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HIPAA Privacy Rule, Fraud and Abuse Prevention, and Healthcare Auditing, Quizzes of Medical Records

Various terms related to the hipaa privacy rule, fraud and abuse prevention, and healthcare auditing. It includes definitions for key terms such as phi, authorization, consent, notice of privacy practices, and more. The document also discusses laws and regulations that fight against fraud and abuse, such as hipaa, the stark law, and the false claims act. It explains the role of the office of inspector general in protecting medicare and other hhs programs against fraud and abuse.

Typology: Quizzes

2017/2018

Uploaded on 12/26/2018

wendolyne-saenz
wendolyne-saenz 🇺🇸

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TERM 1
The Office of Inspector General is responsible
for...
DEFINITION 1
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
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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