Understanding Health Insurance chapter 5
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| ABUSE | show 🗑
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| ANSI ASC X12N 837 | show 🗑
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| AUTHORIZATION | show 🗑
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| show | NONPUBLISHED CODE EDITS, WHICH WERE DISCONTINUED IN 2000.
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| BREACH OF CONFIDENTIALITY | show 🗑
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| show | ALSO CALLED COMMON LAW; BASED ON A COURT DECISION THAT ESTABLISHES A PRECEDENT.
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| CHECK DIGIT | show 🗑
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| CIVIL LAW | show 🗑
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| show | REQUESTS AND SCREENS MEDICAL RECORDS FOR THE PAYMENT ERROR PREVENTION PROGRAM (PEPP)TO SURVEY SAMPLES FOR MEDICAL REVIEW, DRG VALIDATION, AND MEDICAL NECESSITY.
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| COMMON LAW | show 🗑
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| show | ASSESSES AND MEASURES IMPROPER MEDICARE FEE-FOR-SERVICE PAYMENTS (BASED ON REVIEWING SELECTED CLAIMS AND ASSOCIATED MEDICAL RECORD DOCUMENTATION).
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| CONFIDENTIALITY | show 🗑
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| show | PUBLIC LAW GOVERNED BY STATUTE OR ORDINANCE THAT DEALS WITH CRIMES AND THEIR PROSECUTION.
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| CURRENT DENTAL TERMINOLOGY (CDT) | show 🗑
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| show | TO DECODE AN ENCODED COMPUTER FILE SO THAT IT CAN BE VIEWED.
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| show | CREATED MEDICAID INTEGRITY PROGRAM (MIP), WHICH INCREASED RESOURCES AVAILABLE TO CMS TO COMBAT ABUSE, FRAUD, AND WASTE IN THE MEDICAID PROGRAM. CONGRESS REQUIRES ANNUAL REPORTING BY CMS ABOUT THE USE AND EFFECTIVENESS OF FUNDS APPROPRIATED FOR THE MIP.
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| DEPOSITION | show 🗑
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| show | APPLICATION OF MATHEMATICAL FUNCTION TO AN ELECTRONIC DOCUMENT TO CREATE A COMPUTER CODE THAT CAN BE ENCRYPTED (ENCODED).
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| show | ALSO CALLED TRANSACTIONS RULE; A UNIFORM LANGUAGE FOR ELECTRONIC DATA INTERCHANGE.
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| ENCRYPT | show 🗑
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| FALSE CLAIMS ACT (FCA) | show 🗑
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| show | REQUIRES MEDICARE ADMINISTRATIVE CONTRACTORS (PREVIOUSLY CALLED CARRIERS AND FISCAL INTERMEDIARIES), AS AGENTS OF THE FEDERAL GOVERNMENT, TO ATTEMPT THE COLLECTION OF OVERPAYMENTS.
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| FEDERAL REGISTER | show 🗑
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| show | DATA ANALYSIS TOOL, WHICH PROVIDES ADMINISTRATIVE HOSPITAL AND STATE SPECIFIC DATA FOR SPECIFIC CMS TARGET AREAS.
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| show | INTENTIONAL DECEPTION OR MISREPRESENTATION THAT COULD RESULT IN AN UNAUTHORIZED PAYMENT.
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| HOSPITAL INPATIENT QUALITY REPORTING (HOSPITAL IQR)PROGRAM | show 🗑
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| show | HEALTHCARE REFORM MEASURE THAT PROMOTES BETTER CLINICAL OUTCOMES AND PATIENT EXPERIENCES OF CARE; EFF OCT 2012, HOSPITALS RECEIVE REIMBURSEMENT FOR INPATIENT ACUTE CARE SERVICES BASED ON CARE QUALITY (INSTEAD OF THE QUANTITY OF SERVICES PROVIDED).
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| IMPROPER PAYMENTS INFORMATION ACT OF 2002 (IPA) PART I | show 🗑
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| IMPROPER PAYMENTS INFORMATION ACT OF 2002 (IPA) PART II | show 🗑
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| IMPROPER PAYMENTS INFORMATION ACT OF 2002 (IPA) PART III | show 🗑
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| LISTSERV | show 🗑
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| MEDICAID INTEGRITY PROGRAM (MIP) | show 🗑
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| MEDICAL REVIEW (MR) | show 🗑
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| MEDICARE ADMINISTRATIVE CONTRACTOR (MAC) | show 🗑
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| MEDICARE INTEGRITY PROGRAM (MIP) | show 🗑
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| MEDICARE SHARED SAVINGS PROGRAM | show 🗑
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| MESSAGE DIGEST | show 🗑
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| show | MAINTAINED BY THE FOOD AND DRUG ADMINISTRATION (FDA); IDENTIFIES PRESCRIPTION DRUGS AND SOME OVER-THE-COUNTER PRODUCTS.
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| NATIONAL HEALTH PLANID (PLANID) | show 🗑
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| NATIONAL INDIVIDUAL IDENTIFIER | show 🗑
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| NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM (NPPES) | show 🗑
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| NATIONAL PROVIDER IDENTIFIER (NPI) | show 🗑
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| NATIONAL STANDARD EMPLOYER INDENTIFICATION NUMBER (EIN) | show 🗑
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| show | FLAT-FILE FORMAT USED TO BILL PHYSICIAN AND NONINSTITUTIONAL SERVICES, SUCH AS SERVICES REPORTED BY A GENERAL PRACTITIONER ON A CMS-1500 CLAIM.
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| OVERPAYMENT | show 🗑
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| PART A/B MEDICARE ADMINISTRATIVE CONTRACTOR (A/B MAC) | show 🗑
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| PATIENT SAFETY AND QUALITY IMPROVEMENT ACT PART I | show 🗑
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| show | AGGREGATE, AND ANALYZE CONFIDENTIAL INFORMATION REPORTED BY HEALTHCARE PROVIDERS AND DESIGNATES INFORMATION REPORTED TO PSOs AS PRIVILEDGED AND NOT SUBJECT TO DISCLOSURE UNLESS A COURT DETERMINES OTHERWISE.
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| PAYMENT ERROR PREVENTION PROGRAM (PEPP) | show 🗑
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| show | NUMBER OF DOLLARS PAID IN ERROR OUT OF TOTAL DOLLARS PAID FOR INPATIENT PROSPECTIVE PAYMENT SYSTEM SERVICES.
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| PAYMENT ERROR RATE MEASUREMENT PROGRAM (PERM) | show 🗑
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| PHYSICIAN QUALITY REPORTING SYSTEM | show 🗑
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| PHYSICIAN SELF-REFERRAL LAW (SAME AS STARK I) PART I | show 🗑
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| show | PHYSICIAN'S FAMILY HAS A FINANCIAL OWNERSHIP/INVESTMENT INTEREST AND/OR COMPENSATION ARRANGEMENT; ALSO CALLED PHYSICIAN SELF-REFERRAL LAW.
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| PHYSICIANS AT TEACHING HOSPITALS (PATH) | show 🗑
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| PRECEDENT | show 🗑
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| show | RIGHT OF INDIVIDUALS TO KEEP THEIR INFORMATION FROM BEING DISCLOSED TO OTHERS.
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| PRIVACY ACT OF 1974 | show 🗑
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| PRIVACY RULE | show 🗑
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| show | PRIVATE INFORMATION SHARED BETWEEN A PATIENT AND HEALTHCARE PROVIDER; DISCLOSURE MUST BE IN ACCORDANCE WITH HIPAA AND/OR INDIVIDUAL STATE PROVISIONS REGARDING THE PRIVACY AND SECURITY OF PROTECTED HEALTH INFORMATION (PHI).
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| PROGRAM FOR EVALUATING PAYMENT PATTERNS ELECTRONIC REPORT (PEPPER) | show 🗑
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| show | RESPONSIBLE FOR FRAUD AND ABUSE DETECTION FROM CARRIERS AND FISCAL INTERMEDIARIES (FIs). IN 2009, PSCs WERE REPLACED BY THE ZONE PROGRAM INTEGRITY CONTRACTOR (ZPIC).
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| show | DOCUMENT PUBLISHED BY MEDICARE CONTAIN NEW/CHANGED POLICIES OR PROCEDURES THAT ARE INCORPORATED INTO A CMS PROGRAM MANUAL; SUMMARIZES NEW/CHANGED MATERIAL, SUBSEQUENT PAGES PROVIDE DETAILS. THEY ARE TO BE SENT TO EACH MEDICARE ADMINISTRATIVE CONTRACTOR.
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| show | INFORMATION THAT IS IDENTIFIABLE TO AN INDIVIDUAL (OR INDIVIDUAL IDENTIFIERS) SUCH AS NAME, ADDRESS, TELEPHONE NUMBERS, DATE OF BIRTH, MEDICAID ID NUMBER, MEDICAL RECORD NUMBER, SOCIAL SECURITY NUMBER (SSN), AND NAME OF EMPLOYER.
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| QUI TAM PART I | show 🗑
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| QUI TAM PART II | show 🗑
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| RECORD RETENTION | show 🗑
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| show | MANDATED BY THE MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003 (MMA) TO FIND AND CORRECT IMPROPER MEDICARE PAYMENTS PAID TO HEALTHCARE PROVIDERS PARTICIPATING IN FEE-FOR-SERVICE MEDICARE.
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| show | GUIDELINES WRITTEN BY ADMINISTRATIVE AGENCIES (E.G., CMS).
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| RELEASE OF INFORMATION (ROI) PART I | show 🗑
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| RELEASE OF INFORMATION (ROI) PART II | show 🗑
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| show | USED TO DOCUMENT PATIENT INFORMATION RELEASED TO AUTHORIZED REQUESTORS; DATA IS ENTERED MANUALLY (E.G., THREE-RING BINDER) OR USING ROI TRACKING SOFTWARE.
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| show | SAFEKEEPING OF PATIENT INFOMATION BY CONTROLLING ACCESS TO HARD COPY AND COMPUTERIZED RECORDS. PROTECTION INFORMATION FROM ALTERATION, DESTRUCTION OR LOSS; PROVIDE EMPLOYEE TRAINING IN CONFIDENTIALITY AND SIGNATURE OF STATEMENT THAT DETAILS CONSEQUENCES.
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| show | HIPAA STANDARDS AND SAFEGUARDS THAT PROTECT HEALTH INFORMATION COLLECTED, MAINTAINED, USED OR TRANSMITTED ELECTRONICALLY; COVERED ENTITIES AFFECTED BY THIS RULE INCLUDE HEALTH PLANS, HEALTHCARE CLEARINGHOUSES AND CERTAIN HEALTHCARE PROVIDERS.
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| show | RESPONDED TO CONCERNS ABOUT PHYSICIANS CONFLICTS OF INTEREST WHEN REFERRING MEDICARE PATIENTS FOR A VARIETY OF SERVICES; PROHIBITS TO CLINICAL LABORATORY SERVICES IN WHICH THE PHYSICIAN OR A MEMBER OF THE
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| STARK I (SAME AS PHYSICIAN SELF-REFERRAL LAW) PART II | show 🗑
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| STATUTE (SAME AS STATUTORY LAW) | show 🗑
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| show | ALSO CALLED STATUTE; LAWS PASSED BY LEGISLATIVE BODIES (FEDERAL CONGRESS AND STATE LEGISLATURES).
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| SUBPOENA | show 🗑
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| show | REQUIRES DOCUMENTS (LIKE PATIENT RECORDS) TO BE PRODUCED.
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| TAX RELIEF AND HEALTH CARE ACT OF 2006 (TRHCA) | show 🗑
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| show | INSURANCE CLAIM OR FLAT FILE USED TO BILL INSTITUTIONAL SERVICES, SUCH AS SERVICES PERFORMED AT HOSPITALS
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| UNIQUE BIT STRING | show 🗑
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| show | ASSIGNMENT OF AN ICD-9-CM DIAGNOSIS CODE THAT DOES NOT MATCH PATIENT RECORD; DOCUMENTATION FOR THE PURPOSE OF ILLEGALLY INCREASING REIMBURSEMENT.
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| WHISTLEBLOWER | show 🗑
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| ZONE PROGRAM INTEGRITY CONTRACTOR (ZPIC) | show 🗑
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Created by:
tnatchez