Unit 3 Medical Terms

Question 1

Under the Health insurance Portability Accountability Act (HIPAA) privacy rule, AN INDIVIDUALS FORMAL, WRITTEN PERMISSION TO USE OR DISCLOSE HIS OR HER PERSONAL IDENTIFIABLE health information for purposes other than treatment, payment, or health care operations.

Answer 1

Authorization

Question 2

A DOCUMENT signed by the patient that is needed for use and disclosure of protected health information that is not included in any existing consent form agreements.

Answer 2

Authorization form

Question 3

Breach means ‘breaking or violation of a law agreement.’ in the context of the medical office, it means the unauthorized release of information about the patient.

Answer 3

Breach of confidential communication

Question 4

A PERSON who, on behalf of the covered entity, performs or assists in the performance of a function or activity involving the use or disclosure of individually identifiable health information, including claims processing or administration, data analysis, process or administration, utilization review, quality assurance, billing, benefit management, practice management, and repricing.

Answer 4

Business associate

Question 5

An independent organization that receives insurance claims from a HealthCare organization or physicians office, performs software edits, and redistributes the claims electronically to various insurance carriers.

Answer 5

Cleainghouse

Question 6

A privileged COMMUNICATION that may be disclosed only with the patient’s permission

Answer 6

Confidential communication

Question 7

The state of treating privately or secretly, and not disclosing to other individuals or for public knowledge, the patients conversations or medical records.

Answer 7

Confidentiality

Question 8

A verbal or written agreement that gives APPROVAL to some action, situation, or statement

Answer 8

Consent

Question 9

An ENTITY that transmits health information in electronic form in connection with a transaction covered by the Health insurance portability and Accountability act (HIPAA)

(Health coverage such as Bluecross/blue shield

Answer 9

Covered entity

Question 10

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

Answer 10

Disclosure

Question 11

The mode of electronic transmission (for example, internet, extranet, lease phone or dial- up phone lines, fax modems)

Answer 11

Electronic media

Question 12

Regulation that became effective in 2013 under the health insurance portability and accountability act (HIPAA) that modified privacy and security rules for covered entities and their business associates.

Answer 12

HIPAA Omnibus Rule

Question 13

For a breach of privacy under the health insurance portability and accountability act (HIPAA), this means to alleviate the severity, reduce, or make mild and harmful effects of such violation.

Answer 13

Mitigation

Question 14

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

Answer 14

Non Privileged information

Question 15

Illness or injuries by the patient BEFORE enrollment in an insurance plan

Answer 15

pre-existing condition

Question 16

The condition of being secluded from the presence or view of others.

Answer 16

Privacy

Question 17

An individual designated to help the provider remain in compliance by setting policies and procedures and by training and managing the staff regarding Health Insurance Portability and Accountability Act (HIPAA) and patient rights; usually the contact person for questions and complaints

Answer 17

Privacy officer/ privacy official

Question 18

Date related tot he treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained

Answer 18

Privileged information

Question 19

Any data that identify an individual and describe his or her health status, age, sex, ethnicity, or other demographic characteristics, whether or not that information is stored or transmitted electronically.

Answer 19

Protected health information

Question 20

Notes recorded in any medium by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the individuals medical records

Answer 20

Psychotherapy notes

Question 21

Health insurance portability and accountability act (HIPAA) regulations related to the security of electronic protected health information (ePHI) that, along with regulations related to electronic transactions and code sets, privacy, and enforcement, compose the administrative simplification provisions

Answer 21

Security Rule

Question 22

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

Answer 22

Transaction

Question 23

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

Answer 23

Abuse

Question 24

A system and objective review of transaction

Answer 24

Auditing

Question 25

Legislation authorizing the United states federal government to recover monetary damages from people who file fraudulent claims for payment with the federal government.

Answer 25

Civil False Claims Act

Question 26

Federal statute that imposes fines and sanctions to combat health care fraud and abuse and imposed on individuals or health care facilities that do not comply with the Centers for Medicare and Medicaid services regulations.

Answer 26

Civil Monetary Penalty

Question 27

Reporting one level of services for all patient visits, regardless of the patients presenting problem or the amount of work or time spent with the patient

Answer 27

Clustering

Question 28

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

Answer 28

Compliance plan

Question 29

Slang expression for a diagnostic creep (coding that is inappropriately altered to obtain a higher payment rate; also known as coding creep, or upcoding

Answer 29

DRG crep

Question 30

A willful act by an employee of taking possession of an employer’s money

Answer 30

Embezzlment

Question 31

An intentional misrepresentation of the facts to deceive or mislead another

Answer 31

Fraud

Question 32

The performance of services and procedures that are consistent with the diagnosis in accordance with standards of good medical practice, performed at the proper level and provided in the most appropriate setting, medical necessity must be established (via diagnostic or other information presented on the individual claim consideration) before the carrier may make payment

Answer 32

Medical necessity

Question 33

The phrase coined through the occurrence of private hospitals refusing to examine or treat the poor or uninsured in the emergency department and transferring them to public hospitals

Answer 33

Patient dumping

Question 34

Bills for service not performed

Answer 34

Phantom bills

Question 35

A provision under the FCA which offers financial incentives to private citizens who act as informants and report suspected fraud on behalf of the federal government

Answer 35

Qui tam

Question 36

Deliberate manipulation of current procedural terminology (CPT) codes for increased payment

Answer 36

Upcoding