Unit 5 Flashcards
compliance
Adherence to rules- for instance, regulations and standards: also refers to the culture of an organization to provide high-quality. cost-effective, efficient healthcare that operates within the requirements of regulatory, accreditation. and other requirements.
Some of the major conditions and standards of the CoP that directly impact health information processes are the following:
- The Governing Body (including that of the medical staff and chief executive officer)
- Care of Patients
- Emergency Services
- Patient’s Rights
- Privacy and Safety
- Confidentiality of Patient Records
- Restraint or Seclusion
- Death Reporting Requirements
- Quality Assessment and Performance Improvement (including scope, data, activities, and projects)
- Composition of the Medical Staff
- Medical Staff Organization and Accountability
- Medical Staff By-laws
- Nursing Services (including organization, staffing, and delivery of care)
- Medical Record Services (including organization and staffing, form and retention of the medical record, and content of medical records)
- Utilization Review (including applicability, composition of the Utilization Review Committee, scope and frequency of review, and admissions, continued stay, and extended stay review)
Covered entity
Any health-care provider or contractor that transmits in electronic form any individually identifiable health information
Clearinghouse
An organization or entity (public or private) that processes data into a standard-ized billing format and checks for inconsistencies or other errors in the claims data
Business associate
An individual or organization with which a covered entity contracts to perform functions or duties that involve the use or disclosure of individually identifiable health information.
Individually identifiable health information
Data that identify a patient, such as name, address, date of birth, and gender.
Privacy
The right to be left alone and to expect that one’s health information is available only to those who have a need to access it.
Protected health information (PHI)
Any piece of data that identifies a patient as well as the clinical data tied to the patient.
Notice of Privacy Practices (NPP)
Written notification, which must be signed by the patient/legal representative, that communicates how PHI is used, disclosures made without the need for authorization, the patient’s rights regarding PHI, the persons to whom PHI may be released, and the covered entity’s legal duties with respect to that information.
Security rule
The HIPAA rule that protects PHI through standard procedures and methods of storage, access, and transmission, as well as through auditing for security breaches.
National Provider Identifier (NPI) number
A unique 10-digit number that identifies each care provider on all administrative or financial transactions—for instance, claim forms.
Health Plan Identifier (HPID)
A unique identifier assigned to every health plan that controls its own business activities, actions, or policies or that is controlled by entities that are not health plans; the effective dates for use of the HPID are November 5, 2014, for large plans and November 5, 2015, for small plans.
The enforcement and compliance rule
contains the provisions that pertain to compliance and investigations of noncompliance, the civil money penalties imposed for violations of the HIPAA Administrative Simplification Rules, and the provision for procedures for hearings.
Omnibus Final Rule to the HITECH Act
Legislation that updates and clarifies the requirements in the HITECH Act.
Accounting of disclosures
A listing of all disclosures of a patient’s PHI, including those for treatment, payment, and health-care operations.
