Legal and Regulatory Issues
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| Statutes | Laws
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| Regulations | Guidelines written by administrative agencies.
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| Case Law | Based on court decisions that establish a standard (Common Law)
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| Precedent | A standard
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| Civil Law | Law that is not classified as criminal.
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| Criminal Law | Public law that defines crimes and their prosecution
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| Subpoena | An order of the court that requires a witness to appear at a particular time and place to testify.
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| Subpoena Duces Tecum | An order of the court that requires documents (e.g., patient record) to be produced.
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| Deposition | A testimony under oath taken outside of court.
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| Interrogatory | A document containing a list of questions that must be answered in writing.
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| Qui tam | Abbreviation; meaning "who as well for the king as for himself sues in this matter". A provision of the Federal False Claims Act, which allows a private citizen to file a lawsuit.
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| Federal Register | A legal newspaper published every business day by the National Archives and Records Administration (NARA).
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| Program Transmittals | Contain new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program manual.
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| Medicare Administrative Contractor (MAC) | An organization that contracts with CMS to process fee-for-service healthcare claims and perform program integrity tasks for both Medicare Part A and Part B.
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| Record retention | The storage of documentation for an established period of time usually mandated by federal and/or state law.
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| How long must patient records be retained in their original form? | 7 years
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| How long does HIPAA require health insurance claims and accounting records to be retained? | 6 years
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| How long must health insurance claims be retained after a patient's death? | 2 years
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| What is fraud? | an intentional deception or misrepresentation that someone makes, knowing it is false that could result in an unauthorized payment.
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| What is abuse? | Actions that are inconsistent with accepted, sound medical business, or fiscal practices.
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| What are overpayments? | Funds a provider or beneficiary receives in excess of amounts due and payable under Medicare and Medicaid statues and regulations.
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| What is recovery/how does it begin? | Issuing an overpayment demand letter to the provider.
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| National Correct Coding Initiative? | Regulations that govern privacy, security and electronic transaction standards for healthcare information.
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| Code Pairs | Edi pairs included in the Correct Coding Iniative cannot be reported on the same claim if each has the same date of service.
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| Unique Identifiers | That administrative simplification provision of HIPAA that requires establishment of standard identifiers for third party payers.
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| National Provider Identifier (NPI) | A 10 digit numeric identifier that is assigned to healthcare providers by HIPAA.
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| Privileged Communication | Any information communicated by a patient to a healthcare provider.
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| Protected Health Information (PHI) | Information that is identifiable to an individual such as name, address, telephone numbers, date of birth.
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| Privacy | The right of individuals to keep their information from being disclosed to others.
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| Confidentiality | Restricting patient information access to those with proper authorization and maintaining the security of patient information.
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| Security | The safekeeping of patient information.
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| Breach of Confidentiality | The unauthorized release of patient information to a third party.
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| Federal Anti-Kickback Law | Protects patients and federal healthcare programs from fraud and abuse by curtailing the corrupting influence of money on healthcare decisions.
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| When was the Occupational Safety and Health Act created? | 1971
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| Occupational Safety and Health Act (OSHA) | Act to ensure safe and healthful workplaces in America.
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| What year was the Correct Coding Initiative developed? | 1996
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