Complete Claims Processing and Billing Solution

News

Here's where you can find out about what CHS is up to, what's coming in the future and events. Keep up to date with CHS happenings and find out what's on our calendar.

SIIA TRADE SHOW

It is time for the annual SIIA National Conference and Expo. As in years past, Complete Health Systems will be exhibiting at the show, which will be held on October 1 - 3, 2012 in Indianapolis, IN. The conference's theme is "Raising the Game".

Be sure to stop by booth #500, so we can show you how CHS can help improve how you manage self-insured programs.

RBS (REGULATORY BUDGET SENTINEL)

DEBATE OVER REGULATION OF STOP-LOSS INSURANCE DIVIDES INDUSTRY
By: Nicola Crean, CHS Marketing Coordinator

Stop-loss insurance has recently become a controversial topic that has industry professionals debating over the need for regulation with this type of health care insurance. While new legislation created updated standards and guidelines for insurance companies, stop-loss coverage has not been affected.

When the PPACA was passed, it brought on significant changes within the health insurance industry. It placed a burden on insurance companies to comply with new regulations and federal expectations. This legislation has created obstacles for insurers and how they operate their business.

From an employer’s perspective, companies have looked for ways to combat the rising cost of health care.  Some small businesses, in particular, are considering ways to manage their own insurance plans in-house to reduce costs.

“The Affordable Care Act is driving more organizations to look at becoming self-insured; and when you become self-insured, you are more interested in loss control,” said Art Koirtzinsky, managing director of Marsh Inc.’s Captive Solutions Group, as reported in an article published in Modern Healthcare.

Traditionally, large companies with enough risk predictability and the ability to pay health claims often choose to insure them, according to an article published in the Pittsburgh Post-Gazette. Smaller companies have been able to consider being self-insured by utilizing stop-loss insurance to assist with covering healthcare costs.

In the event that a company does not have the means to cover a medical claim, the stop-loss insurance will pay for the expense.  Essentially. this policy acts as a safety net for companies that choose to insure themselves. 

According to an article published in Life Health Pro, a stop-loss program can be determined based on each individual employee or on the company as a whole. The attachment point, or deductible, determines the amount that a company stops paying and the stop-loss policy takes over.

“In general, self-funded employers tend to be more generous than average when it comes to premium contributions for the employees,” says Janet Trautweign, chief executive of the National Association of Health Underwriters (NAHU), as reported in an article published in Life Health Pro. “Since plan designs can be adapted to accommodate claims and the unique need of the workforce, employers may be more apt to pay more towards overall employee premiums and may adjust coverage so that employees have more benefit cost-sharing.”

In theory, utilizing a stop-loss policy for any self-insured company has significant benefits. However, from the viewpoint of an insurance company, it provides them with an opportunity to provide a service that is free from restriction and standards that are required under the PPACA. This allows insurers to ultimately determine who they choose to cover, in addition to the rate they will charge. Essentially, insurance companies have the power to control the cost.

Within the healthcare industry, there are mixed opinion as to whether or not stop-loss insurance should be included under the PPACA. Some groups, such as the Self-Insured Institute of America, have demonstrated concern that new legislation could be a disadvantage for small businesses by reducing accessibility to multiple health care options.

On the other hand, companies that utilize stop-loss insurance do not have the ability to take advantage of the benefits that PPACA has to offer to both companies and their employees. While the debate continues, the future for stop-loss insurance appears to be optimistic as more companies consider becoming self-insured.

EMPLOYERS REQUIRED TO ACCOMMODATE INDIVIDUALS SUFFERING FROM SAD

By: Nicola Crean, CHS Marketing Coordinator

Employee well-being is a constant concern for all companies. Beyond the financial burden of unhealthy workers, businesses can suffer a loss of productivity and absenteeism, resulting in a decrease in revenue if employees are unable to perform in the workplace.

While there are many obvious things that contribute to an individual’s wellness, some factors may not be considered by both companies and their employees. One component that can have an effect on a person’s mental health is the season’s changing, which in turn results in less daily sunlight.

Seasonal Affective Disorder, or SAD as it’s commonly referred to as, is a mental illness that affects approximately 100 million Americans a year, according to an article published on the Society for Human Resource Management’s website. The disorder is ultimately a result of people not getting enough natural light throughout the day. Since sunlight decreases in the fall and winter months, this is the most common timeframe for individuals to experience symptoms of depression.

According to the Mayo Clinic’s website, SAD is a depression that occurs annually at the same time of year. Although the definite cause is unknown, the clinic reports that there are three major factors that have been determined to contribute to this disorder.

One explanation is that the decline in sunlight causes a disruption in the body’s circadian rhythm, or natural biological clock. Additionally, Mayo Clinic reports that a reduced intake of natural light may decrease the level of serotonin in the body, which is a chemical that affects mood. Additionally, melatonin, a hormone affecting sleep patterns and mood, can be affected by seasonal changes.

“We have learned in the past five years that it’s the presence and intensity of light in the blue region of the visible spectrum that suppresses our body’s daytime product of melatonin, and helps regulate our internal clock know as our circadian rhythm, which signals the body to fall asleep and wake up at proper times,” said Neal Digert, PH.D, in the article published on Society for Human Resource Management’s website.

Many of the symptoms that accompany SAD can ultimately affect individuals throughout every aspect of their lives, including work. Anxiety, inability to concentrate and fatigue are just a few signs of this disorder that can lead to reduced productivity and absenteeism.

An article published in Plantservices.com stated that according to Homer Johnson, PH.D., a professor at Loyola University Chicago, SAD is a disorder that is protected under the Americans with Disabilities Act (ADA). This legislation requires employers to make “reasonable accommodations” for individuals with disabilities in the workplace.

Although the extent of “reasonable accommodations” is somewhat up for interpretation, the U.S. Department of Labor’s Office of Disability Employment Policy has created the Job Accommodation Network, JAN, which assists businesses in determining what they should do in order to best accommodate workers with disabilities.

With regards to an employee suffering from Seasonal Affective Disorder, JAN reports on their website what companies can do to assist these individuals.

  • Allow flexible schedules and the option to work from home.
  • Reduce distractions in the work places by providing a quiet work space
  • Increase natural light by placing employee by a window or providing a portable light box
  • Allow breaks throughout work day when employee feels overwhelmed
  • Provide information about stress management counseling
  • Divide large projects into small tasks and keep a checklist of items to be accomplished
  • Create notes on meetings that can be accessed by all employees
  • Have a space that is private for employee to escape potentially stressful or frustrating situations

It is important to remember that every individual is affected differently from the disorder. The recommendations from JAN are a starting place for employers to explore solutions that will help a person manage their symptoms.

THERE ARE SOME BEHAVIORS YOU JUST CAN'T REGULATE.

By: Chacko Kurian

Regulations depend on carrots and sticks. If you don’t pay your taxes, there will be serious consequences – the stick. If you buy a home with a home loan, we’ll let you take the interest payment deduction on your taxes – the carrot. The HITECH Act has a number of sticks associated with the security of Protected Health Information (PHI). We at CHS will be addressing the issue of security of PHI in forthcoming articles. There is, under some circumstances, one link in the security chain that no regulation can affect -the uninformed behavior of the user. This article addresses one method where cyber criminals make unwitting users partners in a security breach.

Prior to founding Apple Computers, the Steves (Wozniak and Jobs) could be found ripping off Ma Bell using a blue box to make long distance phone calls (domestic and international) for free. The subculture that reveled in this activity called “phreaking” was probably the progenitor of the subculture of hackers who, today, like to hack computer systems just because they’re there. There is the story of Steve Woz(niak) actually making a “phreak” phone call to the Vatican and asking to speak to the Pope while pretending to be Henry Kissinger with a think German accent. These are the guys who later found legal ways to take your money.

Before the age of digital telephone switching systems, telephone switches reset trunk (long distance) lines with a tone at a specific frequency – 2600Hz. This meant that the trunk line was disconnected at one end and available for dialing at the other end. The dialing was also accomplished by tones at preset multiple frequencies. How did one get those frequencies? Legend has it that the 2600Hz frequency was discovered by accident by Joe Engressia, known among phreakers as ‘Joybubbles’, at the age of 7! He was apparently able to whistle at that frequency and so attach himself to the dialing end of an available long distance line.

But how does one progress from knowing that you could get a trunk line to using it to make free long distance calls. In 1954, the then undivided Bell System published an article in the Bell System Technical Journal about the basics of signaling using multi-frequency tones. This piece of information by itself was of little use. The second and final piece of the puzzle was published, again courtesy of Ma Bell, in the November 1960. Bell System Technical Journal in an article called “Signaling systems for control of telephone switching”. This article published the actual multi-frequency tones used to control the switches. From that information to the creation of the reputed “Blue Box” that became a clandestine product was a short step. With one of these boxes, anybody was able pick up a phone and make free long distance calls.

To be able to win this questionable prize, the phreaker required two pieces of information and they were found in two locations, but once they were combined, the information became quite powerful. Today – cybercriminals put two pieces of information discovered from different locations together to achieve their nefarious goals..

Spear Phishing is the technique by which pieces of information stolen from different locations are put together, by cybercriminals, to steal your identity, your money and anything of value. How does this work? Unlike the shot gun approach taken by those Nigerian scam artists who send out millions of emails, the Spear Phisher is looking for prey with a small email blast to very targeted prospects. All they need to start the process is one piece of information – your email address and sometimes your name. They don’t need anything like a credit card number, the password to your on-line bank account or your social security number– well, not yet. The attack is quick and over in less than a day, before security and software companies have an opportunity to react.

A typical Spear Phishing attack starts with an email that comes to you and looks something like this, courtesy of the Microsoft Safety and Security center

Remember they already have your email address and sometimes your name so the “Hello” salutation is not so innocuous. It looks very familiar but the highlighted items should make you suspicious. If you examine the links you will find that they link to unsecured and unfamiliar sites as shown below:

Once you click on the link and enter the information they’re asking for, they’ve got you.

Another variation of this technique is to send you an email making you an offer that sounds reasonable on the surface, but requires you to open an attachment with the details of the offer. Again, once you open that attachment, they’ve got you. What happens behind the scenes is that the attachment has a robot program that can do almost anything that they want it to do. It can install a keystroke logger and send your internet banking or credit card passwords to the cybercriminal. It can give control of your computer over to the cybercriminal and so enable more of these schemes to be run from your computer. The possibilities are endless.

Sometimes the Spear Phisher makes the email look like its coming from your boss – again remember he has email addresses and names. The email may require you to give up password and other authentication information in order to perform a “security audit” or an “account verification”.

Key to making this criminal endeavor work is that it requires your participation to either provide the missing information or open the attachment. So the best defense it to verify the email by contacting the sender by phone or alternate method if the email looks suspicious. A good antivirus program installed on your computer can help too.Remember for the scheme to work it requires your participation.

We might as well brace for a number of these email attacks. Recently Epsilon, a division of Alliance Data suffered an illegal entry on its client’s email databases. This is the company that processes marketing communications for loyalty programs like Marriott Rewards, Citibank Advantage and many other large organizations. Imagine the rich information for cybercriminals that email addresses, names and loyalty program associations can provide. If you belong to the Marriott Rewards program like I do, expect an incredibly valuable offer to come to you via email. Do not open the attachment even though the logo looks almost right and the text has only one or two spelling mistakes.

There’s lots of regulations coming from Washington DC these days, but I don’t think they can think one up for this.

CHS SOFTWARE UPDATE

CHS Software you may want to use

Often, we at CHS, are guilty of not informing you of products or features that we have implemented over the past year that you may want to use. This year we have rounded out our individual enrollment, billing and administration offering with a full cycle product. If you sell individual policies or sell voluntary products in addition to your regular employer sponsored group health offerings, this may interest you.

"Full Cycle" in this context means the following:
i) taking the application for enrollment of the individual/family on the web, after getting their responses to qualifying/underwriting questions,
ii) enrolling them in the plan of choice,,
iii) billing their credit card or bank account at the appropriate frequency, i.e. monthly, quarterly, semi-annually or annually,
iv) applying the payments received against the appropriate invoices
v) disbursing premium/commission and other payments to carriers, brokers/agents and other suppliers
vi) updates to Accounts Receivable, Accounts Payable and General Ledger without manual intervention after set-up.

We would like to say that all of the above happens "automatically" (a grossly over-used word) but it doesn't. It happens with minimal, but appropriate, human intervention. For example, there are checks and balances in place to make sure that premium billing adjustments owing to changes in family composition or product choices are made accurately. The web enrollment product, CHS iCoverNow, has to be customized with your logo, color palette, questions and response logic. Users of our product like it. It has allowed them to grow into areas where they couldn't before. We believe that this will interest administrators of individual health plans who sell to the public at large and may become a valuable tool in the context of health care reform.