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MED112 Chapter 2
| Question | Answer |
|---|---|
| What is the purpose of medical records? | 1) they trace the course of patient care. 2) they help make accurate diagnoses. |
| What are personal health records? | Private, secure electronic files that are created, maintained, and controlled by patients. |
| Encounters take place between _____. | patients and healthcare providers. |
| The revenue cycle merges the patient's _______ documentation and financial/billing information in the chart. | medical |
| The main federal government agency responsible for healthcare is abbreviated as | CMS |
| A(n) ______ is a file containing the documentation of a patient's medical history and related information. | medical record |
| __________ regulate the operations and compliance of health insurance companies. | The States |
| It is considered _____ when an EHR system can provide access to the latest medical research on approved medical websites to assist with medical decision making. | clinical decision support |
| Which of the following is documented in the patient's chart? | Diagnosis, Patient's name, Encounter date, Plan of care |
| Which of the following steps of the revenue cycle fall under coding and charge capture documentation? | Review coding compliance, Review billing compliance, Check out patients |
| Many payers use ______ as the model for the healthcare industry. | CMS policy |
| Which of the following are true of state regulations in healthcare? | State commissioners of insurance investigate consumer complaints, State laws ensure the solvency of insurance companies and managed care organizations, States can restrict price increases on premiums. |
| Which of the following are among the five provisions (titles) of HIPAA? | Healthcare Access, Portability and Renewability, Tax-Related Health Provisions, Revenue Offsets, Preventing Healthcare Fraud and Abuse, Application and Enforcement of Group Health Plan Requirements |
| Which of the following statements are true regarding medical records? | Thorough medical records are a defense against accusations of malpractice or wrongdoing, Patient medical records are legal documents, Medical records show medical necessity. |
| Which of the following are true of the HITECH Act? | It promotes the adoption of meaningful use of health information technology, It guides the use of federal stimulus money, It addresses privacy and security concerns associated with the electronic transmission of health information. |
| A(n) ______ is a meeting between a patient and a medical professional. | encounter |
| An ACO is a network of which type of healthcare professionals? | Hospitals and Doctors |
| Which of the following are examples of activities performed by CMS to ensure the quality of healthcare? | Researching the effectiveness of healthcare management Evaluating the quality of healthcare services and facilities Regulating lab testing Preventing discrimination based on health status |
| Who controls the amount and type of information that is released to an entity not directly involved in the patient's care? | The patient |
| The protection of patients' private health information is covered under which law? | HIPAA |
| Which of the following are the three parts of the Administrative Simplification? | Electronic Transaction and Code Set Privacy Rule Security Rule |
| The law promoting the adoption and use of health information technology is called the ________. | Health Information Technology for Economic and Clinical Health Act |
| A health plan, clearinghouse, or provider who transmits any health information in electronic form is called a(n): | covered entity |
| The health system reform legislation that offers improved insurance coverage and other benefits is abbreviated as: | ACA |
| The law regulating the use and disclosure of patients' protected health information is called the ______. | HIPAA Privacy Rule |
| Who has ownership of the actual progress notes, reports, and other clinical materials in a medical record? | The provider who created them |
| A covered entity is an organization that electronically transmits any information that is protected under ______. | HIPAA |
| The law promoting the adoption and use of health information technology is abbreviated as ______. | HITECH |
| Healthcare __________ are companies that help providers handle electronic transactions. | Clearinghouses |
| The HIPAA Standards for Privacy of Individually Identifiable Health Information Rule is also known as the HIPAA ______ Rule. | Privacy |
| __________ is defined as individually identifiable health information that is transmitted or maintained by electronic sources other than a paper chart. | PHI or Protected health information |
| When releasing patient information the covered _______ must have an authorization to release information. | entity |
| An electronic exchange of healthcare information is called a(n) ______. | transaction |
| In which circumstances might CEs disclose PHI without the patient's consent? | To grant public health authorities access to PHI necessary to carry out their public health mission, To prevent or lessen a serious threat to the health and safety of the public, To treat the patient or another patient |
| The ______ is a law that requires covered entities to establish safeguards to protect health information. | HIPAA Security Rule |
| What is the main purpose of encrypting data? | To provide security of patient information |
| Which of the following is a part of a patient's PHI? | Name, Social security number, Address |
| Which of the following healthcare workers would need a password to access a patients chart? | Nurse, Registration, Doctor |
| Which of the following statements define authorization? | A document signed by a patient to permit release of medical information |
| An impermissible use or disclosure of PHI that could pose a risk to the affected person is called a(n) ______. | breach |
| Which of the following is the agency that governs emergency guidance for release of information? | HHS |
| Which of the following are true of breaches of information? | A breach compromises the security or privacy of PHI, A breach is an impermissible use or disclosure under the Privacy Rule, Covered entities are required to notify affected individuals after the discovery of a breach. |
| What does the HIPAA Security Rule establish safeguards to protect? | PHI |
| ______________management programs encrypt data between the office and the Internet. | Practice |
| Role-based access into computer records means that ______. | only those who need the information can see it |
| HIPAA Electronic Health Care Transactions and Code Sets is abbreviated as: | TCS |
| Unprotected health information that is not secured through the use of technologies or methods that HHS has specified is called ______ PHI. | unsecured |
| Health plan premium payments is the HIPAA transaction name for number X12 _________. | 820 |
| What must a covered entity do when a breach of unsecured PHI is discovered? | Notify the individuals whose information has been suspected of being disclosed |
| Under _________ , a code set is any group of codes used for encoding data elements. | HIPAA |
| ______ is a method of converting a message into encoded text. | Encryption |
| What are identifiers? | Numbers of predetermined length and structure |
| Rules governing the electronic exchange of health information are called ______. | HIPAA Electronic Health Care Transaction and Code Sets |
| Select the HIPAA transaction number for referral certification and authorization. | X12 278 |
| The _______ Rule contains regulations that enhance patient's privacy protections, and improved rights for patients to their health information. | Omnibus |
| Which of the following are examples of how code sets can be used? | Medical diagnosis codes, Medical concepts, Tables of terms, Medical procedure codes |
| Which federal government department prosecutes criminal violations of HIPAA privacy standards? | Department of Justice |
| A person's Social Security number is an example of a(n) | identifier |
| Which of the following are rules governing the electronic exchange of health information? | TCS |
| In the United States, an estimated $50 billion are lost annually in healthcare as a result of ____. | fraud |
| A set of regulations enhancing patients' privacy protections and rights to information is called the ______. | Omnibus Rule |
| The _________ is the abbreviation for the government agency that has the task of detecting healthcare fraud and abuse and enforcing all laws relating to them. | OIG |
| An alphabetic and/or numeric representation of data is called a(n) _____. | code set |
| Which of the following is a term used to describe whistle-blower cases? | Qui tam |
| Which of the following applies to the role of the Department of Justice with regards to HIPAA? | Criminal violations of HIPAA privacy standards are prosecuted by the DOJ. |
| The Employer Identification Number is also called the ______. | tax identification number |
| What makes it illegal to knowingly offer incentives to induce referrals for services paid by government healthcare programs? | An antikickback statute |
| What is the purpose of healthcare fraud and abuse laws? | Help to control cheating in the healthcare system |
| The government agency that prosecutes and investigates healthcare fraud is the: | Office of the Inspector General |
| An intentional deceptive act to obtain a benefit is called | fraud |
| ___________ stands for the Fraud Enforcement and Recovery Act of 2009. | FERA |
| Reporting services at a higher level than performed is an example of ___________ or ____________ billing practice. | fraudulent, abusive |
| The Office for _____ Rights enforces the HIPAA Privacy Act. | Civil |
| A compliance plan seeks to ensure compliance with which of the following laws? | Employment laws and Federal laws |
| Self-referral prohibitions, also called as ______ rules, make it illegal for physicians to have financial relationships with clinics for the purpose of self referrals. | Stark |
| The OIG compliance plan has _________ elements. | seven |
| What does a compliance committee do? | Oversees compliance programs |
| An action that improperly uses another's resources is called ______. | abuse |
| A requirement of any compliance plan includes ongoing ______: | training |
| Which of the following are examples of fraudulent or abusive billing acts? | Performing procedures that are not medically necessary Reporting services at a higher level than were carried out Intentionally billing for services that were not performed or documented |
| A(n) ____________ plan is a medical practice's written plan for complying with regulations. | compliance |
| According to the OIG, voluntary compliance plans should contain which of the following? | Training, Appointment of a compliance committee, Appointment of a compliance officer, Consistent written policies and procedures |
| A code of conduct for the members of a practice would cover which of the following? | Provisions for discussing compliance during performance reviews, A policy to encourage employees to report compliance concerns to the compliance officer, Procedures for ensuring compliance with laws relating to referrals |
| To maintain ______, physicians should be regularly trained and updated in coding and regulatory matters. | compliance |
| Which of the following is included in the OIG compliance plan? | Communication |
| Which of the following is an example of healthcare fraud? | Double billing a procedure that was performed once |
| Law under the Administrative Simplification provisions of HIPAA regulating the use and disclosure of patients’ protected health information—individually identifiable health information that is transmitted or maintained by electronic media | HIPAA Privacy Rule |
| Impermissible use or disclosure of PHI that could pose significant risk to the affected person | Breach |
| The principle that individually identifiable health information should be disclosed only to the extent needed to support the purpose of the disclosure | Minimum necessary standard |
| A person or organization that performs a function or activity for a covered entity but is not part of its workforce | Business associate |
| A company that offers providers, for a fee, the service of receiving electronic or paper claims, checking and preparing them for processing, and transmitting them in proper data format to the correct carriers | Clearinghouse |
| Which of the following laws is designed to uncover fraud and abuse? | HIPAA |
| A Notice of Privacy Practices is given to: | A practice's patients |
| Patients always have the right to: | withdraw their authorization to release information. |
| The authorization to release information must specify: | the entity to whom the information is released to. |
| Health information that does not identify an individual is referred to as: | De-identified health information. |
| Analyze the following scenarios to determine which would likely warrant a breach notification. | The database of a large insurance company is accessed by a hacker. |
| The main purpose of the HIPAA Security Rule is to: | Control the confidentiality & integrity of & access to protected health info. |
| A compliance plan contains: | Consistent written policies and procedures. |
| X12 837 | Health Care Claims Equivalent Encounter Information/Coordination of Benefits |
| X12 276/277 | Health Care Claim Status Inquiry/Response |
| X12 270/271 | Eligibility for a Health Plan Inquiry/Response |
| X12 278 | Referral Certification and Authorization |
| X12 835 | Health Care Payment and Remittance Advice |
| X12 820 | Health Plan Premium Payments |
| X12 834 | Health Plan Enrollment and Disenrollment |
Created by:
shaedw8525
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