HCCA Compliance 101 - Compliance
Glossary
Americans with Disabilities Act (ADA) - ANS-The Americans with Disabilities Act of 1990
(ADA) is a civil rights law that prohibits discrimination based on disability. It offers
comparable protections against discrimination to human beings with disabilities because the
Civil Rights Act of 1964, which made discrimination primarily based on race, religion, sex,
country wide starting place, and other traits illegal, and later included discrimination based
totally on sexual orientation.
Anti-Kickback Statute (AKS) - ANS-Prohibits solicitating, receiving, supplying, or paying any
remuneration immediately or circuitously in cash or in kind in exchange.
Attestation - ANS-The confirmation by signature, typically on a printed form, that the motion
outlined has been finished with the aid of the character signing; e.G., the person has read
the code of behavior and agreed to adhere to its concepts.
Legal professional-customer privilege - ANS-A legally prevalent policy that conversation
between a purchaser and legal professional is private in the course of the professional
relationship and that such communique cannot be disclosed with out the consent of the
client. Its reason is to encourage full and frank conversation among attorneys and their
customers.
Audit, baseline - ANS-A systematic inspection of records, guidelines, and processes with the
aim to establish a fixed of benchmarks for comparison for destiny inspections.
Audit, concurrent - ANS-An ongoing inspection of information, regulations, and strategies at
a given factor in time wherein diagnosed ability troubles are investigated as they arise (e.G.,
prepublished financial statements).
Audit, retrospective - ANS-A comprehensive inspection of records, guidelines, and tactics
performed typically in anticipation of launching a compliance software. All potential troubles
are diagnosed after which investigated (e.G., published monetary statements, ancient audit).
Benchmarking - ANS-The measurement of overall performance in opposition to "satisfactory
practice" requirements.
High-quality practices - ANS-Generally identified superior performance by way of groups in
operational and/or monetary techniques.
Enterprise companion - ANS-A man or woman or entity, aside from a member of the
personnel of a blanketed entity, who performs features or sports on behalf of or gives
positive services to a covered entity that contain get admission to by way of the business
accomplice to blanketed fitness information. Also a subcontractor that creates, receives,
, maintains, or transmits protected health statistics on behalf of another commercial enterprise
companion.
Enterprise accomplice settlement - ANS-A written agreement between a blanketed entity
and a business companion.
Caremark International Derivative Litigation - ANS-The 1996 US civil settlement of Caremark
International Inc. Wherein an imposed company integrity settlement precluded Caremark
from providing healthcare in certain paperwork for a length of five years. Also indicates that
the failure of a corporate director to attempt in desirable religion to institute a compliance
application in certain conditions can be a breach of a director's fiduciary duty.
Centers for Medicare and Medicaid Services (CMS) - ANS-A federal company within the
U.S. Department of Health and Human Services that administers the Medicare program and
works in partnership with state governments to manage Medicaid, the State Children's
Health Insurance Program, and medical health insurance portability standards.
Civil Monetary Penalties Law (CMPL) - ANS-Regulations that observe to any claim for an
item or carrier that changed into not furnished as claimed or that become knowingly
submitted as fake and which presents hints for levying of fines for such offenses.
Compliance - ANS-Adherence to legal guidelines and regulations surpassed by using
reliable regulating our bodies in addition to widespread principles of moral behavior. In the
USA, such regulating our bodies consist of the U.S. Congress, federal government
departments and federal businesses and commissions, and corresponding nation-stage
entities.
Corporate integrity settlement (CIA) - ANS-A negotiated settlement between an corporation
and the government in which the company accepts no liability but ought to agree to put in
force a strict plan of government-supervised corrective motion. (Also known as consent
decrees.)
included entities - ANS-Under HIPAA, covered entities encompass health plans, healthcare
providers, and healthcare clearinghouses.
Culpability score - ANS-Part of the Federal Sentencing Guidelines, a machine that adds
points for hectic elements and subtracts points for mitigating elements in determination of
fines imposed for fraud and abuse.
Modern-day procedural terminology (CPT) - ANS-A procedural code set developed via the
American Medical Association (AMA). It is maintained via the CPT Editorial Panel. The CPT
code set describes scientific, surgical, and diagnostic offerings and is designed to speak
uniform facts approximately clinical services and tactics among physicians, coders, sufferers,
accreditation companies, and payers for administrative, monetary, and analytical functions.
Department of Justice (DOJ) - ANS-A federal executive branch of the US government tasked
with enforcement of federal regulation and administration of justice. (Also: Justice
Department)
Glossary
Americans with Disabilities Act (ADA) - ANS-The Americans with Disabilities Act of 1990
(ADA) is a civil rights law that prohibits discrimination based on disability. It offers
comparable protections against discrimination to human beings with disabilities because the
Civil Rights Act of 1964, which made discrimination primarily based on race, religion, sex,
country wide starting place, and other traits illegal, and later included discrimination based
totally on sexual orientation.
Anti-Kickback Statute (AKS) - ANS-Prohibits solicitating, receiving, supplying, or paying any
remuneration immediately or circuitously in cash or in kind in exchange.
Attestation - ANS-The confirmation by signature, typically on a printed form, that the motion
outlined has been finished with the aid of the character signing; e.G., the person has read
the code of behavior and agreed to adhere to its concepts.
Legal professional-customer privilege - ANS-A legally prevalent policy that conversation
between a purchaser and legal professional is private in the course of the professional
relationship and that such communique cannot be disclosed with out the consent of the
client. Its reason is to encourage full and frank conversation among attorneys and their
customers.
Audit, baseline - ANS-A systematic inspection of records, guidelines, and processes with the
aim to establish a fixed of benchmarks for comparison for destiny inspections.
Audit, concurrent - ANS-An ongoing inspection of information, regulations, and strategies at
a given factor in time wherein diagnosed ability troubles are investigated as they arise (e.G.,
prepublished financial statements).
Audit, retrospective - ANS-A comprehensive inspection of records, guidelines, and tactics
performed typically in anticipation of launching a compliance software. All potential troubles
are diagnosed after which investigated (e.G., published monetary statements, ancient audit).
Benchmarking - ANS-The measurement of overall performance in opposition to "satisfactory
practice" requirements.
High-quality practices - ANS-Generally identified superior performance by way of groups in
operational and/or monetary techniques.
Enterprise companion - ANS-A man or woman or entity, aside from a member of the
personnel of a blanketed entity, who performs features or sports on behalf of or gives
positive services to a covered entity that contain get admission to by way of the business
accomplice to blanketed fitness information. Also a subcontractor that creates, receives,
, maintains, or transmits protected health statistics on behalf of another commercial enterprise
companion.
Enterprise accomplice settlement - ANS-A written agreement between a blanketed entity
and a business companion.
Caremark International Derivative Litigation - ANS-The 1996 US civil settlement of Caremark
International Inc. Wherein an imposed company integrity settlement precluded Caremark
from providing healthcare in certain paperwork for a length of five years. Also indicates that
the failure of a corporate director to attempt in desirable religion to institute a compliance
application in certain conditions can be a breach of a director's fiduciary duty.
Centers for Medicare and Medicaid Services (CMS) - ANS-A federal company within the
U.S. Department of Health and Human Services that administers the Medicare program and
works in partnership with state governments to manage Medicaid, the State Children's
Health Insurance Program, and medical health insurance portability standards.
Civil Monetary Penalties Law (CMPL) - ANS-Regulations that observe to any claim for an
item or carrier that changed into not furnished as claimed or that become knowingly
submitted as fake and which presents hints for levying of fines for such offenses.
Compliance - ANS-Adherence to legal guidelines and regulations surpassed by using
reliable regulating our bodies in addition to widespread principles of moral behavior. In the
USA, such regulating our bodies consist of the U.S. Congress, federal government
departments and federal businesses and commissions, and corresponding nation-stage
entities.
Corporate integrity settlement (CIA) - ANS-A negotiated settlement between an corporation
and the government in which the company accepts no liability but ought to agree to put in
force a strict plan of government-supervised corrective motion. (Also known as consent
decrees.)
included entities - ANS-Under HIPAA, covered entities encompass health plans, healthcare
providers, and healthcare clearinghouses.
Culpability score - ANS-Part of the Federal Sentencing Guidelines, a machine that adds
points for hectic elements and subtracts points for mitigating elements in determination of
fines imposed for fraud and abuse.
Modern-day procedural terminology (CPT) - ANS-A procedural code set developed via the
American Medical Association (AMA). It is maintained via the CPT Editorial Panel. The CPT
code set describes scientific, surgical, and diagnostic offerings and is designed to speak
uniform facts approximately clinical services and tactics among physicians, coders, sufferers,
accreditation companies, and payers for administrative, monetary, and analytical functions.
Department of Justice (DOJ) - ANS-A federal executive branch of the US government tasked
with enforcement of federal regulation and administration of justice. (Also: Justice
Department)
