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Regulatory Comp
H.I.T
| Term | Definition |
|---|---|
| The Health Insurance Portability & Accountability Act (HIPAA) of 1996 | The first uniform standard that included protections for the privacy & security of patient information |
| The Health Information Technology for Economic & Clinical Health (HITECH) Act | Includes changes to HIPAA that relate to privacy |
| Documentation | Is the record of clinical observations & care for a patient receives at a health facility |
| Informed Consent | Providers are required to explain any medical or diagnostic procedures, as well as surgical interventions, & give patients an opportunity to ask questions before any work is done |
| Implied Consent | If a patient voluntarily undergoes treatment |
| Protected Health Information (PHI) | Individually identifiable health information transmitted by electronic media, maintained in any electronic medium, or maintained in any other form or medium |
| Clearinghouses | Agency that converts claims into standardized electronic format, looks for errors, & formats then according to HIPPA & insurance standards |
| Individually Identifiable | Documents that identify the person or provide enough info so that the person could be identified |
| Minimum Necessary Standard | When disclosing info providers & other covered entities must limit uses, disclosures, & requests to only the amount needed to accomplish a specific purpose |
| Notice of Privacy Practices | The legal obligation of providers to explain to patients how their PHI will be used & disclosed |
| De-identified Information | Does not protect de-identified info which is info that does not identify a individual because unique & personal characteristics have been removed |
| Authorization | Means permission granted by the patient or the patient's representative to release info for reasons other than treatments, payments or health care operations |
| Consent | A patient's permission evidenced by signature |
| Billing Audits | The claim is a record of the medical & surgical services provided to a patient during a episode of care |
| Reimbursement | Payment for services rendered from a third-party payer |
| Auditing | Is the review of claims for accuracy & completeness |
| Fraud | Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist |
| Upcoding | Assigning a diagnosis or procedure code at a higher level then the documentation supports, such as coding bronchitis as pnumonia |
| Unbunding | Is the practice of using multiple codes that describe different components of a treatment instead of using the correct single code that describe all steps of the procedure |
| Abuse | Practices that directly or indirectly result in unnecessary costs to the Medicare program |
| HIPAA's Role in Protecting Against Fraud & Abuse | Law mandated that info about fraud & abuse be complied into the national Healthcare Integrity & Protection Data Bank (HIPDB) |
| Final Rule | BA's must ensure that PHI remains secure & they are expected to report any breaches in security |
| Stark Law | Law states that physicians are not allowed to refer pts to a practitioner with whom they have a financial relationship |
| Fair Debt Collection Practices Act (FDCPA) | Law says debt collectors, including collection agencies, lawyers, or companies who pay unpaid debts, cannot use unfair or abusive practices to collect payment |
| Business Associates (BA) | Individuals, groups, or organizations who are not members of a covered entity's workforce that perform functions or activities on behalf of or for a covered entity |
| False Claims Act | Protects the Gov. from being overcharged for services provided or sold, or substandard goods or services |
| Role of the Office of the Inspector General (OIG) | Protects Medicare & HHS programs form fraud & abuse by conducting audits, investigations, & inspections to answer formal compliants |
Created by:
diasiar
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