mit 104 chapter 2 book exercise

Which of the following healthcare workers would need a password to access a patients chart? (Select all that apply.)

Nurse Doctor Registration

The government agency that prosecutes and investigates healthcare fraud is the _____.

Office of the Inspector General

_______ Rule contains regulations that enhance patient's privacy protections, and improved rights for patients to their health information.

Omnibus

A set of regulations enhancing patients' privacy protections and rights to information is called the _____.

Omnibus Rule

Which of the following examples constitute claims fraud? (Select all that apply.)

Overcharging for services Failure to provide complete services under a contract Billing for services not performed Falsely reporting charges to payers

What does the HIPAA Security Rule establish safeguards to protect?

PHI

Which of the following are examples of fraudulent or abusive billing acts?

Performing procedures that are not medically necessary Reporting services at a higher level than were carried out Intentionally billing for services that were not performed or documented

______ management programs encrypt data between the office and the Internet.

Practice

HIPPA: Title 2

Preventing healthcare fraud and abuse, Administrative simplification

The HIPAA Standards for Privacy of Individually Identifiable Health Information Rule is also known as HIPAA Rule.

Privacy

Private, secure electronic files that are created, maintained, and controlled by patients are called _____ health records.

personal

Individually identifiable health information transmitted or maintained by electronic media is called _____.

phi

What information must be included on an authorization to release information? (Select all that apply.)

*Name of the person authorized to disclose the information *Purpose of the disclosure *Name of the people to whom the disclosure is being made *Expiration date *Description of the information to be disclosed

Which of the following are true of state regulations in healthcare?

*States can restrict price increases on premiums. *State laws ensure the solvency of insurance companies and managed care organizations. *State commissioners of insurance investigate consumer complaints.

Health plan premium payments is the HIPAA transaction name for number X12___

820

The health system reform legislation that offers improved insurance coverage and other benefits is abbreviated as _____.

ACA

What makes it illegal to knowingly offer incentives to induce referrals for services paid by government healthcare programs?

An antikickback statute

HIPPA: Title 4

Applications and Enforcement of Health Group Plan Requirements

Which of the following tasks are outlined in compliance plans?

Audit and monitor compliance with government regulations

Which of the following guidelines are helpful in conducting physician training classes? (Select all that apply.)

Be straightforward in presentations. Develop a procedure for sharing information between trainings. Explain the purpose of compliance. Keep the presentations brief. Use examples and facts.

The main federal government agency responsible for healthcare is the _____.

Centers for Medicare and Medicaid Services

Which of the following steps of the revenue cycle fall under coding and charge capture documentation? (Select all that apply.)

Check out patients Review coding compliance Review billing compliance

PHR

Choice Private, secure electronic files that are created, maintained, and controlled by patients

are companies that help providers handle electronic transactions. (Enter only one word per blank.)

Clearinghouse

Which of the following is included in the OIG compliance plan?

Communication

EHR

Computerized lifelong healthcare records

EMR

Computerized records of one physician's encounters with a patient over the time; they are the physician's legal record of patient care.

Which of the following applies to the role of the Department of Justice with regards to HIPAA?

Criminal violations of HIPAA privacy standards are prosecuted by the DOJ.

Which of the following is an example of healthcare fraud?

Double billing a procedure that was performed once

__ is a method of converting a message into encoded text.

Encryption

_____ stands for the Fraud Enforcement and Recovery Act of 2009.

FERA

In the United States, an estimated $50 billion are lost annually in healthcare as a result of ____.

Fraud

Which of the following is the agency that governs emergency guidance for release of information?

HHS

Rules governing the electronic exchange of health information are called ____.

HIPAA Electronic Health Care Transaction and Code Sets

The law regulating the use and disclosure of patients' protected health information is called the _____.

HIPAA Privacy Rule

is a law that requires covered entities to establish safeguards to protect health information.

HIPAA Security Rule

The law promoting the adoption and use of health information technology is abbreviated as _____.

HITECH

The government program to uncover misuse of funds in federal healthcare programs is called the _____.

Health Care Fraud and Abuse Control Program

The law promoting the adoption and use of health information technology is called the _____.

Health Information Technology for Economic and Clinical Health Act

HIPPA: Title 1

Healthcare acess, portablility, renewability

What is the purpose of healthcare fraud and abuse laws?

Help to control cheating in the healthcare system

Which of the following are true of the OCR? (Select all that apply.)

It has the authority to investigate complaints. It can issue subpoenas for evidence. It enforces HIPAA privacy standards. It is an agency of HHS. It takes action on behalf of individuals who have had PHI disclosed inappropriately.

Which of the following are examples of how code sets can be used? (Select all that apply.)

Medical concepts Medical procedure codes Tables of terms Medical diagnosis codes

Which of the following are parts of the Omnibus Rule? (Select all that apply.)

Prohibiting health plans from disclosing genetic information for determining insurance coverage Increasing civil monetary penalties for violations Strengthening previous HIPAA/HITECH rules Restating the standards for reporting breaches

PHI is the abbreviation for which of the following?

Protected health information

Which of the following is a term used to describe whistle-blower cases?

Qui tam

Which of the following are examples of activities performed by CMS to ensure the quality of healthcare?

Researching the effectiveness of healthcare management Preventing discrimination based on health status Evaluating the quality of healthcare services and facilities Regulating lab testing

Hippa: Title 5

Revenue offset

Which of the following are the three parts of the Administrative Simplification?

Security Rule Electronic Transaction and Code Set Privacy Rule

After discovery of a breach of unsecured PHI, how long does a covered entity have to notify the individual(s) who would be affected?

Sixty days

HIPAA Electronic Health Care Transactions and Code Sets is abbreviated as

TCS

The Employer Identification Number is also called the _____.

Tax Identification number

HIPPA: Title 3

Tax-Related Health Provisions

Which of the following describe the purposes of medical records? (Select all that apply.)

They help make accurate diagnoses. They trace the course of patients' care.

In which of the following circumstances would it be appropriate to use an EIN? (Select all that apply.)

When disenrolling employees from a health plan When making premium payments to plans on behalf of employees When enrolling employees in a health plan

Select the HIPAA transaction number for referral certification and authorization.

X12 278

A network that shares responsibility for managing the quality and cost of care provided to a group of patients is called a(n) _____.

accountable care organization

When states ensure the solvency of insurance companies, it means the companies will _____.

be able to pay the enrollees' claims

An impermissible use or disclosure of PHI that could pose a risk to the affected person is called a(n) _____.

breach

It is considered _____ when an EHR system can provide access to the latest medical research on approved medical websites to assist with medical decision making.

clinical decision support

An alphabetic and/or numeric representation of data is called a(n) _____.

code set

______ plan is a medical practice's written plan for complying with regulations.

compliance

To ensure that a compliance plan is established and followed, most practices will appoint a _____ to be in charge of ongoing work.

compliance officer

The practice's code of _____ covers compliance in referral arrangements, and employee performance compliance.

conduct

A health plan, clearinghouse, or provider who transmits any health information in electronic form is called a(n) _____.

covered entity

When releasing patient information the covered ____________must have an authorization to release information.

entity

New emergency guidance from HHS stating that CEs may disclose PHI without the patient's consent was applicable to a recent outbreak of Ebola virus because ______.

it was needed to lessen a serious and imminent threat to the health of the public

Being able to prove that a procedure is related to the patient's condition is called _____.

medical necessity

A(n) _____ is a file containing the documentation of a patient's medical history and related information.

medical record

The document notifying an individual of a breach is called a breach

notification

Role-based access into computer records means that _____.

only those who need the information can see it

Encounters take place between _____.

patients and healthcare providers

A person who makes an accusation of fraud or abuse is called a(n) _____.

relator

The cycle that explains how using EHRs is integrated with practice management programs is called the _____ cycle.

revenue

Self-referral prohibitions also called as _______ rules, make it illegal for physicians to have financial relationships with clinics for the purpose of self referrals.

stark

_______________ regulate the operations and compliance of health insurance companies.

state

Who controls the amount and type of information that is released to an entity not directly involved in the patient's care?

the patients

Who has ownership of the actual progress notes, reports, and other clinical materials in a medical record?

the provider who created them

There are five _____ in HIPAA that focus on various aspects of healthcare.

titles

A requirement of any compliance plan includes ongoing

training

An electronic exchange of healthcare information is called a(n) _____.

transaction

Unprotected health information that is not secured through the use of technologies or methods that HHS has specified is called _____ PHI.

unsecured