Pyc3705 Assignment Of Benefits

Chapter 1 page 2-6 Assignment 1-1 Review Questions
#2 a.) Acute care hospitals
    b.) Skilled nursing facilities
    c.) Rehabilitation centers
#4 a.) Multi-skilled health practitioner (MSHP)
    b.) claims assistance professional (CAP)
    c.) insurance billing specialist
#5 a.) Abstract health information from patient records
    b.) Exhibits an understanding of ethical and medico legal responsibilities related to insurance                                         billing programs
    c.) Operates computer to transmit insurance claims
#9 a.) Failure to verify insurance plan benefits
    b.) obtain authorization or precertification
    c.) collect copayments and deductibles
#12 a.) Illegal
      b.) illegal
      c.) unethical
#15. D #23. False
#16. C #24. True
#17. A
#18. D
#19. A
#20. True
#21. False
#22. True
Chapter 2 Pages 16-18 Assignment 2-2: Critical Thinking-Incidental Disclosure versus HIPAA Violation
#2. (V) When someone calls you always make sure who you are talking to. Never give patient information to anyone without confirming information regarding the patient first.
#3. (N) When sending a fax there is a cover page. Noted at the bottom of the cover page it should say that the fax is intended for the person wrote on the line, if you are not that person please send fax back to the number it was faxed from.
#4. (ID) It is great that people try to speak softly, but there are times that other’s won’t hear you.  
#6. (ID) When talking to some patients on the phone you need to speak loudly and clearly. Walls are thin in a doctor’s office. No matter how hard you try to speak softly, someone is going to heat something of the conversation.  
#9. (V) When leaving a message tells the person who you are and that they need to return your call, and leave number. Never leave information on an answering machine.
#10. (V) When calling a patient, call by their first name or say Mr. or Mrs. And say their last name....

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TALLAHASSEE — Readying to leave the state Cabinet at the end of the month, Florida Chief Financial Officer Jeff Atwater said Wednesday that lawmakers need to address an insurance practice that critics argue is driving up homeowners’ rates.

Lawmakers this spring could not agree on changes to the practice known as “assignment of benefits.” Insurers contend the practice has become riddled with fraud and abuse — particularly in claims for water damage to homes — and is increasing property-insurance costs

“The Legislature needs to deal with it,” Atwater, who has been heavily involved in insurance issues, said after a Cabinet meeting.

The issue involves homeowners who need property repairs signing over benefits to contractors, who then pursue payments from insurance companies. Insurers argue the process has been abused by some contractors and law firms, spurring litigation and higher costs. But contractors and plaintiffs’ attorneys contend the process helps force insurers to properly pay claims.

Even as he called for lawmakers to address the issue, Atwater was careful Wednesday to say that legitimate claims need to be paid, describing the situation as a “balancing act.”

“We never want to harm any individual out there in getting the absolute quick and full coverage they deserve on a claim,” Atwater said. “But the majority of this right now is costing the honest Floridian tremendous pain.”

Atwater, who will leave the Cabinet on June 30 for a job at Florida Atlantic University, made the comments after Insurance Commissioner David Altmaier spoke to Gov. Rick Scott and Cabinet members about the assignment-of-benefits issue. The state-backed Citizens Property Insurance Corp. also has been heavily involved the assignment-of-benefits debate.

Altmaier, who unsuccessfully lobbied this spring for the Legislature to pass an assignment-of-benefits bill, said his agency is looking at regulatory steps to address the issue.

“We are going to continue to see homeowners’ insurance companies raise their rates for our consumers in a best-case scenario, and in a worst-care scenario, just simply stop offering their products in certain regions of the state,” Altmaier said.

The House in April approved a bill (HB 1421) that would have made a series of changes, in part, to curb litigation about claims. But the Senate did not take up the measure, which was derided by opponents as being too favorable to the insurance industry.

After the session, the Florida Justice Association, which represents plaintiffs’ attorneys, said defeating the assignment-of-benefits legislation was one of its key achievements. On its website, the association said it had protected a “key property right by stopping the insurance industry's attempts to restrict the ability of homeowners to engage emergency remediation services through assignment of benefits agreements.”

Similarly, the Florida Association of Restoration Specialists disputed that a “crisis” exists with assignment of benefits and said insurers were trying to gain an advantage in paying claims.

“Insurance companies and their adjusters like to control the claim,” the group said on its website. “When they can hire their own adjusters and engineers they maintain the upper hand against their own insureds — us homeowners.”

But, like Atwater, state Agriculture Commissioner Adam Putnam said Wednesday that changes are needed, referring to “systemized fraud that’s known as AOB.”

“It will cost the citizens of Florida money, and it will continue to grow as a problem if unchecked,” said Putnam, who is running for governor next year.


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