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mos insurance

insurance study guide ch 2

AUTHORIZATION Document signed by a patient to permit release of particular medical information under the stated specific conditions.
BUSINESS ASSOCIATE A person or organization that performs a function or activity for a covered entity but is not part of its workforce.
CLEARINGHOUSE A company that converts nonstandard transactions into standard transactions and transmits the data to health plans; also handles the revers process, changing standard transactions from health plans into nonstandard formats for providers.
CODE SET A coding system used to encode elements of data.
COVERED ENTITY Under HIPPA a health plan, clearinghouse, or provider who transmits any health information in electronic form in connection with a HIPPA transaction.
DOCUMENTATION The systematic, logical, and consistent recording of a patient's health status-history, examination, tests, results of treatment, and observations-in chronological order in a patient medical record.
HIPPA PRIVACY RULE Law that regulates the use and disclosure of patients protected health information(PHI)
HIPPA SECURITY RULE Law that requires covered entities to establish administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of health information
MINIMUM NECESSARY STANDARD Principle that individually identifiable health information should be disclosed only to the extent needed to support the purpose of the disclosure
NOTICE OF PRIVACY PRACTICES A HIPPA-mandated description of a covered entity's principle and procedures related to the protection of patients health information
op Operation
yo Years old
hx History
Dx Diagnosis
adm admission
pt Patient or Physical therapy
ca Cancer
bx Biopsy
EDI Electronic data interchange
What does medical standards of care mean? State-specified performance for delivery of health care by medical professionals
Who owns the medical record and who owns the information in it? The physician or creator owns the medical record and the patient owns the information inside of the medical record
What does malpractice mean? Failure to use an acceptable level of professional skill when giving medical service that results in injury or harm to a patient.
What does E & M service include? Complete interview and physical examination for a new patient or for a new problem presented by a person who is already a patient.
What agency runs Medicare and Medicaid? CMS ( Centers for Medicare and Medicaid services)
What law was made to tighten HIPAA Privacy Rule? HITECH Act- health information technology for electronic and clinical health
What is HITECH Act? Guides use of federal stimulus money to promote the adoption and meaningful use of health information technology, mainly using electronic health records
What is the HIPPA law designed to do? Protect people private health information, ensure health insurance coverage for workers and their families when they change or lose their job, uncover fraud and abuse and create standards for electronic transmission of health care transactions
What would exclude a provider from being considered a covered entity?
what does it mean to be a covered entity, what are the requirements to be a covered entity?
HIPPA identifies three types of covered entities, what are they? Health plans, clearinghouses and provider
What would a vendor that does business with a covered entity be called? Business Associate
What is the HIPPA Privacy Rule for? Protects patients health information (PHI)
When a personal identifier is removed the health information is called what? De-identified
What is a subpoena? A order of a court for a party to appear and testify in court of law.
What is a subpoena duces tecum an order of a court directing a party to appear, to testify, and to bring specified documents or items.
Who is the HIPAA Security Rule for?
What does encryption mean? A method of scrambling transmitted data so it cannot be deciphered without the use of a confidential process or key.
The HIPAA security Rule specifies how to secure PHI on what?
What does breach mean? An impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of PHI and also that could pose significant risk of financial, reputational, or other harm to the affected person.
What does unsecured PHI mean and what is it?
What should a breach notification include?
The HIPAA electronic health care transaction and code set is used for what?
What is NPI and what is it used for?
What are HIPAA national identifiers for?
th health care fraud and abuse control program is for what?
In whistleblower cases the person who makes the accusation of suspected fraud is called what?
who enforces the HIPAA Privacy Rule?
Created by: Jerel handy
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