Chapter 2 HIPAA Compliance and Privacy Insurance Billing

34 terms by tashamarion

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abuse

Incidents or practices, not usually considered fraudulent, that are inconsistent with accepted sound medical business or fiscal practices.

authorization

under the HIPAA privacy rule, an individual's formal, written approval to use or disclose his or her personally identifable health information for purposes other than treatment, payment or health care operations

authorization form

needed for use and disclouse of PHI not including in other existing consent form agreements

breach of confidential information

unauthorized releaseof information

business associate

and organization providing services to a health care provider that involve processing protected health information, such as an accounting firm or billing service.

clearinghouse

A company that receives claims from multiple providers, evaluates them, and batches them for electronic submission to multiple insurance carriers.

code set

Any set of codes with their descriptions used to encode data elements

compliance

acting according to certain accepted standards

compliance plan

A management plan composed of policies and procedures to accomplish uniformity, consistency, and conformity in medical record keeping that fulfills official requirements

confidential communication

A privileged communication that may be disclosed only with the patient's permission.

confidentiality

discretion in keeping secret information

consent

permission to do something

consent form

A document that is not required before physicians use or disclose protected health information for treatment, payment, or routine health care operations of the patient. (For other purposes, see Authorization form)

covered entity

Health care providers and clearinghouses that transmit HIPAA transactions electronically, and must comply with HIPAA standards and rules.

disclosure

The release, transfer, provision of access to, or divulging in any other manner of information outside the entity holding the information.

e-health informatin management

force to describe any and all transaction in which health care information is accessed, processed, stored, and transferred using electronic techologies

electronic media

The mode of electronic transmission (e.g. Internet, extranet, leased phone or dial-up phone lines, fax modems).

embezzlement

taking for one's own use in violation of trust; stealing (of money placed in one's care)

fraud

willingly, knowingly, intentionally submit false information to benefit

health care provider

A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.

individually identifiable health information

Any part of an individual's health information, including demographic information collected from the individual, that is created or received by a covered entity.

nonprivileged information

Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital, such as the psychiatric unit

Notice of Privacy Practices

Under HIPAA, a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.

phantom billing

Billing for services not performed

privacy

the quality of being secluded from the presence or view of others

privacy officer, privacy offical

An individual designated ot help the provider remain in compliance by setting policies and procedures in place, and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.

privileged information

Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.

protected health information

any information that identifies an individual and describes his health status, age, sex, ethnicity, or other demographic information

security officer

A person who protects the computer and networking systems within the practice and implements protocols such as password assignment, backup procedures, firewalls, virus protection, and contingency planning for emergencies.

Security rule

Under HIPAA, regulations related to the security of electronic protected health information that, along with regulations, related to electronic transactions and code sets, privacy, and enforcement, compose the Administrative Simplification provisions.

standard

rule condition or requirement

state preemption

A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.

transaction

the transmission of information between two parties to carry out financial or administrative activities related to health care.

use

sharing application, utilization, examination, or analysis of IIHI within an organization that holds such information

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