Medical Insurance: An Integrated Claims Approach Process
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| HIPAA Privacy Rule | Law under the Administrative Simplification provisions of HIPAA requiring covered entities to establish administrative, physical, and technical safeguards to protect the confidentiality, integrity and availability of health information.
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| Authorization | Document signed by a patient that permits release of medical information under the specific stated conditions.
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| Minimum Necessary Standard | The principle that individually identifiable health information should be disclosed only to the extent needed to support the purpose of disclosure.
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| Business Associate | A person or organization that performs a function or activity for a covered entity but is not part of its workforce.
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| Clearinghouse | A company that offers providers, for a fee, the service of receiving electronic or paper claims, checking and preparing them for processing, and transmitting them in proper data format to the correct carriers.
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| Notice of Privacy Practices | A HIPAA-mandated document that presents a covered entity's principles and procedures related to the protection of patients' protected health information.
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| Code Set | A coding system used to encode elements of data.
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| HIPAA Security Rule | Law under the Administrative Simplification provisions of HIPAA regulating the use and disclosure of patients' protected health information - individually identifiable health information that is transmitted or maintained by electronic media.
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| Covered Entity | Under, HIPAA. a health plan, health care clearinghouse, or health care provider that transmits any health information in electronic form in connection with a HIPAA transaction.
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| Documentation | The systematic, logical , and consistent recording of a patient's health status - history, examinations, tests, results of treatment, and observations - in chronological order in a patient's medical record.
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| T/F Electronic Health records offer advantages over paper records | True
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| T/F Fraud is not intentional | False
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| T/F The chief complaint is usually documented using clinical terminology | False
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| T/F The three major parts of the Administrative Simplification provision are the privacy requirements, the security requirements, and the electronic transactions and code sets. | True
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| T/F When federal and state privacy laws disagree, the federal rule is always followed. | True
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| T/F Under HIPAA regulations,each medical practice must appoint a privacy official. | True
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| T/F Protected health information includes the various numbers assigned to patients, such as their medical record numbers and their health plan beneficiary numbers. | True
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| T/F The minimum necessary standard does not refer to patient's health history. | False
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| T/F Patient's have the right to access, copy, inspect, and request amendment of their medical and billing records | True
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| T/F A patient's authorization is needed to disclose protected information for payment purposes. | False
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| Under the HIPAA Privacy Rule, Physician practices must | A. Train employees about the practice's privacy policy
B. Appoint a staff member as the privacy officer.
C. Both A and B
D. Neither A nor B
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| A Notice of Privacy Practices is given to | A. A practice's patients
B. A practice's business associates
C. the health plans with which a practice contracts
D. none of the above
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| Patients' PHI may be released without authorization to | A. local newspapers
B. employers in workers' compensation cases
C. Social workers
D. Family and friends
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| Which government group has the authority to enforce the HIPAA Privacy Rule? | A. CIA
B. OIG
C. OCR
D. Medicaid
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| Patient's always have the right to | A. Withdraw their authorization to release information
B. Alter the information in their medical records
C. Block release of information about their communicable diseases to the state health department
D. none of the above
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| The authorization to release information must specify | A. The number of pages released
B. The Social Security number of the patient
C. The Entity to whom the information is to be released
D. the name of the treating physician
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| Health information that does not identify an individual is referred to as | A. protected health information
B. authorized health release
C. statutory data
D. de-identified health information
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| Violating the HIPAA Privacy Rule can result in | A. civil penalties
B. criminal penalties
C. both civil and criminal penalties
D. neither civil nor criminal penalties
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| The main purpose of the HIPAA Security Rule is to | A. regulate electronic transaction
B. protect research data
C. control the confidentiality and integrity of and access to protected health information
D. Protect medical facilities from criminal acts such as robbery
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| A compliance plan contains | A. consistent written policies and procedures
B. medical office staff names
C. the practice's main health plans
D. all of the above
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| OCR | Office for Civil Rights
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| PHI | Protected Health Information
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| TCS | HIPAA Electronic Health Care Transactions and Code Sets
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| DRS | Designated Record Set
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| EHR | Electronic Health Records
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| CC | Chief Complaint
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| NPI | National Provider Identifier
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| NPP | Notice of Privacy Practices
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| OIG | Office of the Inspector General
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| Parts of Compliance Plan | 1. Consistent written policies and procedures
2. Appointment of a compliance officer and committee
3. Training
4. Communication
5. Disciplinary systems
6. Auditing and monitoring
7. Responding to and correcting errors
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| Code of Conduct | Emphasizes procedure that are to be followed to meet existing documentation, coding, and medical necessity requirements.
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| What are compliance plans? | is a process of finding, correcting, and preventing, illegal medical office practices.
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| What is informed consent? | for plan of cares that involve significant risk, state laws require the physician to have the patients informed consent in advance.
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