Question 1

A federal law that requires providers to make certain specific categories of clinical notes digitally accessible to patients.

Accepted Answer

21st Century Cures Act

Question 2

Action that improperly uses another person’s resources.

Accepted Answer

abuse

Question 3

A network of doctors and hospitals that shares responsibility for managing the quality and cost of care provided to a group of patients.

Accepted Answer

accountable care organization (ACO)

Question 4

The documentation of the disclosure of a patient’s PHI in his or her medical record in cases when the individual did not authorize it and it was not a permitted disclosure.

Accepted Answer

accounting of disclosure

Question 5

Health system reform legislation that offers improved insurance coverage and other benefits.

Accepted Answer

Affordable Care Act (ACA)

Question 6

Methodical review; in medical insurance, a formal examination of a physician’s accounting or patient medical records.

Accepted Answer

audit

Question 7

(1) Document signed by a patient to permit release of particular medical information under the stated specific conditions. (2) A health plan’s system of approving payment of benefits for services that satisfy the plan’s requirements for coverage; see preauthorization.

Accepted Answer

authorization

Question 8

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.

Accepted Answer

breach

Question 9

The document notifying an individual of a breach.

Accepted Answer

breach notification

Question 10

A person or organization that performs a function or activity for a covered entity but is not part of its workforce.

Accepted Answer

business associate (BA)

Question 11

Federal agency within the Department of Health and Human Services (HHS) that runs Medicare, Medicaid, clinical laboratories (under the CLIA program), and other government health programs.

Accepted Answer

Centers for Medicare and Medicaid Services (CMS)

Question 12

A company (billing service, repricing company, or network) that converts nonstandard transactions into standard transactions and transmits the data to health plans; also handles the reverse process, changing standard transactions from health plans into nonstandard formats for providers.

Accepted Answer

clearinghouse

Question 13

Alphabetic and/or numeric representations for data. Medical code sets are systems of medical terms that are required for HIPAA transactions. Administrative (nonmedical) code sets, such as taxonomy codes and ZIP codes, are also used in HIPAA transactions.

Accepted Answer

code set

Question 14

A medical practice’s written plan for the following: the appointment of a compliance officer and committee; a code of conduct for physicians’ business arrangements and employees’ compliance; training plans; properly prepared and updated coding tools such as job reference aids, encounter forms, and documentation templates; rules for prompt identification and refunding of overpayments; and ongoing monitoring and auditing of claim preparation.

Accepted Answer

compliance plan

Question 15

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.

Accepted Answer

covered entity (CE)

Question 16

The process of protecting information confidentiality, integrity, and availability by preventing, detecting, and responding to attacks on digital data.

Accepted Answer

cybersecurity

Question 17

Medical data from which individual identifiers have been removed; also known as a redacted or blinded record.

Accepted Answer

de-identified health information

Question 18

A covered entity’s records that contain protected health information (PHI); for providers, the designated record set is the medical/financial patient record.

Accepted Answer

designated record set (DRS)

Question 19

The systematic, logical, and consistent recording of a patient’s health status—history, examinations, tests, results of treatments, and observations—in chronological order in a patient medical record.

Accepted Answer

documentation

Question 20

The system-to-system exchange of data in a standardized format.

Accepted Answer

electronic data interchange (EDI)

Question 21

An office visit between a patient and a medical professional.

Accepted Answer

encounter

Question 22

A method of scrambling transmitted data so they cannot be deciphered without the use of a confidential process or key.

Accepted Answer

encryption

Question 23

Provider’s evaluation of a patient’s condition and decision on a course of treatment to manage it.

Accepted Answer

evaluation and management (E/M)

Question 24

federal law prohibiting intentional misrepresentation related to healthcare claims

Accepted Answer

False Claims Act

Question 25

Intentional deceptive act to obtain a benefit.

Accepted Answer

fraud

Question 26

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.

Accepted Answer

Health Information Technology
 for Economic and Clinical Health 
(HITECH) Act

Question 27

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.

Accepted Answer

Health Insurance Portability and 
Accountability Act (HIPAA) of 1996

Question 28

The HIPAA rule governing the electronic exchange of health information.

Accepted Answer

HIPAA Electronic Health Care 
Transactions and Code Sets (TCS)

Question 29

HIPAA-mandated identification systems for employers, healthcare providers, health plans, and patients; the NPI, National Provider System, and employer system are in place; health plan and patient systems are yet to be created.

Accepted Answer

HIPAA National Identifier

Question 30

Law that regulates the use and disclosure of patients’ protected health information (PHI).

Accepted Answer

HIPAA Privacy Rule

Question 31

Law that requires covered entities to establish administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of health information.

Accepted Answer

HIPAA Security Rule

Question 32

The process by which a patient authorizes medical treatment after discussion about the nature, indications, benefits, and risks of a treatment a physician recommends.

Accepted Answer

informed consent

Question 33

Failure to use an acceptable level of professional skill when giving medical services that results in injury or harm to a patient.

Accepted Answer

malpractice

Question 34

The utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare system.

Accepted Answer

meaningful use

Question 35

A series of steps that explain how using EHRs is integrated with practice management programs as the 10-step billing process is formed.

Accepted Answer

medical documentation and revenue cycle

Question 36

A file that contains the documentation of a patient’s medical history, record of care, progress notes, correspondence, and related billing/financial information.

Accepted Answer

medical record

Question 37

State-specified performance measures for the delivery of healthcare by medical professionals.

Accepted Answer

medical standards of care

Question 38

Principle that individually identifiable health information should be disclosed only to the extent needed to support the purpose of the disclosure.

Accepted Answer

minimum necessary standard

Question 39

Under HIPAA, unique ten-digit identifier assigned to each provider by the National Provider System.

Accepted Answer

National Provider Identifier (NPI)

Question 40

A HIPAA-mandated description of a covered entity’s principles and procedures related to the protection of patients’ health information.

Accepted Answer

Notice of Privacy Practices (NPP)

Question 41

Government agency that enforces the HIPAA Privacy Act.

Accepted Answer

Office for Civil Rights (OCR)

Question 42

Government agency that investigates and prosecutes fraud against government healthcare programs such as Medicare.

Accepted Answer

Office of the Inspector General (OIG)

Question 43

Set of regulations enhancing patients’ privacy protections and rights to information and the government’s ability to enforce HIPAA.

Accepted Answer

Omnibus Rule

Question 44

Rules that improve interoperability between the data systems of different entities, such as health plans and providers, and so increase their usefulness.

Accepted Answer

operating rules

Question 45

Confidential authentication information composed of a string of characters.

Accepted Answer

password

Question 46

Individually identifiable health information that is transmitted or maintained by electronic media.

Accepted Answer

protected health information (PHI)

Question 47

Person who makes an accusation of fraud or abuse in a qui tam case.

Accepted Answer

relator

Question 48

A federal law that governs physician self-referrals in financial relationships with other healthcare service providers.

Accepted Answer

Stark Law

Question 49

Under HIPAA, structured set of electronic data transmitted between two parties to carry out financial or administrative activities related to healthcare; in a medical billing program, electronic financial exchange that is recorded, such as a patient’s copayment or deposit of funds into the provider’s bank account.

Accepted Answer

transaction

Question 50

Under HIPAA, patients’ protected health information may be shared without authorization for the purposes of treatment, payment, and operations.

Accepted Answer

treatment, payment, and healthcare operation (TPO)

MED112 CODE/BILL

MED112 CH 02 KEY TERMS

DEFINITION	TERM
MED112 CH 2 KEY TERMS
A federal law that requires providers to make certain specific categories of clinical notes digitally accessible to patients.	21st Century Cures Act
Action that improperly uses another person’s resources.	abuse
A network of doctors and hospitals that shares responsibility for managing the quality and cost of care provided to a group of patients.	accountable care organization (ACO)
The documentation of the disclosure of a patient’s PHI in his or her medical record in cases when the individual did not authorize it and it was not a permitted disclosure.	accounting of disclosure
Health system reform legislation that offers improved insurance coverage and other benefits.	Affordable Care Act (ACA)
Methodical review; in medical insurance, a formal examination of a physician’s accounting or patient medical records.	audit
(1) Document signed by a patient to permit release of particular medical information under the stated specific conditions. (2) A health plan’s system of approving payment of benefits for services that satisfy the plan’s requirements for coverage; see preauthorization.	authorization
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.	breach
The document notifying an individual of a breach.	breach notification
A person or organization that performs a function or activity for a covered entity but is not part of its workforce.	business associate (BA)
Federal agency within the Department of Health and Human Services (HHS) that runs Medicare, Medicaid, clinical laboratories (under the CLIA program), and other government health programs.	Centers for Medicare and Medicaid Services (CMS)
A company (billing service, repricing company, or network) that converts nonstandard transactions into standard transactions and transmits the data to health plans; also handles the reverse process, changing standard transactions from health plans into nonstandard formats for providers.	clearinghouse
Alphabetic and/or numeric representations for data. Medical code sets are systems of medical terms that are required for HIPAA transactions. Administrative (nonmedical) code sets, such as taxonomy codes and ZIP codes, are also used in HIPAA transactions.	code set
A medical practice’s written plan for the following: the appointment of a compliance officer and committee; a code of conduct for physicians’ business arrangements and employees’ compliance; training plans; properly prepared and updated coding tools such as job reference aids, encounter forms, and documentation templates; rules for prompt identification and refunding of overpayments; and ongoing monitoring and auditing of claim preparation.	compliance plan
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.	covered entity (CE)
The process of protecting information confidentiality, integrity, and availability by preventing, detecting, and responding to attacks on digital data.	cybersecurity
Medical data from which individual identifiers have been removed; also known as a redacted or blinded record.	de-identified health information
A covered entity’s records that contain protected health information (PHI); for providers, the designated record set is the medical/financial patient record.	designated record set (DRS)
The systematic, logical, and consistent recording of a patient’s health status—history, examinations, tests, results of treatments, and observations—in chronological order in a patient medical record.	documentation
The system-to-system exchange of data in a standardized format.	electronic data interchange (EDI)
An office visit between a patient and a medical professional.	encounter
A method of scrambling transmitted data so they cannot be deciphered without the use of a confidential process or key.	encryption
Provider’s evaluation of a patient’s condition and decision on a course of treatment to manage it.	evaluation and management (E/M)
federal law prohibiting intentional misrepresentation related to healthcare claims	False Claims Act
Intentional deceptive act to obtain a benefit.	fraud
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.	Health Information Technology for Economic and Clinical Health (HITECH) Act
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.	Health Insurance Portability and Accountability Act (HIPAA) of 1996
The HIPAA rule governing the electronic exchange of health information.	HIPAA Electronic Health Care Transactions and Code Sets (TCS)
HIPAA-mandated identification systems for employers, healthcare providers, health plans, and patients; the NPI, National Provider System, and employer system are in place; health plan and patient systems are yet to be created.	HIPAA National Identifier
Law that regulates the use and disclosure of patients’ protected health information (PHI).	HIPAA Privacy Rule
Law that requires covered entities to establish administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of health information.	HIPAA Security Rule
The process by which a patient authorizes medical treatment after discussion about the nature, indications, benefits, and risks of a treatment a physician recommends.	informed consent
Failure to use an acceptable level of professional skill when giving medical services that results in injury or harm to a patient.	malpractice
The utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare system.	meaningful use
A series of steps that explain how using EHRs is integrated with practice management programs as the 10-step billing process is formed.	medical documentation and revenue cycle
A file that contains the documentation of a patient’s medical history, record of care, progress notes, correspondence, and related billing/financial information.	medical record
State-specified performance measures for the delivery of healthcare by medical professionals.	medical standards of care
Principle that individually identifiable health information should be disclosed only to the extent needed to support the purpose of the disclosure.	minimum necessary standard
Under HIPAA, unique ten-digit identifier assigned to each provider by the National Provider System.	National Provider Identifier (NPI)
A HIPAA-mandated description of a covered entity’s principles and procedures related to the protection of patients’ health information.	Notice of Privacy Practices (NPP)
Government agency that enforces the HIPAA Privacy Act.	Office for Civil Rights (OCR)
Government agency that investigates and prosecutes fraud against government healthcare programs such as Medicare.	Office of the Inspector General (OIG)
Set of regulations enhancing patients’ privacy protections and rights to information and the government’s ability to enforce HIPAA.	Omnibus Rule
Rules that improve interoperability between the data systems of different entities, such as health plans and providers, and so increase their usefulness.	operating rules
Confidential authentication information composed of a string of characters.	password
Individually identifiable health information that is transmitted or maintained by electronic media.	protected health information (PHI)
Person who makes an accusation of fraud or abuse in a qui tam case.	relator
A federal law that governs physician self-referrals in financial relationships with other healthcare service providers.	Stark Law
Under HIPAA, structured set of electronic data transmitted between two parties to carry out financial or administrative activities related to healthcare; in a medical billing program, electronic financial exchange that is recorded, such as a patient’s copayment or deposit of funds into the provider’s bank account.	transaction
Under HIPAA, patients’ protected health information may be shared without authorization for the purposes of treatment, payment, and operations.	treatment, payment, and healthcare operation (TPO)

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