Ch 2 HIPPA HITECH - MC

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evaluation/management services

providers evaluation of a patients condition and decision on a course of treatment to manage it

HIPAA security rule

law requiring covered entities to establish safeguards to protect information. Specifies how to secure information on computers, internet or storage disks.

TPO (treatment, payment and health care operations)

legitimate reasons for the sharing of patients protected health information without authorization

DRS (designated record set)

covered entitys records that contain protected health information for providers and the medical/financial patient record

minimum necessary standard

principle that individually identifiable health information should be disclosed only to the extent needed (not whole record)

patients medical record

contains facts findings and observations about patients health history

EHR (electronic health record)

contains life long health care record with data from all sources

(CMS) Centers for Medicare and Medicaid Services

administers the Medicare and Medicaid
programs to more than 90 million Americans.

entities that obey HIPAA regulations

Health Plans Health.
Care Providers. Health Care Clearinghouses. Business Associates

(NPP) notice of privacy practice

Covered entities must give each patient at the first contact or encounter.

Encryption

a method of converting a message into encoded text
-the process of encoding information in such a way that only the person (or computer) with the key can decode it

HIPAA standard code set

separate code set for dental services

Stark Rules, Antikickback Statute, and 2010 Affordable Care Act

all laws which regulate fraud and abuse.

Department of Justice (DOJ)

handles HIPAA criminal violations related to kidnapping, robbery, and arson.
-OCR or CMS receives a complaint that may lead to a criminal case, to what entity will the agency usually refer the complaint for investigation

compliance officer

be one of the practice's physicians, the practice manager, or the billing manager.

The American Recovery and Reinvestment act (ARRA) of 2009

contains additional provisions concerning the standards for electronic transmission of health care data.

HIPAA

abbreviation for the Health Insurance Portability and Accountability Act

release of PHI

treatment, payment, and operations, no authorization is required from the patient.

Statutory reports

exceptions under the HIPAA Privacy Rule

NPI

National Provider Identifier. Unique 10 digit number a ssigned to each provider.

HIPAA Electronic Health Care Transactions and Code Set standards

standards specify certain code sets for diagnoses, procedures, and supplies.

relator

The person who is making the accusation of fraurd or abuse under the False Claims Act
-In qui tam, or whistleblower, cases the person who makes the accusation of suspected fraud

OCR

abbreviation for Office for Civil Rights, which enforces the HIPAA Privacy Rule.

compliance plan

helps a medical practice prevent fraud and abuse relating to reimbursement for services and procedures.
-should set up procedures to audit and monitor compliance with government regulations.
-should address the topics of coding and billing.

malpractice

When a provider injures a patient due to failure to follow medical standards of care

surgical procedure

NOT part of usual evaluation and management services

HITECH Act

law made to tighten the HIPAA Privacy Rule

de-identified

When personal identifiers have been removed, protected health information

breach

An impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of PHI and also that could pose a significant risk of financial, reputational, or other harm to the affected person

The HIPAA Electronic Health Care Transaction and Code Sets (TCS)

standards make it possible for physicians and health plan to exchange electronic data using a standard format and standard code sets

The Health Care Fraud and Abuse Control Program

HIPAA created to uncover and prosecute fraud and abuse

Evaluation/management services

providers evaluation of a patients condition and decision on a course of treatment to manage it.

HIPAA security rule

law requiring covered entities to establish safeguards to protect information. Specifies how to secure information on computers, internet or storage disks.

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