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ch 5 UHI & ch 3 MOM


abuse actions inconsistent with accepted practices
ANSI ASC X12N 837 variable-length file format used to bill institutions
confidentiality restricting patient information access to those with proper authorization
civil law laws not classified as criminal
deposition legal proceeding during which a party answers questions under oath (but not in open court)
EDI electronic data interchange - computer-to-computer exchange of data between provider and payer
federal register legal newspaper published every business day by the National Archives and Records Administration
informed consent physicians must give patients all information about a procedure, including risks and alternatives to the procedure
NCCI national correct coding initiative, promotes correct coding methods
NDC national drug code -maintain by the food and drug administration; identifies prescription drugs and come over the counter products
NPI national provider identifier - unique identifier to be assigned to health care providers as and 8- or possibly 10- character alphanumeric identifier
PHI protected health information - any patient information that includes identifiers that could be used to identify the patient
DHHS department of human health services - conducts investigations for fraud
RAC recovery audit contractor - finds and corrects improper medicare payments paid to health care providers in fee-for-service medicare
subpoena an order of the court that requires a witness to appear at a particular time and place to testify
transmittal letter provides the recipient with a specific context in which to place the larger document and simultaneously gives the sender a permanent record of having sent the material
stark physician self-referral law prohibits physicians from referring medicare patients to clinical laboratory services in which the physicians or their family member has a financial ownership/investment.
standard of care the amount and type of care a reasonable prudent person would provide, given the same training and circumstances
subpoena duces tecum requires documents to be produced
malpractice medical negligence that results in a patient being harmed in some way
three types of malpractice malfeasance - wrong treatment misfeasance - treatment performed incorrectly nonfeasance - failing to preform treatment
security rule HIPAA standards and safeguards that protect health information collected, maintained, used, or transmitted electronically
fraud intentional deception or misrepresentation that could result in an unauthorized payment
privileged communication private information shared between a patient and healthcare provider
tort wrongful act that leads to damages sustained by another
release of information
Created by: Mika42016