Governing and Regulatory Agencies Flashcards Preview

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Flashcards in Governing and Regulatory Agencies Deck (18)
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1
Q

HIM

A

Health Information Management

2
Q

Joint Commission

A

private non-profit that evals and accredits nearly 15,000 healthcare org and prog in USA. Governed by 29-member Board of Commissioners including physicians, administrators, nurses, employers, labor rep, health plan leaders, quality experts, ethicists, consumer advocate, educators

3
Q

MCare A

A

Hospital Insurance. cover most inpatient care up to 90 days including hospital, snf, hospice, respite

4
Q

MCare B

A

Outpatient Insurance. Covers many services provided from physician care, including general exams, lab tests, counseling, therapy, other outpatient

5
Q

MCare C

A

aka MCare Advantage plan - overrides A, B, D. More comprehensive prog that offered through many private insurance comp and works like a managed care plan

6
Q

MCare D

A

RX plan. Went into effect 2006. Optional plan that can be purchased

7
Q

DHHS

A

Dept of Health and Human Services is fed agency gov and regulating healthcare in USA. Under umbrella: office of surgeon general, center for disease control and prevention, centers for medicare and medicaid

8
Q

DHHS moto

A

Protecting the health of all Americans and providing essential human services, especially those who are least able to help themselves.

9
Q

CMS

A

Centers for MCare and MCal serivces. Provides assist for 1 in 4 Americans. Administers State Children’s Health Insurance Program. Publishes eligibility guidelines for MCare and works w/individual states to provide guidelines for MCal. Regulations such as HIPAA, and standards for providers re: billing for services

10
Q

MCal

A

Joint fed/state. Usually for disabled and/or low-income who lack resources. 51.6 million persons.

11
Q

MCare

A

Gov spons for qualified sr age 65+ and qualified disabled people any age

12
Q

CMA effected by CMS regulations

A

regulates conduct w/regard to px confidentiality/privacy rights under HIPAA; works jointly with private/public org to provide regulations and standards for handling and transmission of med records; provides reference and resource info with regard to standard of conduct, HIPAA, fraud reporting and prevention

13
Q

OIG

A

Office of Inspector General mission is to protect integrity of DHHS programs. Reports to both Secretary and Congress any program and management problems with recommendations to correct them. Duties carried out thru nationwide network of audits, investigations, inspections. Proactive and Reactive Audits

14
Q

Proactive audit

A

audit where OIG is routinely inspecting healthcare provider to make sure documentation and treatment is appropriate [UNDER SURVEY]

15
Q

Reactive audit

A

audit/inspection carried out in response to tip, complaint, concern brought to attention of OIG

16
Q

OCR

A

Office of Civil Rights: responsibility to investigate and, when violations are found, forward for prosecution violators of HIPAA

17
Q

Dept of Justice

A

NOT PART OF DHHS.
Branch of gov tasked with prosecuting criminals who engage in fraud, abusive, discrimination, other law breaking activities. When OCR or OIG investigates and find complaint has merit, info is forwarded to Dept of Justice for investigation and potential prosecution

18
Q

SAMHSA

A

Substance Abuse and Mental Health Services Administration: may impact employer/you if work is mental health services