New MSA / HSA Patient Identification Programs

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Further Implications of the U.S. Patriot Act for Hospitals

By Dr. David E. Marcinko; MBA, CMP™

By Hope R. Hetico; RN, MHA, CMP™dave-and-hope4

With the recent popularity and growth of health savings accounts (HSAs) and / or medical savings accounts (MSAs), compliance with the USA Patriot Act of 2002 has become an important issue for these new, hybrid health insurance products.

Many of these insurance plans place patients and insurers into relationships with shared information institutions like hospitals, healthcare organizations, medical clinics and patient clients.

The “Online” Connection

This occurs because many, perhaps even the majority of HSAs, MSAs and high deductible healthcare plans [HD-HCPs] are opened online, as patients and insurance company clients use Internet search engines to find the “best” policy type to meet their needs. 

Ditto, for more traditional health insurance plans, as well? 

Example: 

For example, on October 1, 2003, Section 326 (Customer Identification Program) of the US Patriot Act went fully into effect, requiring the implementation of reasonable procedures to verify the identity of new customers and certain existing customers opening a new MSA or HSA account. 

And, Section 3261 of the Act also requires banks, savings associations, insurance companies, hospital and medical union credit unions, and certain non-federally regulated banks to have the CIP fully implemented. Broker-Dealers [BDs] in securities are subject to similar, but slightly different rules.   

Bank Secrecy Act [BSA] 

For additional compliance, The USA Patriot Act also amended the Bank Secrecy Act (BSA) to give the federal government enhanced authority to identify, deter and punish money laundering and terrorist financing activities.

Increased Hospital Vigilance

This, the passage of the USA Patriot Act – and these important derivatives – means that affected hospitals and healthcare organizations must be more vigilant about laws concerning money laundering; reporting of disease and quarantine; and cyber attacks.

Moreover, it means that healthcare organizations must adhere to the Act, regarding affected health insurance policies, by meeting its Customer Identification Program (CIP) and anti-money laundering requirements.  

Assessment

Whatever the financial outlays required for compliance – there be very large savings later if affected hospital assets and patient health insurance information is safeguarded against attacks of virtual or real assets. 

Conclusion

And so, what is your opinion on the above health law and policy? 

Related source:Marc B. Royo and David B. Nash.Sarbanes-Oxley and Not-for-Profit Hospitals: Current Issues and Future.”

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

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Charitable Giving Terms and Definitions for Physicians

A “Need to Know” Glossary for all Medical Professionals

Staff Writer’sdhimc-book

For most medial professional’s, charitable giving can either be a financial planning goal or an economic tool to achieve other goals more effectively.   

When charitable giving is viewed as a financial goal it becomes a very personal matter to the physician, much like an individual’s other lifestyle choices. 

For some doctors, charitable giving is a way of showing gratitude for their well-being. For others, it is a matter of social status. Still some physicians approach charitable giving as a discipline of their religious or philosophical view of life.  

Nevertheless, various charitable giving techniques are available to meet a physician’s unique financial planning requirements. These techniques generally fall into two broad categories: current gifts and planned or deferred gifts.  

Current gifts are rather simple techniques that can be completed at or near the current moment.

Planned or deferred gifts are generally complicated transactions that are to be completed in the future. 

Use of a particular charitable giving technique will depend largely on the doctor’s capacity to understand and evaluate complex alternatives – strength of donative intent – as well as his/her current and future cash flow needs, types of assets owned, strength of charitable intent, and income and estate tax considerations.

Glossary of Terms

5% probability rule: In general, charitable income tax deductions are disallowed when there is greater than a 5% chance that a noncharitable beneficiary will live long enough to exhaust the charity’s remainder interest. Charitable remainder unitrusts are exempt from this rule [Rev. Rul. 77-374]. 

Bargain sale: A sale of property to a charity for less than the property’s fair market value [Regs. §1.1011.2].

Charitable gift annuity: An arrangement under which a donor makes a gift to a charity in exchange for systematic payments of income for a period of time [Regs. §1.170A-1(d)]. 

Charitable income trust: A trust created by a donor doctor that provides for income payments to a charity for a period of time, after which the remainder is paid to a non-charitable beneficiary. Payments to the charity are limited to the amount of income earned by the trust [Rev. Rul. 79-223]. 

Charitable lead trust: A trust created by a donor that provides for payments to a charity for a period of time, after which the remainder is paid to a non-charitable beneficiary. Payments to the charity are either a fixed amount annually or a fixed percentage of the value of assets in the trust at the beginning of each year. Payments are not limited to the amount of income earned by the trust [IRC §664(a)]. 

Charitable remainder trust: A trust created by a physician-donor that provides for payments to a non-charitable beneficiary for a period of time, after which the remainder is paid to a charity. Payments to the non-charitable beneficiary are a fixed amount annually. Payments are not limited to the amount of income earned by the trust [IRC §664(a)].

Charitable remainder annuity trust (CRAT): A trust created by a physician-donor that provides for payments to a non-charitable beneficiary for a period of time, after which the remainder is paid to a charity. Payments to the non-charitable beneficiary are a fixed amount annually. Payments are not limited to the amount of income earned by the trust [IRC §664(d)(1)].

Charitable remainder unitrust (CRUT): A trust created by a physician-donor that provides for payments to a non-charitable beneficiary for a period of time, after which the remainder is paid to a charity. Payments to the non-charitable beneficiary are a fixed percentage of the value of assets in the trust at either the beginning or the end of each year, depending on the trust agreement. Payments are not limited to the amount of income earned by the trust [IRC §664(d)(2)].

Donative intent: The inclination of a physician-donor to make a gratuitous gift to charity.

Income in respect of a decedent: Amount due and payable to a decedent at his or her death because of some right to income. Examples of income in respect of a decedent include salaries, retirement benefits, annuity payments, interest, dividends, rents, and deferred gain on an installment contract, earned but not received by the decedent before his or her death [IRC §691(c)(2)].

Insubstantial rights: Rights to the use of donated property that is retained by a physician-donor when the retained rights do not interfere with the donee-charity’s unrestricted use or full ownership of the donated property [George v. U.S. 11/30/61, DC-MI]. 

Pooled income fund: A fund that commingles property gifted by several donors, where each donor designates a non-charitable person to receive income for life and a charity to receive the remainder interest [Regs. §1.642(c)-5].

Private foundation: A tax-exempt organization under IRC §501(c)(3) that does not enjoy a broad base of public support [IRC §§508, 509].

Public Charity: A tax-exempt organization under IRC §501(c)(3) that enjoys a broad base of public support [IRC §509(a)(2)].

Qualified appreciated stock: Stock for which a market price quotation is readily available and that would generate a capital gain if sold [IRC §170(e)(5)].

Qualified charity: An organization described in IRC §170(c). Gifts to these organizations can be deducted by donors for income, gift, or estate tax purposes. 

Qualified conservation contributions: A restriction on the use of real property, a remainder interest in real property, or a physician-donor’s entire interest in real property that is given to a qualified charity for conservation purposes [IRC §170(f)(3)(A)].

Quid pro quo: The expectation by a physician-donor that he or she will receive a bargained-for benefit in exchange for a gift to a charity [Rev. Rul. 76-185].

Reduction rules: Exceptions to the general rule that gifts to charity are deductible to the extent of the fair market value of the donated property [IRC §170(e)(1)(A)].

Supporting Organizations: A tax-exempt entity that is established by an individual or small group of donors for the purpose of supporting a public charity.

Remainder interests: Property rights that can be enjoyed only after prior rights have terminated. 

Undivided interests: Rights that joint owners share in the entirety of a property as opposed to rights they enjoy to segregated pieces of a property. 

For related information: www.HealthDictionarySeries.com 

Additional info: http://www.jbpub.com/catalog/0763745790/

Note: Feel free to send in your own related terms and definitions so that this section may be updated continually in modern Wiki-like fashion.

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Using Fraud Detection Software to Review Medical Claims

MDs May be Slow HIT Adopters – CMS and Insurers are Not!

Staff WritersShadows

Did you know that Medicare and private health plans increasingly have been “mining” medical claims data for potential fraud – for some time now – and with the help of sophisticated computer technology? 

Yes, it seems true – and such IT may be needed more than ever in 2008!

How Much Fraud? 

Fraud accounts for an estimated 3% to 10% of the $2 trillion spent annually on healthcare in the U.S. Within the past few years, companies including Fair Isaac, IBM, ViPS and Ingenix, a subsidiary of UnitedHealth Group, have developed software that detects suspicious patterns in claims data.  

“Spider-Web” Technology

According to the CMS, their technique is called “spider-webbing. 

IOW: Find one common denominator and follow the thread. 

“Red flags” indicating possible fraud include medical providers charging more than peers; providers who administer more tests or procedures per patient than peers; providers who conduct medically “unlikely” procedures; providers who bill for more expensive procedures and equipment when there are cheaper options; and patients who travel long distances for treatment. 

Private Insurers to Follow CMS

For example, Aetna reported its fraud-detection software helped the insurer prevent more than $89 million in fraudulent reimbursements from being paid last year, compared with $15 million it was able to recover after fraudulent payments were already made.

Companies are able to save far more money by detecting fraud before claims are paid than recovering the money after the fact. 

Conclusion 

And so, what are your thoughts on this HIT initiative? Are the private insurance companies and CMS taking advantage of the slow HIT adoption of medical providers? Who is to blame, if anyone? 

Please comment: 

More info: www.HealthcareFinancials.com

Related info: http://www.jbpub.com/catalog/9780763733421/ 

Original source: USA Today 11/07/06

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