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INSUR {McGH}
Acts, Laws, Legalities, and Privacy Standards
| Term | Definition |
|---|---|
| 21st Century Cures Act | A federal law that requires providers to make certain specific categories of clinical notes digitally accessible to patients. |
| Health Insurance Portability and Accountability Act (HIPAA) of 1996 | Federal act that set forth guidelines for standardizing the electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information. |
| HIPAA | Health Insurance Portability and Accountability Act (HIPAA) of 1996 |
| Title I | Healthcare access, Portability and Renewability |
| Title II | Preventing Healthcare Fraud and Abuse; Administrative Simplification |
| Title III | Tax-Related Health Provisions |
| Title IV | Application and Enforcement of Group Health Plan Requirements |
| Title V | Revenue Offsets |
| HIPAA act | (is designed to) Protect people's private health information |
| HIPAA act | (is designed to) Ensure health insurance coverage for workers and their families when they change or lose their jobs |
| HIPAA act | (is designed to) Uncover fraud and abuse |
| HIPAA act | (is designed to) Create standards for electronic transmission of healthcare transactions |
| ARRA of 2009 | American Recovery and Reinvestment Act of 2009 |
| American Recovery and Reinvestment Act of 2009 | also known as the Stimulus Package |
| HITECH act | Health Information Technology for Economic and Clinical Health Act |
| Health Information Technology for Economic and Clinical Health (HITECH) Act | Law that guides the use of federal stimulus money to promote the adoption and meaningful use of health information technology, mainly using electronic health records. |
| Title XIII of the ARRA | HITECH act |
| Affordable Care Act (ACA) | Health system reform legislation that offers improved insurance coverage and other benefits. |
| Three Administrative Simplification Provisions | HIPAA Privacy Rule | HIPAA Security Rule | HIPAA Electronic Transaction and Code Sets Standards |
| HIPAA Privacy Rule | The privacy requirements cover patients' health information |
| HIPAA Security Rule | The security requirements state the administrative, technical, and physical safeguards that are required to protect patients' health information |
| HIPAA Electronic Transaction and Code Sets Standards | These standards require every provider who does business electronically to use the same healthcare transactions, code sets, and identifiers |
| Covered Entities | Under HIPAA, a health plan, clearinghouse, or provider who transmits any health information in electronic form in connection with a HIPAA transaction; does not specifically include workers’ compensation programs, property and casualty programs, or disability insurance programs. |
| Three types of covered entities | health plans | healthcare clearinghouses | healthcare providers |
| health plans | the individual or group plan that provides or pays for medical care |
| healthcare clearinghouses | companies that convert nonstandard transactions into standard transactions and transmit the data to health plans, and the reverse process |
| healthcare providers | people or organizations that furnish, bill, or are paid for healthcare in the normal course of business |
| HIPAA Privacy Rule | Law that regulates the use and disclosure of patients’ protected health information (PHI). |
| protected health information (PHI) | Individually identifiable health information that is transmitted or maintained by electronic media. |
| PHI | protected health information |
| HIPAA Privacy Rule | (states that covered entities must) have a set of privacy practices that are appropriate for its healthcare services |
| HIPAA Privacy Rule | (states that covered entities must) notify patients about their privacy rights and how their information can be used or disclosed |
| HIPAA Privacy Rule | (states that covered entities must) train employees so that they understand the privacy practices |
| HIPAA Privacy Rule | (states that covered entities must) appoint a privacy official responsible for seeing that the privacy practices are adopted and followed |
| HIPAA Privacy Rule | (states that covered entities must) safeguard patients' records |
| Use of PHI | sharing or performing analysis WITHIN the entity that hold the info |
| Disclosure of PHI | the release, transfer, and provision of access to or divulging of PHI OUTSIDE the entity holding the info |
| Treatment | providing and coordinating the patient's medical care |
| Payment | refers to the exchange of information with health plans |
| Healthcare operations | the general business management functions |
| Incidental use or disclosure | secondary use of patient information that cannot reasonably be prevented, is limited, and usually occurs as the result of another permitted use |
| DRS | designated record set |
| designated record set (DRS) | A covered entity’s records that contain protected health information (PHI); for providers, the designated record set is the medical/financial patient record. |
Created by:
VA_MedCod3r