Chapter 2 Key Terms

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Accreditation

The process by which an organization or agency performs an external review and grants recognition to a program of study or institution that meets certain predetermined standards

Admitting Privileges

Granted to heath care professionals to define what categories of patients can be seen by the professional along with type of services and procedures that can be performed within the hospital

Agency for Health Care Administration (AHCA)

A regulatory agency in Florida created in 1992 under the Health Care Reform Acts of 1992 for the purpose of ensuring that efficient quality health care services are accessible to all Floridians

American Academy of Professional Codes (AAPC)

National organization founded for the purpose of elevating medical coding standards by providing ongoing education, networking opportunities, certification , and recognition to health insurance billing and coding professionals

American Health Information Management Association (AHMA)

National organization founded for the purpose of setting national standards in health information management and certification and providing support to health information management professional

American Osteopathic Association (AOA)

An organization established in 1997 for the purpose of advancing the philosophy and practice of osteopathic medicine

Centers for Medicare and Medicaid Services (CMS)

Agency under the Department of Health and Human Services that oversees the federal responsibilities for the Medicare and Medicaid programs. CMS was formerly known as the Health Care Financing Administration (HCFA)

Civil Monetary Penalties Law (CMPL)

A law passed in 1983 for the purpose of prosecuting cases of Medicare and Medicaid fraud

Conditions for Participation

Condition established for provides to participate in the Medicare program. Medicare's COP contains CMS rules and regulations that govern the Medicare program. Provides of service are required to follow regulations outlined in the COP implemented under the Code of Federal Regulations Title 42

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Legislation passed in prevent inappropriate transfer or discharge of patients from one facility to another, commonly referred to as "dumping."

Continuing education units (CEUs)

Credits earned by individual s when they attend an educational function. Organizations generally grant 1 CEU for each hour attended

Credentialing

The process followed by hospitals and other organizations for evaluating physical to determining whether they should be granted admitting privileges

Department of Health (DOH)

Agency within each state that is involved in the state's health care initiatives, including residents through disease prevention and ensuring that quality medical care is provided

Department of Health and Human Services (DHHS)

Federal department responsible for health issues, including controlling the rising cost of health care the health and welfare of various populations, occupational safety, and income security plans

Emergency Medical Treatment and Labor Act (EMTALA)

Legislation passed by Congress to ensure public access to emergency services regardless of ability to pay

Federal False Claims Act

Legislation passed to prevent overuse of services and uncover fraudulent activities in the Medicare and Medicaid programs

Federal Register

The official publication in which federal regulations and legal notices are published

Health, Education, and Welfare (HEW)

A governmental health education and welfare of the people of the United States

Health Information Management (HIM)

A hospital department responsible for the organization maintenance, production, storage retention, dissemination, and security of patient information

Health Insurance Portability and Accountability Act (HIPAA)

Legislation implemented in phases form 1996 to 2008 to address several issues: continuity of health insurance prevention and detection of frauds and abuse the administration of health insurance standards for the claims process and protection of privacy of health information

Joint Commission on Accreditations of Healthcare Organizations (JCAHO)

A national commission formed to evaluate and accredit health care organizations based on established standards of quality for operations and medical services

Medicaid

Federal program administered at the state level established under Title XIX of the SSA to provide health care benefits for medically indigent people

Medicare

Government program created under Title XVIII of the Social Security Act that provides health care benefits disabled and other qualified individuals

Occupational Safety and Health Administration (OSHA)

Agency under the Department of Labor created under the OSHA Act for the purpose of developing standards and conduction site visits to determine compliance with safety standards

Office of Inspector General (OIG)

A federal agency under DHHA programs such as Medicare and Medicaid

Patient Self-Determination Act (PDSA)

Legislation passed in 1990 for the purpose of ensuring that individuals are informed of their right regarding health care decisions. The act requires facilities to provide patients with information regarding a living will, durable power of attorney, and advanced directives

Professional Standards Review Organization (PSRO)

Organizations that contract with Medicare to conduct reviews to determine the appropriateness and medical necessity of services provided. PSROs have full authority to deny reimbursement for health care services provides to Medicare patients if the services are deemed inappropriate

Prospective Payment System (PPS)

A reimbursement system implemented in 1983 as mandated under TEFRA for provides a predetermined payment based on the patient's diagnosis and procedures performed

Registered Health Information Technician (RHIT)

Responsible for coding services and conditions provided by hospitals and verifying the completeness accuracy, and proper entry of medical information into computer systems

Tax Equality and Fiscal Responsibility Act (TEFRA)

Legislation passed in1982 that mandated a total restructuring of reimbursement methods used for Medicare services. One of the most significant changes was the implementation of the Prospective Payment System of reimbursement in 1983

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