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1360-59 Healthcare Documentation > Chapter 5 > Flashcards

Flashcards in Chapter 5 Deck (36)
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1
Q

compliance

A

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

2
Q

covered entity

A

any health-care provider or contractor that transmits in electronic form any individually identifiable health information

3
Q

business associate

A

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

4
Q

clearinghouse

A

an organization or entity (public or private) that processes data into a standardized billing format and checks for inconsistencies or other errors in the claims data

5
Q

individually identifiable health information

A

data that identify a patient, such as name, address, date of birth and gender

6
Q

privacy

A

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

7
Q

protected health information (PHI)

A

any piece of data that identifies a patient as well as the clinical data tied to the patient

8
Q

Notice of privacy practices (NPP)

A

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.

9
Q

security rule

A

the HIPAA rule that protects PHI through standard procedures and methods of storage, access, and transmission, as well as through auditing for security breaches

10
Q

National Provider Identifier (NPI) number

A

a unique 10-diget number that identifies each care provider on all administrative or financial transactions-for instance, claim forms.

11
Q

Health plan identifier (HPID)

A

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 HPID are November 5, 2015, for small plans

12
Q

Omnibus Final Rule to the HITECH Act

A

legislation that updates and clarifies the requirements in the HITECH Act.

-increases the requirements for protecting patient privacy, adds to patients’ rights, and strengthens enforcement ability of law enforcement

13
Q

Accounting of disclosures

A

a listing of all disclosures of a patient’s PHI, including those for treatment, payment, and health-care operations

14
Q

Deemed status

A

be virtue of achieving accreditation status, a facility is also in compliance with CoP.

15
Q

Critical Access Hospital

A

a hospital that has no more than 25 inpatient beds’ maintains an annual average length of stay of 96 hours or less for acute inpatient care; offers 24-hour, 7-day a week emergency care’ and is located in a rural area at least 35 miles drive away from any other hospital or other critical access hospital; the CoP regulations for CAHs differ from those for hospitals that are not CAHs.

16
Q

accreditation

A

voluntary assessment by an accrediting agency that proves a health care facility exceeds the minimum requirements set by licensing agencies

-more stringent than licensure requirements

17
Q

Licensing requirements

A

all states, and federal government, have mandatory licensing requirements for health care providers and facilities

18
Q

What does health information prove?

A

whether organizations are maintaining standards and regulations or not

19
Q

Regulatory Agencies

A
  • state requirements
  • federal regulations
  • Medicare and Medicaid
  • licensure for medical professionals
  • mandatory
20
Q

Accrediting Bodies

A
  • voluntary standards
  • apply to organizations, rather than individuals
  • often more stringent than mandatory regulations and requirements
21
Q

Third-party payers

A
  • insurers
  • managed care plans
  • apply to both facilities and providers
  • meet goals to qualify for special status
  • certain level of compliance mandatory
22
Q

If there is a state requirement and a federal requirement for regulations, which do you follow?

A

the more stringent law on holding that

23
Q

Health Information Management Professionals (HIM Professionals)

Responsible for-

A

knowing the regulations and standards that apply to healthcare organizations and specialties

24
Q

Most common state regulations for medical records

A

-record must be kept for all services provided
-record must be available at all times
-policies and procedures pertaining to record completion and content are in place
(TJC- says it must be complete in 30 days. EMR day - 24-48 hours)
-only authorized individuals can access records
-records are safely stored and preserved

25
Q

The Conditions of Participation (CoP)

A

apply to all facilities that diagnose or treat Medicare and Medicaid patients and, in turn, expect payment from either.

  • the CoP regulations apply to the entire facility, not just the care, treatment, and resulting health records of that patient population
  • organizations that treat Medicare and Medicaid patients must adhere to the conditions of participation (CoP) regulations
  • CoP guidelines should be used during internal reviews as well as on-site visits
  • health records for all patients not just Medicare and Medicaid, must comply with CoP
  • HIM Personnel are responsible for making sure that the organization knows and complies with all CoP
26
Q

Conditions and Standards of the CoP impacting health information processes

A
  • the governing body
  • care of patients
  • emergency services
  • patients rights
  • privacy and safety
  • confidentiality of patient records
  • restraint or seclusion
  • death reporting requirements
  • quality assessment and performance improvement
  • composition of the medical staff
  • medical staff organization and accountability
  • medical staff by-laws
  • nursing services
  • medical record services
  • utilization review
  • discharge planning
  • the organization, staffing and delivery of services for individual services
27
Q

Health Insurance participation and accountability act (HIPPA)

A

-commonly referred to as “the privacy law”

  • health care coverage
  • privacy and security
  • code set rule
  • unique identifier rule
  • enforcement and compliance

HIPPA applies to covered entities that process, store, transmit, or received records, claims, and remittance advices

28
Q

Health Information Technology for Economic and Clinical Health (HITECH) Act’s intent-

A

is to increase the quality and efficiency of healthcare

29
Q

HITECH introduced meaningful use. Describe the 3 stages

A

stage 1- focus on the collection of data the will improve patient care and outcomes

stage 2- focus on advancing clinical process and sharing patient information

stage 3- focus on improved patient outcomes through the use of technology

30
Q

Office for Civil Rights (OCR)

A

enforces compliance with HIPPA, and failure to comply could result in monetary and/or criminal penalties

31
Q

What are patients entitled to?

A

-request a copy of every disclosure of PHI and all individuals who have accessed their information

32
Q

When a breach of security happens-

A
  • it needs to be reported to the impacted individuals, HHS, and the covered entity if the breach occurred by a business associate
    • includes description of breach, steps for patients to protect themselves, and description of the investigation and actions being taken to mitigate harm and prevent future breaches
  • when the breach involves 500 or more residents of a state or jurisdiction, the previously mentioned measures must be taken and the media outlets that serve that area must be notified as well
  • when the breach involves less than 500 residents the secretary of HHS ay be notified annually, but no later than 60 days following the end of the calendar year in which the breaches occurred
33
Q

Voluntary Accrediting Agencies

A
  • most healthcare organizations choose to work with an accreditation agency to be more competitive
  • accreditation is voluntary but if an organization decides to participate, then a small fee is involved
  • accreditation agencies award “deemed status” which enables the health care organization to obtain reimbursement from Medicare without a separate application and review process
34
Q

What is the most common accreditation agency?

A

the joint commission (TJC)

35
Q

the joint commission (TJC)

A

provides benchmarking data so that organizations can compare themselves to other similar organizations

36
Q

Standards related to health information include:

A
  • record of care
  • treatment and services
  • information management