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Workbook Chap 2


Meeting regulations, recommendations & expectations of federal and state agencies that pay for health care services and regulates the industry is the process known as what? Compliance
Transactions in which health care information is accessed, processed, stored and transferred using electronic technologies are known as what? eHealth Information Management
Acronym for eHealth Information Management is what? eHIM
How would the required Health Level 7 format for a date of birth of January 20, 2005 @ 7:15a.m. be transmitted? 200501200715 - YYYYMMDDHRMM
What is SNOMED? Systemized nomenclature of Human and Veterinary Medicine International - a code system used for managing patient electronic health records, information & billing lab procedures.
What is the primary purpose of HIPAA Title 1: Insurance Reform? Provide continuous insurance coverage for workers and insured dependents when they change or lose jobs.
What is administrative simplification? The part of HIPAA with goals that focus on the health care practice setting and reduction of administrative costs and burdens.
What is a clearinghouse? An independent organization that receives insurance claims from the physician's office, performs edits, and transmits claims to insurance carriers.
Under HIPAA a health care coverage carrier such as Blue Cross, that transmits health information in electronic form in connection with a transaction is called what? A covered entity
Dr. Doe contracts with an outside billing company to manage claims and accounts receivable. Under HIPAA the billing company is called what? A business associate
What is a privacy officer? An individual designated to assist the provider by putting compliance policies and procedures in place and training office staff.
To give, release or transfer information to another entity is known as what? Disclosure
Define protected health information (PHI). Any information that identifies an individual and describes his/her health status, age, sex, ethnicity or other demographics whether or not that information is stored or transmitted electronically.
Unauthorized release of a patient's health information is called what? Breach of confidential communication
A confidential communication related to the patient's treatment and progress that may be disclosed only with the patient's permission is known as what? Privileged information
Under HIPAA, exceptions to the right of privacy are those records involving what: Managed care patients, communicable diseases, medical device failures or malfunctions, patient's suspected of criminal activity, subpoenas issued, suspicious death, physician exam requested by a third party payer & state laws that require report of abuse
The document that must be given so the patient acknowledges the provider's confidentiality of their protected health information is called what? Notice of Privacy Practices
Name the three main sections of the HIPAA Security Rule. 1. Administrative safeguards 2. Technical safeguards 3. Physical safeguards
Under the False Claims Act, billing a claim for services not medically necessary is considered to be what? Fraud
Changing a figure on an insurance claim form to get increased payment is considered what? Fraud
Dismissing the copayment and/or deductible is considered what? Fraud
Neglecting to refund an overpayment to the patient is considered what? Abuse
Billing for a complex fracture when the patient suffered a simple break is considered what? Fraud
A standards developing organization whose mission is to provide standards for the exchange, management and integration of data that support clinical patient care and the management, delivery and evaluation of health care services is called Health Level Seven (HL7)
Entities covered under the HIPAA transaction standards are 1. Health care third party payers 2. Health care providers 3. Clearinghouses
Enforcement of the privacy standards of HIPAA is the responsibility of what government organization? Office of Civil Rights (OCR)
Verbal or written agreement that gives approval to some action, situation, or statement is called Consent
An individual's formal written permission to use or disclose PHI for purposes other than treatment, payment or health care operations is called Authorization
Individually identifiable health info (IIHI) is any part of a person's health data obtained from the patient that is created or received by a covered entity. True
HIPAA requirements protect disclosure of PHI outside the organization but not for internal use of health information. False
Under HIPAA, patients may request confidential communications and may restrict certain disclosures of PHI. True
A national provider identifier (NPI) number is issued for 5 years and must be renewed. False
To submit an insurance claim for medical services that were not medically necessary is a violation of the False Claims Act. True
Created by: mpeoples