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IHMO Ch 2 Key Term

Question	Answer
Disclosure	The release, transfer, provision of access to, or divulging in any other manner of information outside the entity holding the information.
E-Health information management (e-HIM)	A term coined by the American Health Information Management Association's eHealth Task Force to describe any and all transactions in which health care information is accessed, processed, stored, and transferred using electronic technologies.
Electronic media	The mode of electronic transmission (e.g., Internet, Extranet, leased phone or dial-up phone lines, fax modems).
Fraud	An intentional misrepresentation of the facts to deceive or mislead another.
Health care provider	A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.
Individually identifiable health information (IIHI)	Any part of an individual's health information including demographic information (e.g., address, date of birth) collected from the individual that is created or received by a covered entity.
Nonprivileged information	Information consisting of ordinary facts unrelated to the treatment of the patient.
Notice of Privacy Practices (NPP)	Under the Health Insurance Portability and Accountability Act (HIPAA), a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information (PHI).
Phantom billing	Billing for services not performed.
Privacy	The condition of being secluded from the presence or view of others.
Privacy officer, privacy official	An individual designated to help the provider remain in compliance by setting policies and procedures in place, and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
Privileged information	Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
Protected health information (PHI)	Any data that identify an individual and describe his or her health status, age, sex, ethnicity, or other demographic characteristics, whether or not that information is stored or transmitted electronically.
Security officer	A person who protects the computer and networking systems within the practice and implements protocols such as password assignment, backup procedures, firewalls, virus protection, and contingency planning for emergencies.
Security Rule	Regulations related to the security of electronic protected health information (ePHI) that compose the Administrative Simplification provisions.
Standard	A rule, condition, or requirement.
State preemption	A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
Transaction	The transmission of information between two parties to carry out financial or administrative activities related to health care.
Use	The sharing, employment, application, utilization, examination, or analysis of individually identifiable health information (IHII) within an organization that holds such information.
Abuse	Incidents or practices, not usually considered fraudulent, that are inconsistent with accepted sound medical business or fiscal practices.
Authorization	Under the HIPAA privacy rule, an individual's formal, written permission to use or disclose his or her personally identifiable health information for purposes other than treatment, payment, or health care operations.
Authorization form	A document signed by the patient that is needed for use and disclosure of protected health information that is not included in any existing consent form agreements.
Breach of confidential communication	Breach means “breaking or violation of a law or agreement.” In the context of the medical office it means the unauthorized release of information about the patient.
Business associate	A person who, on behalf of the covered entity, performs or assists in the performance of a function or activity involving the use or disclosure of individually identifiable health information.
Compliance	A process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry.
Compliance plan	A management plan composed of policies and procedures to accomplish uniformity, consistency, and conformity in medical record keeping that fulfills official requirements.
Confidential communication	A privileged communication that may be disclosed only with the patient's permission.
Confidentiality	The state of treating privately or secretly, and not disclosing to other individuals or for public knowledge, the patient's conversations or medical records.
Consent	Verbal or written agreement that gives approval to some action, situation, or statement.
Consent form	A document that is not required before physicians use or disclose protected health information for treatment, payment, or routine health care operations of the patient. For other purposes, see Authorization form.
Assignment	A transfer, after an event insured against, or an individual's legal right to collect an amount payable under an insurance contract.
Clearinghouse	An independent organization that receives insurance claims from the physician's office, performs software edits, and redistributes the claims electronically to various insurance carriers.
Code sequence	The correct order of diagnostic codes when submitting an insurance claim that affects maximum reimbursement.
Code set	Any set of codes with their descriptions used to encode data elements such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.
Covered entity (CE)	An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA.
Deductible	A specific dollar amount that must be paid by the insured before a medical insurance plan or government program begins covering health care costs.
Embezzlement	A willful act by an employee of taking possession of an employer's money.
CCI	Correct Coding Initiative
CD	compact disk
CDT	Code on Dental Procedures and Nomenclature
CLIA	Clinical Laboratory Improvement Amendments
CMP	civil monetary penalty
CMS	Centers for Medicare and Medicaid Services
CPT	Current Procedural Terminology
DHHS	U.S. Department of Health and Human Services
DOJ	Department of Justice
EDI	electronic data interchange
eHIM	electronic health information management
FBI	Federal Bureau of Investigation
FCA	False Claims Act
FDIC	Federal Deposit Insurance Corporation
FTP	file transfer protocol
HCFAP	Health Care Fraud and Abuse Control Program
HIPAA	Health Insurance Portability and Accountability Act
HL7	Health Level Seven
IIHI	individually identifiable health information
MIP	Medicare Integrity Program
NCVHS	National Committee on Vital and Health Statistics
NDC	National Drug Code
NHII	National Health Information Infrastructure
NPP	Notice of Privacy Practices
NSF	National Standard Format
OCR	Office for Civil Rights
OIG	Office of the Inspector General
ORT	Operation Restored Trust
OSHA	Occupational Safety and Health Administration
P & P	policies and procedures
PHI	protected health information
PO	privacy officer or privacy official
TCS	HIPAA transaction and code set
TPA	third-party administrator
TPO	treatment, payment, and health care operations

Created by: curriculum

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