics Author: Alfred Turner Professor: Michael Hanners Strayer University 20 January 2012 Abstract This paper will discuss the GAO analysis to determine whether Aetna Government Health Plans LLC (AGHP), should be excluded from the competitive bid based on alleged unfair competitive advantage stemming from AGHP’s hiring of former TMA (TRICARE Management Activity) employee. Health Net argues that the award to AGHP has been irreparably tainted do the fact that AGHP has hired one of Health Net top level with access to inside, non public source selection information and contract proprietary information. This paper will also go into details on some of the tactics to prevent this from happening if he or she knew about this contract. I will try to identify and legal and ethical issues related to the issue. While reading this Case and carefully and thinking this out after reading the FAR. If the employee that Aetna hired from TMA (TRICARE Management Activity. There is little to nothing that the FAR states that this contract shouldn’t be awarded to Aenta. There is nothing stating that the former TRICARE employee knew anything about this RFP, therefore by law you can not exclude AGHP from the competitive bid range. Actions for TMA to take Why there appears to be little TMA can do. TMA may want to do an investigation and start by going to their former employee contract history to see was a pattern started with him and AGHP. Was he ever on the awarding...
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...Tricare Medical Targeted UMUC Brandon Murchison Table of Content Abstract ……………………………………………….3 Tricare/Data Breach……………………………..4 Stolen medical price/Chart…….……………..5 Hackers Motivation………..……………………..6 Conclusion…………………………………………….7 Reference……………………………………………..8 Abstract Hackers, while this term originally referred to a clever or expert programmer, it is now associated commonly in reference to someone who can gain unlawful access to other computers. A hacker can "hack" his or her way through the security levels of a computer system or network. This can be as simple as figuring out somebody else's password or as complex as writing a custom program to break another computer's security software. Hackers are the reason software manufacturers release periodic "security updates" to their programs. While it is unlikely that the average person will get "hacked," some large businesses and organizations receive multiple hacking attempts a day. In this instance the organization falls under health care, with digital medical records becoming more and more common this allow massive amounts of personal data to become vulnerable to hackers. This paper will cover not only hackers but the motivations of the hackers and ways to help defend and prevent. Medical records have become similar to finding gold during the California gold rush for identity thieves. This is exactly why healthcare provider’s cyber-attacks have become more and more frequent. These data breaches exposes...
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...I chose the profession that utilizes health information management which is called the Chief Information Officer (CIO). It is a job title for the head of information technology within an organization. The CIO typically reports to either the chief financial officer or, in IT-centered organizations, to the chief executive officer. CIO is a job title commonly given to the person in an enterprise responsible for the information technology and computer systems that support enterprise goals. As information technology and systems have become more important, the CIO has come to be viewed in many organizations as a key contributor in formulating strategic goals. Typically, the CIO in a large enterprise delegates technical decisions to employees more familiar with details. Usually, a CIO proposes the information technology an enterprise will need to achieve its goals and then works within a budget to implement the plan. Typically, a CIO is involved with analyzing and reworking existing business processes, with identifying and developing the capability to use new tools, with reshaping the enterprise's physical infrastructure and network access, and with identifying and exploiting the enterprise's knowledge resources. Many CIOs head the enterprise's efforts to integrate the Internet and the World Wide Web into both its long-term strategy and its immediate business plans. The prominence of the CIO position has risen greatly as information technology has become a more important...
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...Case Brief SUBJECT is an employee of the Widget Corporation. SUBJECT is assigned a computer and thumb drive. During basic maintenance, Mr. I am Helpful, Human Resource Specialist, for the Widget Corporation, was presented with what appeared to be an image of a young child depicted in a sexually explicit manner. Mr. I am Helpful telephoned myself, and employee of the Widget Corporation assigned as a technical specialist to the company’s Intellectual Property and compliance section. I responded and observed the image and confirmed it to be a violation of a state statue. I then removed the evidence from Mr. I am Helpful and presided to recover the evidence. Objective: To determine whether SUBJECT possessed child pornography. This was complicated by the number of people who handled the devices. Offense: Possession of child pornography Chain of Custody: See attached form Processing Packaging: Toshiba disk drive was taken from Mr. I am Helpful and placed in a clear antistatic bag. The bag was then sealed and marked with initials DPF. USB thumb drive was taken from Mr. I am Helpful and placed in clear antistatic bag. The bag was then sealed and marked with initials DPF. Toshiba disk drive and USB thumb drive were then placed in cardboard boxes surrounded by Styrofoam inserts. The cardboard boxes were finally labeled on the outside with the time, and date stamp of the packaging. Transportation: The cardboard boxes containing the evidence are loaded into the van. The boxes...
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...Tricare is a health care program utilized by the United States Department of Defense. The program provides civilian health benefits for active duty military personnel, military retirees, families of active duty members or retirees, as well as survivors and former spouses. In order to address the issue of decreased access to medical care in military facilities due to lack of resources and growing demand, Congress passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These legislations allowed the Secretary of Defense to contract medical care to civilian health care providers. The civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services, or...
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...Tricare Prime is a managed care option that is used for Active duty members. Active duty family members may choose this plan or one of the others. This option has fewer out of pocket costs and less freedom of choice for a provider to choose. With this option you have an assigned primary who you see. The care is usually provided in a military facility. With Prime there are no out of pocket costs, no enrollment fees, no network co-payments or no point of service fees. Tricare Extra is an option where you choose your provider that is in network. This plan is available to active duty family members, survivors, retired service members, non- active guard/reserves. You have an annual deductible you must meet then you only pay your co-pays as long...
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...The History and Future of TRICARE and HIPP Abstract In this term paper I will discuss the history and future of Tricare and HIPAA. Tricare is the program that the military provides for active duty and retired service personnel, their eligible family members and survivors' healthcare. I will be discussing the history and the future of Tricare. I will also discuss the types of Tricare. HIPAA stands for Health Insurance Portability and Accountability Act. It was enacted by the U.S. Congress and signed by President Bill Clinton in 1996. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. I will also discuss the differences, if any on how HIPPA is applied at military and civilian hospitals. History of Tricare In 1884, Congress set the stage for a program to serve the Armed Forces' medical needs. It was a very simple statement: “Medical officers of the Army and contract surgeons shall whenever possible attend the families of the officers and soldiers free of charge.” In 1943, Congress gave the go ahead for the Emergency Maternal and Infant Care Program (EMIC). This program provided maternity and infant care up to one year of age for wives and children of Service members...
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...Intro to task two: The Indian Health Service (IHS): The IHS is a health care system for nearly 2 million American Indians and Alaska Natives who belong to the 566 different, federally recognized, tribes in 35 states. 1 IHS is an agency within HHS, which is the Department of Health and Human Services. 2 The Indian Health Service was established in 1955 taking over from the Bureau of Indian Affairs. It is based on Article I, Section 8 of the Constitution and the relationship developed from numerous treaties, Executive Orders, and Supreme Court decisions 3. The IHS is the primary health care provider for the American Indian people 4, and it’s dedicated to raise their health and well-being to the highest level. Health Information Exchange(s): A Health Information Exchange is the virtualization of healthcare information electronically, and access to said information exchanged between HIE members. This data spans across organizations within a community, or hospital system, or even whole regions. HIEs facilitate transmitting protected health information to other organizations and government agencies according to national standards. HIEs often include collaboration among physicians, home health, nursing homes, hospitals, and mental health facilities. 5 Federal Employees Health Benefits Program: The FEHB Program is for Federal employees present and retired as well as their survivors. Members have the widest selection of health plans in the country. With the ability to choose...
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...The challenges which are met in today’s healthcare are vast. It would seem that there are obvious reasons for the incorporation of health informatics to justify apparent flaws in the government programs such as Medicaid, TRICARE and Federal Employees Health Benefits Program are three legislative policies which impede its progress. With most disciplines there exists certain parameters which provide the basic focus for which the disciplines fashion themselves around. In all there are seven elements in the public health sector; http://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a5.htm, and in this scope exist, planning and systems design, data collection, data management and collation analysis, interpretation, dissemination, and finally the application to public health programs. Like most new technologies; robust changes to processes can be delivered, but are met with opposition. Health information technology can defeat a lot of the lethargic processes comprised in healthcare management, but arguably by some as the use of terms such as unintended consequences can slow growth to the field and prospects of health information exchange http://www.amia.org/amia2012/panels. It is believed that while the Electronic Health Record would be composed and stored within secured database systems that there is huge risk which exist; patient privacy, as mandated by the Health Insurance and Portability and Accountability Act (HIPPA). The opposition that some have towards health informatics...
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...families’ healthcare is currently proposed to be cut saving the Federal Government approximately $1.8 billion by 2013. TRICARE, the health care program for active duty, retirees, and military families, was enacted May 1997. TRICARE replaced Civilian Health and Medical Program of the Uniformed Services “CHAMPUS” and was intended to increase quality of care for eligible beneficiaries. TRICARE has several different plans that make up the overall TRICARE health care program. TRICARE Prime the plan for active duty, their dependents and retired personnel. TRICARE Prime is a HMO style plan with no enrollment fee. Beneficiaries have a primary care provider, typically at a military installation’s medical facility; they see and attain referrals from for all specialty care. TRICARE Reserve Select is available to all military reservists. TRICARE Reserve Select has a monthly premium and allows beneficiaries to see civilian healthcare providers that are payable under TRICARE regulations. In May 2001 TIRCARE for life was added for retired military personnel and their families who prior to TFL lost their TRICARE benefits once enrolled in Medicare. TRICARE for Life pays the remaining patient responsibility of medical costs after Medicare coverage has been utilized. TRICARE Young Adult is available to unmarried military dependents ages 21-23 years old attending college full time. TRICARE Young adult was...
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...than four million babies born annually in U. S. hospitals (Kozhimannil), and more than 100,000 babies born to Tricare beneficiaries annually (Abramson), the cost of maternity and newborn care exceeds any other hospital expense – and those costs are rising (Truven Analytics). With budget cuts necessitating review of Tricare benefits and payments for medical services of all kinds for beneficiaries, it would seem counterintuitive to suggest that a way for Tricare to save money on maternity and newborn care would be to cover a new service. However, research shows that the cost savings associated with doula support during labor and delivery are significant...
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...Veteran Health Administration Disability Claims Introduction The United States Armed Forces serve the nation selflessly; therefore, they deserve the compensation guaranteed to them by the federal government, especially after engagement in combat. American troops are will begin departing from Afghanistan this year after 11 years at war; however, it seems that the government is not committed in compensating former armed service personnel. This is due to the increasing number of veterans’ claims accumulating in the Veterans Affairs offices. Combat has severe impact on veterans and this impact may not only be physical, but mental as well. Many veterans suffer from post-traumatic stress disorder after witnessing the events of war. As a result, many cannot hold jobs to their families. Regardless of their service, there are more than 400,000 veterans who have not yet received resolution of their disability claims. A claim is considered a backlog case if it takes more than 125 days to be processed. Some veterans have been forced to wait over two years and hence suffered severe financial strains. Problem Statement Due to the wars in Iraq and Afghanistan, a vast number of disabled veterans have flooded the Veterans Health Administration system. Although it is the largest health care system in America, it has failed to effectively care for its veterans. There are currently over 400,000 unprocessed medical...
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...Healthcare Ecosystems LTT2 The challenges which are met in today’s healthcare are vast. It would seem that there are obvious reasons for the incorporation of health informatics to justify apparent flaws in the government programs such as Medicaid, TRICARE and Federal Employees Health Benefits Program are three legislative policies which impede its progress. With most disciplines there exists certain parameters which provide the basic focus for which the disciplines fashion themselves around. In all there are seven elements in the public health sector; http://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a5.htm, and in this scope exist, planning and systems design, data collection, data management and collation analysis, interpretation, dissemination, and finally the application to public health programs. Like most new technologies; robust changes to processes can be delivered, but are met with opposition. Health information technology can defeat a lot of the lethargic processes comprised in healthcare management, but arguably by some as the use of terms such as unintended consequences can slow growth to the field and prospects of health information exchange http://www.amia.org/amia2012/panels. It is believed that while the Electronic Health Record would be composed and stored within secured database systems that there is huge risk which exist; patient privacy, as mandated by the Health Insurance and Portability and Accountability Act (HIPPA). The opposition that...
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...RESERVE COMPONENT HEALTH COVERAGE REQUEST PRIVACY ACT STATEMENT AUTHORITY: 10 U.S.C. 1076d and 1076e. PRINCIPAL PURPOSE(S): This form is used by certain Reserve Component members and retired members to purchase or make changes to coverage under the TRICARE Reserve Select and TRICARE Retired Reserve (TRR) health plan. Please see 32 CFR 199.24(c) and 199.25(b) for a list of eligible beneficiaries. ROUTINE USES(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, disclosures may be made to Federal, State, local and foreign government agencies, private business entities, and individual providers of care on matters relating to entitlement, fraud, program abuse, program integrity, or civil and criminal litigation related to the operation of the TRICARE Reserve Select and TRICARE Retired Reserve programs. DISCLOSURE: Voluntary;; however, failure to furnish all requested information will result in the applicant being unable to obtain TRICARE Reserve Select or TRICARE Retired Reserve health plan coverage. INSTRUCTIONS Please review the information in Block 1 for accuracy and provide corrections in Block 2. Then, verify the information printed in Blocks 3 - 6 and sign Block 6 if paying initial payment by Visa or MasterCard...
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