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HIPAA & the Requirements to Check on an Employee's Medicare Status

HIPAA, the Health Insurance Portability and Accountability Act of 1996, was established to set forth standards for electronic health care transactions and national identifiers for providers, plans and employers. For patients, the act attempts to make mobility between doctors, employers and insurance companies easier as well as ensures privacy when it comes to medical records.

  1. Not Required to Check Medicaid Status

    • Employers are not required to know the Medicare status of their employees. This is actually at the employee's discretion in advising the employer regarding their Medicare status. It does not effect how health benefits are issued, as the billing process will sort out which company is the primary payer if necessary.

    HIPAA Requires Communication

    • Employers are required to let employees know their options when it comes to health insurance. This is of significant importance if employment should end for some reason. When the employment ends, if the worker is on a health care plan through the employer, the employer must let the former employee know about HIPAA and COBRA benefits. This was one of the reasons for founding HIPAA, as patients needed to be able to move their records when trying to find new insurance after a change in career or job.

    Patient Privacy

    • While employers do provide health care coverage, HIPAA prevents an employer from obtaining medical records without the direct consent of the patient. A patient, under HIPAA laws, may not be compelled to provide such information without just reason. Such a reason would include workman's comp cases, on the job injuries or drug/alcohol screening done by the employer. Employees have a right to privacy when it comes to their health care and an employer must respect that.

    Streamlining Information

    • HIPAA sets out to streamline the forms in health care to make the process easier for patients and employees as they transition from one health care provider to another or from one insurance provider to another. It is important for employers to urge their providers to comply with the regulations, as this is the process used to verify whether employees are part of the Medicare system or not. If the forms are used properly, the employer will not know the Medicare status, but the caregivers and billers will know. This helps keep the employer's costs down when it comes to insurance premiums.

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