72 terms

HIT Ch. 12-15


Terms in this set (...)

A(n) ______ documents circumstances to access for the possibility of impending litigation
Incident Report
The Darling vs. Charleston Community Memorial Hospital case established the precedent that abolished the ______
Doctrine of Charleston Immunity
______ is a nonclinical function that focuses on how to reduce medical, financial, and legal risk to an organization
Risk Management
State legislatures have passed laws assigning a ______ statues to peer review deliberations and review activities that include minutes of a peer review committee, making them immune from discovery
______ is the process used by parties to obtain information that relates to the subject matter of a lawsuit
An incident in which a surgical procedure is performed on the wrong site would be reported to the ______
Risk Manager
A ______ is an unexpected occurrence involving death or serious physical or psychological injury that organizations must identify, report and manage
Sentinel Event
Information regarding the competence and conduct of health care practitioners and providers is reported to the ______
_____ refers to the function of analyzing and evaluating all of the risks that confront an organization including legal, financial, medical, terrorism, and staffing shortage risks
Enterprise Risk Management
______ is an example of a utilization management function
Preadmission Review
A(n) ______ is defined as an event inconsistent with normal routine operations
Adverse Event
To protect a(n) ______ from discovery, there must be an established attorney-client relationship
Incident Report
______ is a clinical function focusing on how to improve patient care
Quality Management
______ refers to whether information is pertinent and proper for a jury to consider when deciding legal issues
The ______ protects communications a made between attorneys and their clients from disclosure to third parties
Attorney-Client Privilege
State statutes regarding ______ activities protect participants from liability unless they act in malice
Peer Review
______ incorporates evidence-based guidelines from Milliman or McKesson for preadmission, admission, and continued stay reviews
Utilization Review
The obligation of the health care provider to maintain patient information in a manner that will not permit dissemination beyond the health care provider is known as ______
The HIM professional has a responsibility to insure ______ in the health record to reduce organization risk
Proper Documentation
The ePHI risk assessment and analysis is one of the ______ efforts related to the EHR
Risk Management
Per ______, a patient has the right to know how his/her information is being disclosed
The EHR ______ of identifying inconsistent patient record entries enhances security and reduces patient risk
Data Mining Technique
The Joint Commission states that it is not acceptable for physicians or other health care providers to _____ order for patients
______ confirms an entry in the health record by written signature, initials, or a computer-generated signature code
_______ in an electronic health record system refers to keeping data or equipment from being brought down by malicious attempts
Damage Prevention
E-SIGN refers to the ______
Electronic Signatures in Global and National Commerce Act
The patient's ______ is defined by each institution with input from its legal counsel
Legal EHR
The party seeking to admit a health record into a court of law must first meet the foundation requirements of the _____
Business Record Exception
Under the HIPAA Security Rule, each covered entity is required to perform a ______ of its security practices
Risk Assessment
The acquisition, access, use, or disclosure of PHI in a manner which compromises the security or privacy of PHI is known as a _____
Restricting copy functions is a _____ that is used to protect electronic health records
Risk Prevention Technique
A ______ of a patient record, which has been maintained in an electronic medium, can be entered into evidence with testimony by the custodian of health records
Levels of access granted to an operating system or application is an electronic health record system as known as ______
______ should never be considered a private form of communication
Installing antivirus software is a measure that can be taken to discourage or prevent ______
The health can provider should consider improved controls, including the establishment of written policies and procedures covering the loan and use of ______ and whether ePHI should even ve maintained on these media/devices at all
Portable Computer Devices
List 4 Advantages of a digital imaging system
1. Protection against disaster
2. Savings on storage space
3. Audit trail capabilities
4. Easy accessibility
The ______ has primary responsibility for investigating claims of fraud committed against the military's health insurance programs
Defense Criminal Investigative Service
A _____ violation occurs when providers refer patients to a facility in which the provider holds a financial interest
Assigning diagnostic and procedural codes to obtain better reimbursement alone is considered ______
The ______ requires that facilities that receive more than $5 million in Medicare reimbursement must have written compliance policies and handbooks in place to educate staff
Deficit Reduction Act
The efforts to establish a culture that promotes prevention, detection, and resolution of instances of conduct that do not conform to applicable laws and regulations is known as ______
This DHHS OIG program educates entities about proper claims submission
CCI - Correct Coding Initiative
An example of a ______ might be a former employee of a health care organization that has learned of some type of fraud and abuse that wished to expose that fraudulent activity
Whistle Blower
A ______ usually involves a qui tam action
FCA Claim
The term ______ refers to the warning signs of identity theft
Red Flag
A ______ duties include education and training, compliant evaluation and resolution, along with audits and monitoring of compliance
Chief Compliance Officer
In the context of billing fraud, ______ refers to separately billing laboratory tests to increase reimbursement from payers
The ______ directs the DHHS to enter into agreements with private companies to carry out fraud and abuse protections
Medicare Integrity Program
To combat fraud, some organizations use automated ______ to assign a correct code based on official guidelines and reporting rules programmed into the software
Coding Software
The ______ is authorized to conduct civil and criminal investigations of fraud associated with Medicare
A situation where a physician is paid for referrals would be prohibited under the federal ______
Anit-kickback statutes
Written agreements that specify the rules of conduct to be followed to remedy the fraud and abuse found along with any monitoring and reporting requirements are known as ______
CIA - Corporate Integrity Agreements
Choose and critique a law that address fraud and abuse
Anti-kickback Statutes- prohibits the offer/solicitation of remuneration in exchange for referrals of federally payable services
Describe one fraud enforcement program
Beneficiary Incentive Program - encourages Medicare beneficiaries to report any suspected cases of fraud and abuse
Describe the difference between upcoding and unbundling
Upcoding- submitting bill for higher reimbursement
Unbundling- submit separate bills for higher reimbursement
The ______ establishes fair collective bargaining procedures and identities unfair labor practices
National Labor Relations Act
The process of proving work. engaging services or labor, and paying for the work performed is known as ______
______ is the false misrepresentation of fact that is relied on by another to that person's detriment and a departure from reasonable use
Fraud and Abuse
A ______ employee is defined by the tax withholding requirements
Under _____, an employer may refuse employment to a person due to an inability to speak English
Title VII
Employees who are considered _____ are those who can leave an employer or be terminated at any time
At-will employees
This legislation requires an employed to operate a place of employment free from recognized hazards that are likely to cause serious injury or fatality _____
The ______ provides for unpaid time off to adopt a child
A 60-year old female has been laid off from the healthcare facility where she works and has applied for a job at another healthcare facility. The healthcare facility will need to determine if she can ______ the job for which she has applied
Physically Perform
An employer is obligated to verify the ______ of employees who are hired to work
Employment authorization and identity
Under the ______, an employer is prohibited from requesting an employee to pay for any accommodations required to perform the job if hired by the organization
An employer is permitted to ______ an employee who has been found guilty of a DUI
The ______ is the government agency that established and overseas collective bargaining procedures
______ in the workplace may contribute to illegal behavior to support the habit
Substance Abuse
Employers monitor ______ postings to determine if the employer's positive online image is being maintained
Social media
Justify the ethics elements in a performance appraisal
Keep employees motivated by appraising them for good performance (treating people nicely/with respect, work with integrity, model good behavior)