CHAPTER 15
HEALTHCARE ADMINISTRATION
In the Medical Department, proper records
administration is very important. We are charged with
administering not only routine personnel records, but
also clinical records that may affect the rights and
benefits of patients and their dependents years beyond
retirement or discharge.
As a Hospital Corpsman, you could be assigned to
or responsible for the administrative affairs
concerning inpatients or outpatients. This chapter will
provide information on the function of healthcare
programs you may be involved with or responsible for.
We will also discuss the legal implications in medical
care, including the various aspects of consent, incident
reports, and release or nonrelease of medical information
under the Privacy and/or Freedom of Information
Acts. Further, guidance concerning your relationship
and interaction with law enforcement personnel and
the legal community will also be outlined.
PATIENT ELIGIBILITY FOR
HOSPITALIZATION AND
NONFEDERAL CARE
LEARNING OBJECTIVE: Recognize the
policies and procedures for DEERS,
CHAMPUS, and TRICARE.
The fact that a person seeking treatment is or was
connected with the federal government does not
automatically entitle him to treatment at a naval
medical treatment facility.
A number of factors
determine eligibility for certain types of medical
attention and the source and amount of remuneration
for that treatment. The following section deals with
eligibility verification by presentation of a valid ID
card and utilization of the Defense Enrollment
Eligibility System (DEERS). Further guidance can be
obtained by familiarizing yourself with the following
sources:
NAVMEDCOMINST 6320.3, Medical and
Dental Care for Eligible Persons at Navy
Medical Department Facilities
NAVMEDCOMINST 6320.18, Civilian Health
and Medical Program of the Uniformed Services
(CHAMPUS) Regulation
NAVMED P-5020, Resources Management
Handbook
DEFENSE ENROLLMENT ELIGIBILITY
REPORTING SYSTEM (DEERS)
The Defense Enrollment Eligibility Reporting
System (DEERS) was developed to improve
distribution and control of military healthcare
services. Additionally, DEERS was implemented to
assist in the projection and allocation of costs for
healthcare programs and to minimize fraudulent
healthcare claims. Navy medicines eligibility for care
instruction, NAVMEDCOMINST 6320.3, provides
guidance as to who and under what circumstances
members can receive medical and dental care at Navy
Medical Department facilities; the extent and
conditions under which such care may be provided;
and the collection process to pay for that care.
Enrollment for all seven uniformed services (i.e.,
Army, Air Force, Marine Corps, Navy, Coast Guard,
Public Health Service, and National Oceanic and
Atmospheric Administration) is accomplished
through completion and submission of an Application
for Uniformed Services Identification and Privilege
Card, DD 1172, for a members dependent. When a
new ID card is obtained for the dependent, the
members DEERS data is updated online. If problems
exist within a patients database, active duty personnel
and their dependents must be referred to the sponsors
personnel office. Refer all other beneficiaries (e.g.,
retired personnel and their dependents) to the nearest
personnel office.
Direct Care System Procedures
In addition to providing authorization to standard
medical care through inclusion in its membership
database, DEERS now includes a dental policy based
upon beneficiary information (versus the previous
policy based on sponsor information). This change in
policy occurred in part because of the increased
accuracy of the database as well as the percentage of
personnel enrolled.
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