Module 4 - Compliance Requirements Flashcards
What does HIPAA stand for
Health Insurance Portability and Accountability Act
It just also includes privacy, security, etc.
What are the three major areas addressed in HIPAA?
- Use and Disclosure of PHI/IIHI
- Patient Rights to PHI/IIHI
- Security in Administrative and Physical PHI/IIHI
What do PHI and IIHI stand for?
PHI = Protected Health Information
IIHI = Individual Identifiable Health Information
What does ARRA stand for?
American Recovery and Reinvestment Act
What does the ARRA (American Recovery and Reinvestment Act) provide?
- Regulates changes to HIPAA
- Enforces changes in HIPAA
- Provisions to address health information held by entities not covered by HIPAA
- Misc: Administration, Studies, Reports, Educational Initiatives
What is a Breach in PHI
Unauthorized access to or use of PHI
Covered Entity
Health Care business that maintain or transfer PHI electronically
Indirect Treatment Relationship
Patient/Provider relationship based on the orders of another Health Care Provider
Direct Treatment Relationship
Patient/Provider Relationship that’s not indirect
Minimum Necessary (Minimum Disclosure)
What PHI is absolutely necessary to share
Not applicable if patient has requested otherwise (whole chart, etc.)
Patient Rights
Patients have rights to their PHI/IIHI and records of PHI/IIHI transfers
Business Associates
Any organization or entity that provides a service involving PHI/IIHI
I.E. Insurance companies, Holland Hospital, etc.)
Training (PHI training requirements)
Covered entity must train all workers on PHI policy/procedures
Administrative Safeguards
Managing Policy/Procedures and Workforce Conduct in regards to PHI
Insurance Fraud
Intentional Deception of insurance for the benefit of a patient (self or other)
Insurance Abuse
Insurance practices that either directly or indirectly result in unnecessary cost to (Medicare)
Cannot be proven to be intentional
Civil Monetary Penalties (CMP)
Penalties imposed on person or entity who have violated (Medicare) rules/regulations
Up to $10,000 per violation
What does OIG stand for?
What does just OI stand for?
OIG = Office of the Inspector General
OI = Office of Investigations
Stark Violations
Physicians referring patient to services which they(or family member) have financial interest
What does OSHA stand for?
Occupational Safety and Health Act
