Legal Aspects of Health Insurance & Reimbursement |
Questions with answers
Which federal law protects the privacy and security of a patient's health information?
*** Health Insurance Portability and Accountability Act (HIPAA)
What is a legal document that requires an individual to appear to court? *** subpoena
What is any information that can link a specific individual to medical records? ***
Protected health information (PHI)
What must a patient sign in order to disclose his or her health information? ***
authorization
The HIPAA Security Rule provides standards for health information maintained or
transmitted in what format? *** electronic
What's the main difference between fraud and abuse? *** a person's intent
A patient should sign an additional, specifically worded authorization statement to
release information for which of the following medical conditions? *** HIV
laws passed by legislative bodies *** statues
mandated guidelines written by administrative agencies. *** regulations
official directive, instruction, or order to take or perform a certain action, such as a
federal regulation. Also authoritative commands, such as by courts, governors, and
legislatures *** mandate
common law; based on court decisions that establish a precedent *** case law
based on a court decision that is legally binding and follows the doctrine of state decisis
for deciding subsequent cases involving identical or similar facts. Serves as "the
standard" for similar cases. *** precedent
requires courts to apply precedent law in the same manner to cases with the same
facts. *** stare decisis
deals with all areas of law that are not classified as criminal law *** civil law
public law (statute or ordinance) that defines crimes and their prosecution *** criminal
law
, order of the court that requires a witness to appear at a particular time and place to
testify. Used to obtain witness testimony at trial and at deposition *** subpoena
requires documents (e.g., patient record) to be produced. *** subpoena duces tecum
testimony under oath taken outside of court (e.g., at the provider's office) ***
deposition
document containing a list of questions that must be answered in writing ***
interrogatory
provision of the Federal False Claims Act, which allows a private citizen to file a lawsuit
in the name of the U.S. government, charge government contractors and other entities
that receive or use government funds with fraud, and share in any money recovered.
*** qui tam
protected individuals that make specified disclosures relating to funds covered by the
act (e.g., Medicare payments) *** whistleblowers
legal newspaper published every business day by the National Archives and Records
Administration (NARA). *** Federal Register
contain new and changed Medicare policies and procedures that are to be incorporated
into a specific CMS program manuak. *** CMS transmittals
includes regulations and major policies that have been implemented or canceled and
new/revised Internet-only Manual (IOM) instructions. *** CMS quarterly provider
update (QPU)
organization that contracts with CMS to process fee-for-service health care claims and
perform program integrity tasks for both medicare Part A and Part B. Also process
home health and hospice claims (HHH MACs) and durable medical equipment,
prosthetics, orthotics, and supplies claims (DMEPOS MACs). Each contractor makes
program coverage decisions and publishes a newsletter, which is sent to providers who
receive Medicare reimbursement. *** Medicare administrative contractor (MAC)
CMS publishes; requirements that health care organizations must meet in order to begin
and continue participating in the Medicare and Medicaid programs. Foundation for
improving quality of patient care and protecting the health and safety of patients. ***
Conditions of Participation (CoP) & Conditions for Coverage (CfC)
Clinics, rehabilitation agencies, and public health agencies as providers of outpatient
physical therapy and speech-language pathology services
Community mental health centers (CMHCs)
Comprehensive outpatient rehabilitation facilities (CORFs)
Critical access hospitals (CAHs)
Questions with answers
Which federal law protects the privacy and security of a patient's health information?
*** Health Insurance Portability and Accountability Act (HIPAA)
What is a legal document that requires an individual to appear to court? *** subpoena
What is any information that can link a specific individual to medical records? ***
Protected health information (PHI)
What must a patient sign in order to disclose his or her health information? ***
authorization
The HIPAA Security Rule provides standards for health information maintained or
transmitted in what format? *** electronic
What's the main difference between fraud and abuse? *** a person's intent
A patient should sign an additional, specifically worded authorization statement to
release information for which of the following medical conditions? *** HIV
laws passed by legislative bodies *** statues
mandated guidelines written by administrative agencies. *** regulations
official directive, instruction, or order to take or perform a certain action, such as a
federal regulation. Also authoritative commands, such as by courts, governors, and
legislatures *** mandate
common law; based on court decisions that establish a precedent *** case law
based on a court decision that is legally binding and follows the doctrine of state decisis
for deciding subsequent cases involving identical or similar facts. Serves as "the
standard" for similar cases. *** precedent
requires courts to apply precedent law in the same manner to cases with the same
facts. *** stare decisis
deals with all areas of law that are not classified as criminal law *** civil law
public law (statute or ordinance) that defines crimes and their prosecution *** criminal
law
, order of the court that requires a witness to appear at a particular time and place to
testify. Used to obtain witness testimony at trial and at deposition *** subpoena
requires documents (e.g., patient record) to be produced. *** subpoena duces tecum
testimony under oath taken outside of court (e.g., at the provider's office) ***
deposition
document containing a list of questions that must be answered in writing ***
interrogatory
provision of the Federal False Claims Act, which allows a private citizen to file a lawsuit
in the name of the U.S. government, charge government contractors and other entities
that receive or use government funds with fraud, and share in any money recovered.
*** qui tam
protected individuals that make specified disclosures relating to funds covered by the
act (e.g., Medicare payments) *** whistleblowers
legal newspaper published every business day by the National Archives and Records
Administration (NARA). *** Federal Register
contain new and changed Medicare policies and procedures that are to be incorporated
into a specific CMS program manuak. *** CMS transmittals
includes regulations and major policies that have been implemented or canceled and
new/revised Internet-only Manual (IOM) instructions. *** CMS quarterly provider
update (QPU)
organization that contracts with CMS to process fee-for-service health care claims and
perform program integrity tasks for both medicare Part A and Part B. Also process
home health and hospice claims (HHH MACs) and durable medical equipment,
prosthetics, orthotics, and supplies claims (DMEPOS MACs). Each contractor makes
program coverage decisions and publishes a newsletter, which is sent to providers who
receive Medicare reimbursement. *** Medicare administrative contractor (MAC)
CMS publishes; requirements that health care organizations must meet in order to begin
and continue participating in the Medicare and Medicaid programs. Foundation for
improving quality of patient care and protecting the health and safety of patients. ***
Conditions of Participation (CoP) & Conditions for Coverage (CfC)
Clinics, rehabilitation agencies, and public health agencies as providers of outpatient
physical therapy and speech-language pathology services
Community mental health centers (CMHCs)
Comprehensive outpatient rehabilitation facilities (CORFs)
Critical access hospitals (CAHs)
