Chapter 2 Flashcards

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1
Q

centers for medicare and medicaid services (CMS)

A

federal agency in the department of health and human services that runs medicare, medicaid clinical laboratories and other gov. health care programs: responsible for enforcing all HIPAA standards other than the privacy and security standers

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2
Q

Electronic data interchange (EDI)

A

computers-to -computers exchange of routine business information using publicly available electronic standers

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3
Q

Health information Technology for economic and clinical health (HTECH) act

A

provisions in the american recovery and reinvestment act of 2009 that extends and reinforce HIPAA and contain new breach.

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4
Q

Covered entity

A

under HIPPA health care plans, clearinghouse or provider who transmits and health information in electronic forms in connection with HIPPA transaction

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5
Q

Clearinhouse

A

companies that processes electronic health information and executes electronic transaction such as insurance verification and claim submission for providers

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6
Q

Business Associate

A

person or organization that requires access to PHI to perform a function or activity on behalf of a covered entity but is not part of its workforce

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7
Q

HIPAA Privacy rules

A

law that regulates the use and disclosure of patients protected health information

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8
Q

Protected health information (PHI)

A

individually identifiable health information transmitted or maintained by electronic media or in any other form or medium

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9
Q

Nice of privacy practices (NPP)

A

HIPAA- mandated document standing the privacy policies and procedures of a covered entity

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10
Q

Acknowledgment of receipt of notice or privacy practices

A

form accompanying a covered entity notices of privacy practices. covered entities must make a good faith to have patients signs it.

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11
Q

Release of information (ROI)

A

process following by employees of covered entities when releasing patients information.

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12
Q

Treatment payment and health care operations (PTO)

A

under HIPAA three conditions under which patients protected health information may be released without their consent

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13
Q

HIPAA security rules

A

law that requirers covered entities to establish administrative physical and technical safeguards to protect the confidentiality integrity and availability of health information

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14
Q

Electronic protected health information (ePHI)

A

PHI that is created received maintained or transmitted in electronic formrmation into an unreadable format before it is distributed

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15
Q

Breach

A

under the HIPAA privacy rules impermissible use or disclosure that compromises the security or privacy of PHI that could pose a significant risk of financial repetitional or other harm to the affected person

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16
Q

Breach notification

A

document used by a covered entity to notify individuals of a breach in their PHI required under the new HITECH breach notification rules

17
Q

HIPAA electronic health care transactions and code sets (TCS)

A

The HIPAA rules governing the electronic exchange of health information

18
Q

ASC X12 Version 5010

A

updated electronic data standard for transmitting HIPAA X12 documants

19
Q

Code Set

A

Alphabetic and or numeric representations for data : a medical code set is a system of medical terms required for HIPAA transcations

20
Q

National Provider Identifier (NPI)

A

under HIPAA system for identifying all health care providers using unique ten-digit identifiers

21
Q

Health care fraud and abuse control program

A

gov. program to uncover misuse of founds in federal health care programs run by the office of the inspector general

22
Q

Fraud

A

international act of deception to take financial advantage of another person

23
Q

Abuse

A

actions that improperly use another person’s resouces

24
Q

Audit

A

formal examination or review such as a review to determine whether an entity is complying with regulations