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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.
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fighting fraud TERM 2
DEFINITION 2 The HITECH, is a part of the American Recovery and Reinvestment Act and it includes the Privacy Rule TERM 3
DEFINITION 3 Documentation is the record of clinical observations and care a patient receives at a health care facility. TERM 4
DEFINITION 4
DEFINITION 5 True
DEFINITION 7
DEFINITION 8
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
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
TERM 17
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
DEFINITION 18 The OCR is a part of the (HHS) Human and Health Services TERM 19
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
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.
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
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
DEFINITION 23 enforcing the FDCPA. TERM 24
DEFINITION 24 True TERM 25
DEFINITION 25 the entities excluded for fraudulent or abusive reasons are listed in the List of Excluded Individuals and Entities (LEIE)
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
DEFINITION 32 A signature from the patient on a consent form TERM 33
DEFINITION 33 Fingerprinting Background checks Site visits TERM 34
DEFINITION 34 True TERM 35
DEFINITION 35 True
(CMS) Center of Medicare and Medicaid Services TERM 37
DEFINITION 37 True TERM 38
DEFINITION 38 The Respondeat superior law states that an employer is responsible for an employee's actions TERM 39
DEFINITION 39 Security Rule TERM 40
DEFINITION 40 Office of Inspector General
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
DEFINITION 47 Subpoena duces tecum is a court order to appear, testify, and bring specified documents or items. TERM 48
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
DEFINITION 49 FERA strengthened the provisions of the FCA TERM 50
DEFINITION 50 a benchmarking practices E/M codes with national averages
Evaluation and Management codes (E/M codes) TERM 52
DEFINITION 52 stop loss provisions protect providers against extreme financial loss TERM 53
DEFINITION 53 CMS