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Stack #552582
| Question | Answer |
|---|---|
| Laws passed by legislative bodies. | Statutory Law |
| Guidelines written by administrative agencies. | Regulations |
| Based on court decisions that establish a precedent. | Case or Common Law |
| Standard | Precedent |
| Contains new and changed Medicare policies/procedures that are to be incorporated into CMS program manual. | Program Transmittals |
| Contracts with CMS to process fee-for-service claims and perform program integrity tasks for both Medicare Parts A & B. | Medicare Administrative Contractor |
| Responded to concerns about physicians' conflicts of interesting when referring patients. | Stark I |
| Requires facilities to identify and reduce improper Medicare payments. | Payment Error Prevention Program |
| Number of dollars paid in error out of total dollars paid for inpatient prospective system services. | Payment Error Rate |
| Responsible for initially requesting and screening medical records for PEPP surveillance sampling for medical review. | Clinical Data Abstracting Centers |
| established PERM, CERT, HPMP, FATHOM, and PEPPER. | Improper Payments Information Act of 2002 |
| Measure improper payments in Medicaid and SCHIPS. | Payment Error Rate Measurement |
| Assess and measure improper Medicare fee-for-service payments. | Comprehensive Error Rate Testing |
| Measure, monitor, and reduce the incidence of fee-for-service payment errors for short-term acute care. | Hospital Payment Monitoring Program |
| Data analysis tool for specific CMS target areas. | FATHOM |
| Contains hospital administrative claims dta for a number CMS-identified problem areas. Uses data to compare their performance with other hospitals. | PEPPER |
| Find and correct improper Medicare payments paid to healthcare providers participating in fee-for-service Medicare. | Recovery Audit Contractor |
| Provide for improved patient safety by encouraging voluntary and confidential reporting of events that adversely affect patients. | Patient Safety and Quality Improvement Act |
| Created Medical Integrity Program. | Deficit Reduction Act |
| Increased resources available to CMS to combat abuse, fraud, and waste in Medicaid. | Medical Integrity Program |
| Created Physician Quality Reporting Initiative. | Tax Relief and Health Care Act of 2006 |
| establishes a financial incentive for eligible professionals who participate in a voluntary quality reporting program. | Physician Quality Reporting Initiative |
| Intentional Deception of misrepresentation that someone makes, knowing is is false, that could result in unauthorized payment. | Fraud |
| Actions that are inconsistent with accepted, sound medical business or fiscal practices. | Abuse |
| Uniform language for electronic data interchange. | Electronic Transactions Standards |
| Used to bill physician and noninstitutional services reported on CMS-1500. | National Standard Format |
| Prior to disclosing the individual's health information. | Authorization |
| Right to keep information from being disclosed from others. | Privacy |
| Restricting information access to those with proper authorization and maintaining the security of patient information. | Confidentiality |
| Safekeeping of information | Security |
| Creates national standards to protect individual's medical records and other personal health information. | Privacy Rule |
Created by:
butterflyaura