Inurance quiz1 ch2
About this set
Created by:
melsofwells on September 19, 2009
Subjects:
medical insurance billing and coding
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22 terms
Terms | Definitions |
|---|---|
 health insurance portability and accountability act | HIPAA |
| fed gov | HIPAA enacted by _ gov |
| to improve continuity of health insurance coverage and the administration of health services | reason HIPAA created |
| april 14, 2003 | date HIPAA law went into effect |
| privacy rule | written to protect an individual's privacy w/ regard to his/her personal health info. |
| privacy rule | wat rule was written: to make certain that a pt's info is easily accesseble to those who shud have access to it, and to secure against unauthorized people |
| covered entities | includes: health care providers, health plans, & health care clearinghouses |
| HIPAA | workforce of covered entity is also included in _ |
| individually identifiable health info | IIHI |
| IIHI | wat info includes personal health care info, & includes past, present, & future conditions, & tx |
| protected health info | PHI |
| PHI | health info related to an individual that must be kept confidential |
| other health-care professionals directly involved in care/tx, ny1 when u r given written permission from pt, & those outlined in "permitted uses & disclosures" | PHI must be kept confidential except in 3 cases |
| written authorization | wat does ny release of info require |
| referred pts, insurance, attorneys, litigation (unless served an subpoena), for publication, telephone requests (or physician return the call), AIDS (sum states allow only this to b given to the spouse, not even to life or health insurance co's) | cannot release info about or to: |
| to the individual, tx, pymt, &/or operations, opportunity to agree or object, inccidental use & disclosure, public interest (for the benefit for the health of the public), limited data set | 6 circumstances to use best professional judgement as to whether or not they shuld use and/or disclose a pt's PHI |
| pt's permission only for everything(exceptions:physician & insurance company), pt info requests via telephone (written requests; pt's signature, relative--dr return the call), & voice mssg(use generic language) | can give privileged info in only 3 instances |
| worker's compensation cases, pt's records required for defense (an individual being sued by the pt), subpoenaed or search warrant, child/elder abuse, contagious/ infection disease, or gunshot wounds or stabbings | exceptions to confidentiality include: |
| employer's liability and employee's liability | scope of practice (liability in the office) include the following- 2 |
| employer's liability | who is responsible for self and employees; needs to hav medical professional liability insurance |
| employee's liability | should hav errors and omissions insurance policy(protects against loss of $ when unintentional errors occur in submitting claims) |
| scope of practice | wat provides job description / defines duties and activities |
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