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False Claims Act
Protects the government from being overcharged for services provided or sold, or substandard goods or services
Strengthens the HIPPA ruling around privacy, security, breach notification, and penalties
A list of prescription drugs covered by an insurance plan
Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist
Provider who determines the appropriateness of the health care service, level of heath care professional called for, and settling for care
general ledger key
Two- or three-digit number that makes sure that a line item is assigned to the general ledger in the hospital's accounting system
Code that determines the party financially responsible for a specific service the general ledger in the hospital's accounting system
group or plan number
Unique code used to identify a set of benefits of one group or type of plan
group practice model
HMO that contracts with an outside medical group for services
Health Insurance Portability and Accountability Act (HIPPA) of 1996
Legislation that includes Title II, the first parameters designed to protect the privacy and security of patient information
health maintenance organization (HMO)
Plan that allows patients to only go to physicians, other health care professionals, or hospitals on a list of approved providers, except in an emergency
health record number
Number the provider uses to identify an individual patient's record
Coding and classification system developed for use in the US only. Specific to inpatient hospital procedures, ICD-10-PCS correlates to Volume 3 in ICD-9-CM.
A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed
independent practice association (IPA) model
HMO that contracts with the IPA, which in turn contracts with individual health providers
Documents that provide the person or provider enough information so that the person could be identified
Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risk involved, giving patients an opportunity to ask questions before medical intervention is provided
managed care organization
Organization developed to manage the equality of health care and control costs
A government-based health insurance option that pays for medical assistance for individuals who have low incomes and limited financial resources. Funded at the state and national level. Administered at the state level.