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Ch.2 Insurance

medicolegal issues and the pharmacy

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
Created by: sarakiefer



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