As a health care provider, and more importantly as a TRICARE provider, you know the central role you play in understanding and complying with the federal government’s Consumer Bill of Rights and Responsibilities.

Drafted in 1998, the purpose of the Bill is threefold:
 

• To build consumer confidence in the health care system by facilitating ways consumers can actively participate
• To support the importance of a good relationship between health care providers and patients
• To support consumers in improving their health by providing them with rights and responsibilities

For your convenience, here is a review of two Bill of Rights chapters that are of utmost importance to TRICARE providers.

As a provider, you know how patient participation in treatment decisions can lead to better treatment as well as higher patient satisfaction. You also know patients often have to make vital decisions when they’re not in optimal condition to do so. That’s why you can make a big difference by clearly explaining all treatment options—including the alternative of no treatment—as well as the risks, benefits and consequences of each option.

TRICARE beneficiaries must be properly informed in advance and in writing of specific services or procedures that are not covered under TRICARE. For beneficiaries to be held financially responsible for non-covered services, they must sign a Waiver of Non-Covered Services form before services are provided.

A good relationship between you and the patient is based on mutual respect. Consumers have the right to considerate, respectful and nondiscriminatory care from their doctors, health plan representatives and other health care providers.

A number of health care industry surveys uncovered dissatisfaction among patients who felt they were not being treated with respect. Reasons ranged from poor communications, such as inadequate information about their condition, to feeling rushed or ignored. Not only did consumers express a desire for medical providers to be respectful of their time, but they also expressed a desire for emotional support to relieve fear and anxiety.

How do you best show respect to a patient? Guidelines from the Bill of Rights suggest providing the patient with the following:

• Your assurance that disrespect or discrimination of any kind from your office is not tolerated
• Information regarding existing laws prohibiting disrespectful or discriminatory treatment
• Enough time to fully discuss their concerns and questions
• Reasonable assistance to overcome language (including limited English proficiency), cultural, physical or communication barriers
• A timely notice and explanation of changes in fees or billing practices
• An explanation and apology for delays that are unavoidable

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Update on Bonus Payments to Providers (Article 13)

Notice: To all TRICARE providers who qualify for the Medicare Health Professional Shortage Areas (HPSA) bonus payment and the Physician Scarcity Area (PSA) bonus payment for primary care providers.

TRICARE still requires modifiers for HPSA- and PSA-submitted claims. Medicare has discontinued the use of modifiers expected on professional claim lines from the appropriate providers of service; however, TRICARE is relying on providers to continue to apply the AQ modifier designated for HPSA and the AR modifier designated for PSA professional services. (The new AQ modifier replaced the QU/QB modifiers beginning 01/01/06.)

TRICARE began offering the HPSA bonus payment to providers in 2003 and followed on in 2005 with the addition of the PSA bonus payment for primary care providers.

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Last Reviewed:  February 2, 2007