Code set
Under HIPAA, terms that provide for uniformity and simplification of health care billing and record keeping
American Recovery and Reinvestment Act (ARRA)
A 2009 act that made substantive change to HIPAA's privacy and security regulations
breach
any unauthorized acquisition, access, use, or disclosure of personal health information which compromise the security or privacy of such information
The Right to Privacy is derived from where
First, Third, Fourth, Fifth, Ninth and Fourteenth Amendments to the Constitution
The False Claim Act provides for
making it a criminal offense to defraud any health care benefit program
An entity may have violated the Stark Law if they can answer yes to what 3 questions:
1)has a physician or a member of her family refer a Medicare or Medicaid patient to an entitity:
2) is the referral for a "designated health service"?:
3) Is there a financial relationship beween the referring physician or family member and the entity pro
Are the Stark Law and the Federal Anti-Kickback Law the same thing?
No, the Stark Law and the Federal Anti-Kickback Law are different laws with distinct differences.
Covered entities
Health care providers and clearinghouses that transmit HIPAA transactions electronically, and must comply with HIPAA standards and rules
Covered transaction
Electronic exchanges of information between two covered-entity business partners using HIPAA-mandated transaction standards.
Criminal Health Care Fraud Statute
A section of the United States Code that prohibits fraud against any health care benefit program.
De-identify
To remove from health care transactions all information that identifies patients
Designated record set
Records maintained by or for a HIPAA-covered entity
Electronic Data Interchange (EDI)
The use of uniform electronic network protocols to transfer business information between organizations via computer networks
Electronic health record (EHR)
A more comprehensive record than the EMR, focusing on the total health of the patient and traveling with the patient
Electronic medical record (EMR)
contains all patient medical records for one practice
Electronic transmission
The sending of information from one network-connected computer to another
Encryption
The scrambling or encoding of information before sending it electronically
Federal Anti-Kickback Law
Prohibits knowingly and willfully receiving or paying anything of value to influence the referral of federal health care program business.
Federal False Claims Act
A law that allows for individuals to bring civil actions on behalf of the US government for false claims made to the federal government, under a provision of the law called qui tam ("to bring an action for the king and for oneself")
Work Plans
Released annually by the OIG and identifies areas they will focus on for review and investigations they believe are the most vulnerable programs for possible fraud and abuse.
Office of the Inspector General
Government agency under the US Department of Health & Human Services that has been charged with fighting and prosecuting waste, fraud, and abuse in Medicare and Medicaid and more than 300 other HHS programs.
CLIA License
Clinical Laboratory Improvement Amendment - this license is required by offices who perform "simple laboratory examinations and procedures that have an insignificant risk of erroneous result." (Tests that most offices are able to perform without sending t
Compliance Plan
A proactive program that ensure fulfillment with all applicable policies, procedures, laws and regulations. It is designed to detect and correct violations, provide employee training, routine physician auditing of documentation and establish standards and
Fiscal Intermediaries
Private insurance companies that serve as the federal government;s agents int he administratioin of the Medicare program.
Firewalls
Hardware, software, or both designed to prevent unauthorized persons from accessing electronic information
Health Information Technology for Economic and Clinical Health Act (HITECH)
A section of the American Recovery and Reinvestment Act (ARRA) the strengthened certain HIPAA privacy and security provisions
Health Insurance Portability and Accountability Act (HIPAA)
A federal law passed in 1996 to protect privacy and other health care rights for patients. This act helps workers keep continuous health insurance coverage for themselves and their dependents when they change jobs, and protects confidential medical inform
What is the primary purpose of the HITECH rule?
To strengthen privacy and security for electronic health information.
Limited data set
Protected health information from which certain patient identifiers have been removed
Minimum necessary
Term referring to the limited amount of patient information that may be disclosed, depending on circumstances
Notice of Privacy Practices (NPP)
A written document detailing a health care provider's privacy practices
Permission
A reason under HIPAA for disclosing patient information
Privacy
Freedom from unauthorized intrusion
Protected Health Information (PHI)
Information that contains one or more patient identifiers
Rule
A document that includes the HIPAA standards or requirements
Security
Policies and procedures that protect PHI from unauthorized access
Standard
A general requirement under HIPAA
Stark Law
Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment. (Basically it is a law against self-referrals.)
State preemption
If a state's privacy laws are stricter than HIPAA privacy standards, the state laws take precedence.
Transaction
Transmission of information between two parties for financial or administrative activities
Treatment, Payment, and Health Care Operations (TPO)
A HIPAA term for qualified providers, disclosure of PHI to obtain reimbursement, and activities and transactions among entities. Treatment means that a health care provider can provider care; payment means that a provider can disclosure PHI to be reimburs
Verification
The requirement under HIPAA to verify any request as legitimate before protected health information is released