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Ch.2 Insurance
medicolegal issues and the pharmacy
Question | Answer |
---|---|
The main federal government agency responsible for health care | The Centers for Medicare and Medicaid Services (CMS) |
Taking reasonable safeguards to protect PHI from incidental disclosure | Minimum Necessary Standard |
Pharmacies must give each patient a notice of privacy practices at this time | First contact or encounter |
Patients must sign this in order for a covered entity to release PHI | Authorization |
This kind of information may be used or disclosed for any purpose | De-identified health information |
The mandated code set for diagnoses under the HIPAA TCS standards | ICD-9-CM |
The ICD-9-CM uses these diagnosis codes to permit reporting the most specific diagnosis possible | Fourth and fifth level diagnosis codes |
This enables physicians to submit prescriptions electronically | E-prescribing |
This act prohibits a prescription drug plan from providing mail-order coverage without also providing non-mail-order prescription benefits | Prescription Equity Act of 1997 |
An action that misuses money that the government has allocated. It is illegal because taxpayers' dollars are misspent. | Abuse |
The number of Americans who benefit from Medicaid and Medicare programs | 90 Million |
The first comprehensive federal protection for the privacy of health information | HIPAA Privacy Rule |
A court request for a witness to bring certain evidence | Subpoena duces tecum |
The process of encoding information in such a way that only the person with the key can decode it | Encryption |
This requires covered entities to establish safeguards to protect PHI | HIPAA Security Rule |
The National Provider Identifier is made up of this many numbers | Nine numbers and a check digit |
The legislation that provided seniors and individuals with disabilities access to prescription drug plans with more choices and better benefits under Medicare | Medicare Prescription Drug Improvement and Modernization Act of 2003 |
The federal government recovered this much money in fraud related judgments and settlements with companies and individuals | $2.2 billion |
This entity has the task of detecting health care fraud and abuse and enforcing all laws relating to them | Office of the Inspector General (OIG) |
A type of law that states that an employer is responsible for an employee's actions | Respondeat superior |
This act was designed to protect peoples' private health information and uncover fraud and abuse | HIPAA - Health Insurance Portability and Accountability Act of 1996 |
In HIPAA terms, agencies that must comply with the law in order to do business with covered entities. This includes law firms, accountants, and collection agencies | Business Associates |
Medication and billing records a pharmacy maintains | Designated Record Set |
This is the HIPAA standard for the identification of providers when filing claims and other transactions | National Provider Identifier (NPI) |
An act of deception used to take advantage of another person | Fraud |
Medical records that are stored in the pharmacy are legal documents that belong to the pharmacy, but the information belongs to whom? | The patient |
The pharmacy cannot withhold the information in a medical record from the patient except in this case | Providing it would be detrimental to a patient's health |
Organizations that electronically transmit any information that is protected under HIPAA | Covered entities |
Individually identifiable health information that is transmitted or maintained by electronic media (name, address, birth date, phone number, etc) | Protected Health Information (PHI) |
Document explaining how patients' protected health information may be used and describing their rights | Notice of Privacy Practices (NPP) |
A computer based record of patient health information. It can automatically generate a complete record of patient encounters. | Electronic Health Record (EHR) |
States may restrict this on premiums and other charges to patients | Price increases |