| Question | Answer |
| What does HIPAA stand for?
What does it do? | Health Ins Portability and Accountability Act, issued by HHS, part of the Privacy and Security Rules
Sets federal standards for insurers, HMO's and employer plans to protect med recs & pers health info and safe and accurate exchange of this info. |
| What was the patient Bill of Rights replaced with and what does it state? | A plain language brochure called Patient Care Partnership
During a hospital stay a pt can expect:
High qual. care
Clean, safe environment
Involvement in care
Help when leaving
Help w/ their billing claims
Protection of their privacy |
| What does HIPAA accomplish? | - gives pt more control of health info
- sets boundaries on use & release of records
- establishes rules for handling/protecting info
- Holds violators accountable (civil & criminal penalties)
- Limits release of info to minimum reasonably needed. |
| What is PHI and list some examples | Protected Health Information - any data that can be used individually or in combo to match patient to med recs.
-DOB -Name -Address -Phone -email -SSN -MR# -Employer info -relatives' info -certificate # for med equipment |
| What does TPO stand for and describe | Treatment, Payment or Healthcare Operations
PHI can be shared w/o consent for TPO.
PHI CANNOT be shared for marketing w/o explicit consent. Cannot be shared with law enforcement without court order. |
| What does ECOA stand for and describe | Equal Credit Opp Act
prohibits discr based on: race, color, nat'l origin, sex, marital status, age or b/c they rec public assist.
May ask for demo info for gov't to enforce laws.
May consider immigration status
May NOT ask if widowed or divorced |
| What does FDCPA stand for and describe | Fair Debt Collection Practices Act
a result of evidence of abuse in debt collection practices.
Limits: how location info of debtor is obtained and communication w/ debtor and others. |
| What are some examples of Harrassment or Abuse as it pertains to the FDCPA | Fair Debt Collection Practices Act
-Use of false/misleading info
-Contacting before 8am or after 9pm in debtor's location
-contacting if we are aware they have legal council
-calling at work if we know it will cause a problem |
| What does FCRA and describe | Fair Credit Reporting Act
Defines what info from consumer reports can be used, by whom and when.
Provides maximum protection of a consumer's right to privacy and confidentiality of credit reports. |
| What does FCBA stand for and describe | Fair Credit Billing Act
Protects consumers from inaccurate or unfair practices by issuers of open-ended credit.
Requires creditors to inform debtors of their rights and of the responsibilities of the creditor. |
| What is another name for Regulation Z and what does it do? | Truth in Lending Act
Deals w/ disclosure of info before credit is extended
Requires APR & finance charges are clearly identified and written disclosures must be provided to the consumer. |
| What does TCPA stand for and describe | Telephone Consumer Protection Act
- restricts telemarketing and use of automated phone equipment.
- prohibits the use of automated tele equipment to a cell phone to contact a debtor w/o express consent. Limits use of pre-recorded messages and texts. |
| What is the False Claims Act? | Prohibits making a false record or statement to get a false/fraudulent claim paid by the government. Prohibits submission of false/fraudulent claims or conspiring to have such claims paid by the government. |
| What are administrative sanctions and when are they used? | If CMS determines the existence of inappropriate/fraudulent behavior by the provider:
- Denial or revocation of provider # application
- Suspension of provider pmts
- Application of civil monetary penalties (CMP's) |
| What does PPACA stand for and describe | Patient Protection and Affordable Care Act
Together w/ the Health Care & Education Reconsiliation Act, represents the most significant overhaul of the US HC system since MC & MA were passed in 1965. |
| What is the goal of PPACA? | Patient Protection and Affordable Care Act
Aims to lower # of uninsured Americans and lower overall cost of HC, using mandates, subsidies and tax credits. |
| Define Fraud | Intentional/illegal deception or misrep for personal gain/to harm or manipulate a person or organization.
(ex: - incorrect report of DX, procedure codes to max payments - billing svcs not rendered -accepting kickbacks - routine waiver of ded or coins. |
| Define Abuse | Not considered fraud but inconsistent with accepted sound practices. (ex: unwarranted use of tech, pharma or svcs. Abuse of authority, abuse of privacy or duty to care, unintentional improper billing. |
| What does PSDA stand for and describe | Patient Self Determination Act
Passed by congress to ensure the pt understands and can participate in their own care decisions.
Deals with advance directives. |
| What is an advance directive and list examples | Written statements regarding patient wishes in the event they later become unable to make choices.
- Living Will - lists wishes
-HC POA or Durable POA for HC - assigns a person to make decisions for you
-DNR |
| What does EMTALA stand for and describe | Emergency Medical Trmt & Active Labor Act
(aka: Federal Anti-dumping statute)
Requires ER prior to asking about pmt:
- med screening exam
-Nec stabilizing trtmt
-restricts xfer until stabilized
-not just for ER, any location on a hospital campus. |
| What does CLIA stand for and describe | Clinical Lab Improvement Ammendment
-clinical lab svcs to MC pts must be performed by a CLIA certified provider. # to each provider and must be on claim.
-state becomes exempt if requirement is more stringent than that of CLIA. Currently, only NY & WA. |
| What does TJC stand for and describe | The Joint Commission
- a private agy that CMS allows to accredit hospitals to protect & improve quality & safety of care.
conducts audit of hospital every 39 mos and labs every 24 mos.
can audit w/o notice as soon as 9-30 mos after initial audit. |
| Which areas of patient access does TJC survey? | Distribution & discussion of advance directives
pt rights and responsibilities
organizational ethics
continuum of care
mngmt of environment of care
confidentiality/privacy
security
communication |
