Download HIPAA Privacy Rule, Fraud and Abuse Prevention, and Healthcare Auditing and more Quizzes Medical Records in PDF only on Docsity!
The Office of Inspector General is responsible
for...
fighting fraud TERM 2
What section of the ARRA includes the Privacy
Rule?
DEFINITION 2 The HITECH, is a part of the American Recovery and Reinvestment Act and it includes the Privacy Rule TERM 3
What is documentation?
DEFINITION 3 Documentation is the record of clinical observations and care a patient receives at a health care facility. TERM 4
How does the Privacy Rule define "PHI":
DEFINITION 4
- individually identifiable health information TERM 5
True or False? The Privacy Rule applies to
both covered entities and BAs...
DEFINITION 5 True
What is the Notice of Privacy
Practices
- its the legal obligation of the practice to inform patients how and why the use of PHI will be disclosed. explains patient rights explains the practices legal responsibilities with respect to PHI explain use, disclosure of PHI Notice of Privacy Practices must be provided to patients at their first time of service. TERM 7
How does the Privacy Rule define
"Authorization":
DEFINITION 7
- permission that a patient grants, or patient's representative, to release information for other reasons than TPO. signature required TERM 8
How does the Privacy Rule define "Consent":
DEFINITION 8
- permission that a patient grants to release information for TPO purposes only. signature required? Y or N TERM 9
True or False? The covered entity can not use
or disclose PHI without a signed authorization
form...
DEFINITION 9 True with the two exceptions of when it is okay to use PHI without authorization: when the patient or patient's representative requests access to their PHI when the department of HHS is conducting a investigation, review, or enforcement action. TERM 10
What three occasions is allowed to use or
disclose PHI without patient authorization
DEFINITION 10 when a patient informally agrees to its disclosure such as notifying loved ones and friends of the patient's health status. if the patient's condition puts at risk the health and safety of the community legal issues - neglect, abuse, domestic violence
What laws exist that purposely fight against
fraud and abuse?
HIPAA
THE STARK LAW
THE FAIR DEBT COLLECTION PRACTICES ACT
THE FALSE CLAIMS ACT
TERM 17
Where is all HIPAA mandated fraudulent and
abuse information recorded?
DEFINITION 17 HIPAA mandates that all information of fraudulent and abuse activity be recorded in the data bank called The National Healthcare Integrity and Protection Data Bank (HIPDB) which transitioned to National Practitioner Databank (NPDB)The merger of the two data banks happened in 2013 due to overlapping data. TERM 18
The Office of Civil Rights is part of
what?
DEFINITION 18 The OCR is a part of the (HHS) Human and Health Services TERM 19
Explain the Final Rule
DEFINITION 19 Under the Final Rule, which is part of HIPAA, The OCR oversees compliance of BAs, this is to ensure that PHI remains secure.Failure of compliance must be reported to the OCR and can lead to monetary penalties discrete resolutions for violations TERM 20
Define The Physician Self-Referral Law
DEFINITION 20 Also known as Stark Law - it states that physicians can not refer patients to a physician with whom they have a financial relationship. it also prohibits referred providers from sending claims to Medicare.
Define FDCPA and False Claims Act
The Fair Debt Collection Practices Act states that companies that buy uncollected debts can not use unfair or abusive practices to collect debt. Federal Trade Commission is responsible for enforcing the Fair Debt Collect Practices Act (FDCPA).The False Claims Act protects the government from fraudulent activity on claims. TERM 22
Define HCFAC
DEFINITION 22 Health Care Fraudulent and Abuse Program protects Medicare and other programs part of HHS from fraud and abuse. run jointly by the Department of Justice and the HHS HCFAC is part of OIG TERM 23
FTC is responsible for...
DEFINITION 23 enforcing the FDCPA. TERM 24
True or False? HCFAC is part of OIG & is run
by Department of Justice and HHS
DEFINITION 24 True TERM 25
Where does the OIG keep data about
excluded entities due to fraudulent or abusive
activity?
DEFINITION 25 the entities excluded for fraudulent or abusive reasons are listed in the List of Excluded Individuals and Entities (LEIE)
What is the HIPAA Final Enforcement Rule?
The HIPAA's Final Enforcement Rule's purpose is to reconcile differences in enforcement procedures that had existed between the privacy and security standards by imposing this single rule. TERM 32
For release of PHI for treatment, payment,
and operations, what is needed?
DEFINITION 32 A signature from the patient on a consent form TERM 33
Under the ACA providers can be subject to 3
things before they are allowed to bill
Medicare/Medicaid Programs
DEFINITION 33 Fingerprinting Background checks Site visits TERM 34
True or False Some state statutes may
contain various definitions of designated
record set, inmate rights, and psychotherapy
notes
DEFINITION 34 True TERM 35
True or False HIPAA Security Rule requires
CEs to establish safeguards to protect PHI
DEFINITION 35 True
The federal agency that runs Medicare and
Medicaid is?
(CMS) Center of Medicare and Medicaid Services TERM 37
True or False The ACA requires the adoption
of operating rules for each of the HIPAA
Standard transactions
DEFINITION 37 True TERM 38
What is the Respondeat superior
law?
DEFINITION 38 The Respondeat superior law states that an employer is responsible for an employee's actions TERM 39
HIPAA Rules for administrative, technical, and
physical safeguards of patient's health
information are in the Security or Privacy
Rule?
DEFINITION 39 Security Rule TERM 40
who investigates healthcare fraud and abuse?
DEFINITION 40 Office of Inspector General
HIPAA of 1996 is designed to do what?
protect PHI uncover fraud and abuse ensure health insurance coverage for workers and their families when they change or lose their job create standards for electronic transmission of health care transactions TERM 47
What is subpoena duces tecum?
DEFINITION 47 Subpoena duces tecum is a court order to appear, testify, and bring specified documents or items. TERM 48
What is the difference between subpoena and
subpoena duces tecum?
DEFINITION 48 Subpoena is a simple court order to appear and testify and Subpoena duces tecum asks to appear, testify, and bring specified documents or items in court. TERM 49
Which act strengthened the provisions of the
FCA?
DEFINITION 49 FERA strengthened the provisions of the FCA TERM 50
What is one way that upcoding is being
monitored by payers?
DEFINITION 50 a benchmarking practices E/M codes with national averages
The CMS/AMA Documentation Guidelines set
up the rules for the selection of?
Evaluation and Management codes (E/M codes) TERM 52
What is the purpose of stop-loss provisions?
DEFINITION 52 stop loss provisions protect providers against extreme financial loss TERM 53
CLIA is administered by?
DEFINITION 53 CMS
