Course Project: Blue Cross and Blue Shield Jacqueline Cohen DeVry University HIT 120 Michelle LeVack Course Project: Blue Cross and Blue Shield Course Project: BLUE CROSS AND BLUE SHIELD Blue Cross and Blue Shield headquarters is located in Chicago, Illinois. The Blue Cross Blue Shield Association (BCBSA) is a federation of 36 separate United States health insurance organizations and companies, providing health insurance to more than 106 million Americans today. Blue Cross was founded in 1929, and became the Blue Cross Association in 1960, while Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948. The two organizations merged in 1982. Blue Cross and Blue Shield developed separately, with …show more content…
Getting the right information and protecting the privacy of patient’s medical records is very important to BCBS, so how medical information is used and disclosed is valued and protected. Medical information may be used and disclosed by BCBS for purposes of treatment, payment and health care operations. A patient’s medical record may also be disclosed to physicians or other health care professional to help him or her provide treatment. BCBS may use members/patient medical information for different forms of payment: Paying claims from physicians, hospitals and other health care providers, obtaining premiums, issuing explanations of benefits to the named insured, providing information to health care professionals or other entities for their payment activities. BCBS may use or disclose medical information in conducting health care operations, including: Quality assessment and improvement activities, reviewing the qualifications of healthcare professionals, compliance and detection of fraud and abuse, underwriting, enrollment and other activities related to creating, renewing or replacing a plan of benefits; providing information to another entity bound by the Federal Privacy Rules for its health care operations. BCBS may share your medical information to a family member, friend or other person for him or her to assist with your health care or payment for your health care. Employers may use the health information from BCBS
. HIPAA privacy rules are complicated and extensive, and set forth guidelines to be followed by health care providers and other covered entities such as insurance carriers and by consumers. HIPAA is very specific in its requirements regarding the release of information, but is not as specific when it comes to the manner in which training and policies are developed and delivered within the health care industry. This paper will discuss how HIPAA affects a patient's access to their medical records, how and under what circumstances personal health information can be released to other entities for purposes
In the health care business, there are certain standards and laws that have been put in place to protect our patients and their personal health information. When a health care facility fails to protect their patient’s confidential information, the US Government may get involved and facilities may be forced to pay huge sums of money in fines, and risk damaging their reputation.
2. San Diego Business Journal Best Places to work and HR Professional Of The Year Awards Supplement, August 20, 2012 v33 i34 pS29(1)
CCC staff are expected to treat all Protected Health Information (“PHI”) and Personally Identifiable Information ( ”PII”) in any form (paper, electronic, or verbal) as confidential in accordance with government regulations and are not to divulge PHI unless the patient, or a legally authorized representative has properly authorized a release of information, or as otherwise permitted or required by law. CCC staff will only release the minimum amount of information necessary to fulfill a
Shadow charts were developed to gather data and information for additional departments and medical personnel that need access to part of a patient’s file or records. The original records should always remain in the patient’s primary chart allow copies may be available to ancillary departments that may need access to the information. The same level of confidentiality and security applies to the shadow charts. They must be in a secure location with access by authorized personnel only. Additional information that should be included in shadow charts is a formal recording process to document those who access the information. Furthermore, a consistent system of upgrading the
This week I began my 6-week internship at Blue Cross Blue Shield of Nebraska (BCBSNE). The first day was a common orientation for all new employees, internally denoted to as the “onboarding process” where all employees are told they matter. This full-day session communicates the core mission, vision and goals of BCBSNE, organizational structure, operating objectives, and workplace culture. BCBSNE is a not-for-profit health insurance company that is focused on collaboration to find the best solution for their customers; in other words, they are customer-focused. Since the implementation of the Affordable Care Act (ACA), many changes to the health insurance market required a change in the organizational structure and culture of BCBSNE. Through partnerships with providers, the goals of BCBSNE are to be responsive, accountable, minimize errors, and decrease costs – all components of the ACA. BCBSNE has strategically aligned their goals to those of the government-mandated goals, and implemented them at all levels of the organization, making them competitive in the health insurance market. I found this very fascinating: I was very excited after day one!
Providing information to patients or staff who have questions about HIPAA and their privacy protections
The Health Insurance Portability and Accountability Act (HIPAA) was passed by congress in 1996, and helps to ensure the privacy and security of Electronic Health Records (EHR's). By following the rules and regulations set forth under HIPAA, we can ensure the safety of patients' EHR's. We are responsible for protecting patients' records, and there are many measures we can take in order do this. Firstly, we must always keep patients' health information private. This means no discussing the records with people that are not authorized to know, and even then, we should only disclose the minimum necessary amount of information possible. For covered entities, we must designate a privacy and security officer to ensure the privacy
HIPAA and HITECH Act help address several problems associated with inappropriate use of healthcare information by authorized users. HIPAA requires minimum necessary infor-mation to be released while HITECH goes into a little further detail but still to release minimum necessary information. Several different organizations need to define how they go about han-dling inappropriate use of information. A guideline must be set within the organization on who will have access to the information and how it is disbursed to other healthcare organizations re-questing records.
Any patient that is seen by a physician within the United States is to be protected by the “Health Insurance Portability and Accountability Act” or HIPAA, which was passed into law in 1996 (Jani, 2009). All health care facilities dealing with any protected health information (PHI) are to ensure that all physical/electronic processes are safeguarded from any third party entity or unauthorized personnel according to HIPAA. All health care data to include any medical insurance
Blue Cross and Blue Shield of Illinois (BCBS) is considered the largest and most experienced insurance company in Illinois. BCBS was founded in order to provide healthcare to teachers at a reasonable cost. It services over 7 million people. Its mission is “To promote the health and wellness of members and communities through accessible, cost-effective, quality health care” (Blue Cross Blue Shield, 2012). Blue Cross Blue Shield provides its customers with affordable health care. The parent company is Blue Cross Blue Shield Association its signature tag is “Creating Healthier Communities,” BCBS does not have any investors and the customers are considered the investors of the company and essentially who BCBS answers to. This is an important factor because they do not have to keep investors interest in the forefront of decision making, but rather they have the interest of their client in mind. (Blue Cross Blue Shield, 2012) In 2013 the Chicago based company reported profits of 684.3 million dollars. The company employees over 17,000 people. “Blue Shield of Illinois fell well below the $1 billion mark for the first time since 2009, in part because the insurance giant is setting aside money to offset expected losses from the troubled rollout of Obamacare” (Wang, 2014). Despite this setback it continues to expand over various parts of the United States. BCBS
But when those involved in these legitimate activities make demands that seem inappropriate, the records must be protected. Disclosure of personal medical information should also be subject to patients’ or families’ consent (Richmond et al. 2009).
Today’s market demands organizations to have a strategic plan. The purpose of the strategic plan describes where the organization wants their organization to go. A strategic plan is a document used to communicate goals, and the actions needed to achieve those goals. In order to remain competitive every organization needs to innovate to stay ahead of the competition. They need to develop new products and services with increasing frequency. The design of these new products and services must meet, or exceed, customer expectations and at the same time, they must generate an acceptable financial return for the organization. However, any business that does not realize the importance of developing new products will not last very long as a consequence
There are many regulations healthcare providers face in challenges. One is HIPAA which governs how providers disclose protected health
The confidentiality of patient visits and medical records are essential in providing the highest quality of health care. Under penalty of law, a patient's medical records or any other information regarding the patient may only be released with his or her authorization. Exceptions to this are certain cases specified by law for example, health care providers are required to report certain communicable diseases such as measles. Many organizations and laws have been developed to maintain patient's rights of confidentiality and access to their medical record. Guided by the principle that confidentiality is essential in developing strong trust between patients and healthcare providers, the