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CertReview4 3/22
Quiz 4
| Term | Definition |
|---|---|
| Fair Debt collection Practices Act (FDCPA) | Debt collectors cannot use unfair or abusive practices to collect payments |
| False Claims Act | Protects the government from being overcharged for services provided or sold, or substandard goods or services |
| Final Rule | Strengthens the HIPPA ruling around privacy, security, breach notification, and penalties |
| formulary | A list of prescription drugs covered by an insurance plan |
| fraud | Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist |
| gatekeeper | Provider who determines the appropriateness of the health care service, level of heath care professional called for, and settling for care |
| general ledger key | Two- or three-digit number that makes sure that a line item is assigned to the general ledger in the hospital's accounting system |
| group code | Code that determines the party financially responsible for a specific service the general ledger in the hospital's accounting system |
| group or plan number | Unique code used to identify a set of benefits of one group or type of plan |
| group practice model | HMO that contracts with an outside medical group for services |
| Health Insurance Portability and Accountability Act (HIPPA) of 1996 | Legislation that includes Title II, the first parameters designed to protect the privacy and security of patient information |
| health maintenance organization (HMO) | Plan that allows patients to only go to physicians, other health care professionals, or hospitals on a list of approved providers, except in an emergency |
| health record number | Number the provider uses to identify an individual patient's record |
| ICD-10-PCS | Coding and classification system developed for use in the US only. Specific to inpatient hospital procedures, ICD-10-PCS correlates to Volume 3 in ICD-9-CM. |
| implied consent | A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed |
| independent practice association (IPA) model | HMO that contracts with the IPA, which in turn contracts with individual health providers |
| individually identifiable | Documents that provide the person or provider enough information so that the person could be identified |
| informed consent | Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risk involved, giving patients an opportunity to ask questions before medical intervention is provided |
| managed care organization | Organization developed to manage the equality of health care and control costs |
| Medicaid | A government-based health insurance option that pays for medical assistance for individuals who have low incomes and limited financial resources. Funded at the state and national level. Administered at the state level. |
Created by:
sbogle
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