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Stack 2

AAHAM CRCS STACK 2

QuestionAnswer
What does HIPAA stand for? What does it do? Health Ins Portability and Accountability Act, issued by HHS, part of the Privacy and Security Rules Sets federal standards for insurers, HMO's and employer plans to protect med recs & pers health info and safe and accurate exchange of this info.
What was the patient Bill of Rights replaced with and what does it state? A plain language brochure called Patient Care Partnership During a hospital stay a pt can expect: High qual. care Clean, safe environment Involvement in care Help when leaving Help w/ their billing claims Protection of their privacy
What does HIPAA accomplish? - gives pt more control of health info - sets boundaries on use & release of records - establishes rules for handling/protecting info - Holds violators accountable (civil & criminal penalties) - Limits release of info to minimum reasonably needed.
What is PHI and list some examples Protected Health Information - any data that can be used individually or in combo to match patient to med recs. -DOB -Name -Address -Phone -email -SSN -MR# -Employer info -relatives' info -certificate # for med equipment
What does TPO stand for and describe Treatment, Payment or Healthcare Operations PHI can be shared w/o consent for TPO. PHI CANNOT be shared for marketing w/o explicit consent. Cannot be shared with law enforcement without court order.
What does ECOA stand for and describe Equal Credit Opp Act prohibits discr based on: race, color, nat'l origin, sex, marital status, age or b/c they rec public assist. May ask for demo info for gov't to enforce laws. May consider immigration status May NOT ask if widowed or divorced
What does FDCPA stand for and describe Fair Debt Collection Practices Act a result of evidence of abuse in debt collection practices. Limits: how location info of debtor is obtained and communication w/ debtor and others.
What are some examples of Harrassment or Abuse as it pertains to the FDCPA Fair Debt Collection Practices Act -Use of false/misleading info -Contacting before 8am or after 9pm in debtor's location -contacting if we are aware they have legal council -calling at work if we know it will cause a problem
What does FCRA and describe Fair Credit Reporting Act Defines what info from consumer reports can be used, by whom and when. Provides maximum protection of a consumer's right to privacy and confidentiality of credit reports.
What does FCBA stand for and describe Fair Credit Billing Act Protects consumers from inaccurate or unfair practices by issuers of open-ended credit. Requires creditors to inform debtors of their rights and of the responsibilities of the creditor.
What is another name for Regulation Z and what does it do? Truth in Lending Act Deals w/ disclosure of info before credit is extended Requires APR & finance charges are clearly identified and written disclosures must be provided to the consumer.
What does TCPA stand for and describe Telephone Consumer Protection Act - restricts telemarketing and use of automated phone equipment. - prohibits the use of automated tele equipment to a cell phone to contact a debtor w/o express consent. Limits use of pre-recorded messages and texts.
What is the False Claims Act? Prohibits making a false record or statement to get a false/fraudulent claim paid by the government. Prohibits submission of false/fraudulent claims or conspiring to have such claims paid by the government.
What are administrative sanctions and when are they used? If CMS determines the existence of inappropriate/fraudulent behavior by the provider: - Denial or revocation of provider # application - Suspension of provider pmts - Application of civil monetary penalties (CMP's)
What does PPACA stand for and describe Patient Protection and Affordable Care Act Together w/ the Health Care & Education Reconsiliation Act, represents the most significant overhaul of the US HC system since MC & MA were passed in 1965.
What is the goal of PPACA? Patient Protection and Affordable Care Act Aims to lower # of uninsured Americans and lower overall cost of HC, using mandates, subsidies and tax credits.
Define Fraud Intentional/illegal deception or misrep for personal gain/to harm or manipulate a person or organization. (ex: - incorrect report of DX, procedure codes to max payments - billing svcs not rendered -accepting kickbacks - routine waiver of ded or coins.
Define Abuse Not considered fraud but inconsistent with accepted sound practices. (ex: unwarranted use of tech, pharma or svcs. Abuse of authority, abuse of privacy or duty to care, unintentional improper billing.
What does PSDA stand for and describe Patient Self Determination Act Passed by congress to ensure the pt understands and can participate in their own care decisions. Deals with advance directives.
What is an advance directive and list examples Written statements regarding patient wishes in the event they later become unable to make choices. - Living Will - lists wishes -HC POA or Durable POA for HC - assigns a person to make decisions for you -DNR
What does EMTALA stand for and describe Emergency Medical Trmt & Active Labor Act (aka: Federal Anti-dumping statute) Requires ER prior to asking about pmt: - med screening exam -Nec stabilizing trtmt -restricts xfer until stabilized -not just for ER, any location on a hospital campus.
What does CLIA stand for and describe Clinical Lab Improvement Ammendment -clinical lab svcs to MC pts must be performed by a CLIA certified provider. # to each provider and must be on claim. -state becomes exempt if requirement is more stringent than that of CLIA. Currently, only NY & WA.
What does TJC stand for and describe The Joint Commission - a private agy that CMS allows to accredit hospitals to protect & improve quality & safety of care. conducts audit of hospital every 39 mos and labs every 24 mos. can audit w/o notice as soon as 9-30 mos after initial audit.
Which areas of patient access does TJC survey? Distribution & discussion of advance directives pt rights and responsibilities organizational ethics continuum of care mngmt of environment of care confidentiality/privacy security communication
Created by: Amy17349
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