Ch. 1 & 2: Intro/Legal

Question 1

What does AAPC stand for?

Answer 1

American Academy of Professional Coders

Question 2

What does AHIMA stand for?

Answer 2

American Health Information Management Association

Question 3

What does CPT stand for?

Answer 3

Current Procedural Terminology

Question 4

What does ICD stand for?

Answer 4

International Classification of Diseases

Question 5

Power of attorney that remains in effect after the individual who grants the power of attorney dies or is declared incompetent

Answer 5

durable power of attorney

Question 6

an individual who has not reached the age of majority, usually 18, who lives independently

Answer 6

emancipated minor

Question 7

stealing money

Answer 7

embezzlement

Question 8

employer’s responsibility for employee job-related actions, know as respondent superior (let the master respond)

Answer 8

employer liability

Question 9

individual legally designated to act on behalf of a minor or an incompetent adult

Answer 9

guardian

Question 10

legal authority to act on behalf of a minor or an incompetent adult

Answer 10

guardianship

Question 11

legal authority over financial resources and other assets

Answer 11

guardianship of the estate

Question 12

legal authority over personal and medical decisions

Answer 12

guardianship of the person

Question 13

any professional behavior of one individual that results in damages to another individual

Answer 13

malpractice

Question 14

failure to exercise the appropriate standard of care, resulting in injury

Answer 14

negligence

Question 15

voluntary transfer of decision-making authority from one competent individual to another competent individual

Answer 15

power of attorney

Question 16

period of time associated with legal liability

Answer 16

statute of limitations

Question 17

a legal document requesting an individual to appear in court; literally means “under penalty”

Answer 17

subpoena

Question 18

a legal document requesting an individual to bring records to court

Answer 18

subpoena duces tecum

Question 19

type of malpractice which means that the wrong action was taken

Answer 19

malfeasance

Question 20

type of malpractice which means that the correct action was done incorrectly

Answer 20

misfeasance

Question 21

type of malpractice which means that no action was taken when action was necessary

Answer 21

nonfeasance

Question 22

what does HIPAA stand for?

Answer 22

Health Insurance Portability and Accountability Act of 1996

Question 23

Who issues the national standards for Privacy of Individually Identifiable Health Information, known as the HIPAA privacy rule?

Answer 23

US Department of Health and Human Services (HHS)

Question 24

What organization under the HHS is responsible for implementing and enforcing the Privacy Rule?

Answer 24

Office of Civil Rights (OCR)

Question 25

When is Protected Health Information (PHI) allowed to be released without written consent? 5

Answer 25

• the info is subpoenaed
• the info is needed to defend the health care provider or agency in a lawsuit
• the info is necessary for life-saving emergency treatment
• the patient is covered by Medicaid or workers’ comp
• the info is needed to comply with another law-like to report suspected child abuse

Question 26

What is the “minimum necessary” rule under the Privacy Rule?

Answer 26

only the amount of info needed to accomplish the intended use, disclosure, or request is allowed. Ex: you can only release info necessary for services provided, only having access to the patients assigned to students, and maintenance staff does not have access

Question 27

What is required in order to comply with the Privacy Rule as a covered entity? 10

Answer 27

• policy and procedures for the use of, release of, and requests for protected info
• designate a privacy officer who is responsible for enforcing procedures
• policies that limit access based on specific roles of employees
• train all workforce members
• apply appropriate sanctions on those who violate
• maintain safeguards (locking cabinets)
• provide written notice to those who receive services
• procedures telling an individual how to submit a complaint related to violations
• identify a contact person for complaints
• policies & procedures to tell an individual how to review, get a copy, and amend their protected info

Question 28

What is the HIPAA Security Rule?

Answer 28

electronic protected health information (EPHI) which is protected health information maintained or transmitted in electronic form, the federally mandated security measures of that info, only applies to the info that is stored electronically

Question 29

What organization is responsible for administering the Security Rule?

Answer 29

Centers for Medicare and Medicaid Services (CMS) which is a division of HHS

Question 30

What is an ROI?

Answer 30

Release of information, which allows someone to release their info and specify which info

Question 31

Under the HIPAA fraud and abuse control program, what federal agencies are involved and what do they do? 3

Answer 31

1. office of the inspector general (OIG)-medicare, Medicaid, workers’ comp, and other fed health care insurance
2. FBI-investigates fraud cases that involve either fed or private health insurance programs, but does not take disciplinary action
3. department of justice (DOJ)-all cases that fall under federal criminal law get referred to it

Question 32

what is the difference between fraud and abuse?

Answer 32

fraud-deliberate

abuse-no intent, unplanned

Question 33

what are the 3 main categories of insurance fraud?

Answer 33

1. submission of fraudulent diagnoses
2. billing for services not rendered
3. medical coding errors

Question 34

what are the 3 categories of insurance abuse?

Answer 34

1. inadvertent billing and coding errors
2. excessive charges for services, equipment, or supplies
3. billing for services that are not medically necessary