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| 4476508411 | Abuse | Actions inconsistent with accepted, sound medical, business or fiscal practices | 0 | |
| 4476508412 | Authorization | Document that provides official instruction, such as the customized document that gives covered entities permission to use specified protected health information (PHI) for specified purposes or to disclose PHI to a third party specified by the individual | 1 | |
| 4476511192 | Breach of confidentiality | Unauthorized release of patient information to a third party | 2 | |
| 4476515257 | Case law | Also called common law: based on a court decision that establishes a precedent | 3 | |
| 4476515258 | Civil law | Area of law not classified as criminal | 4 | |
| 4476517345 | Common Law | Also known as case law: is based on a court decision that establishes a precedent | 5 | |
| 4476517346 | Confidentiality | Restricting patient information access to those with proper authorization and maintaining the security of patient information | 6 | |
| 4476519914 | Criminal law | Public law governed by statue or ordinance that deals with crimes and their prosectution | 7 | |
| 4476521193 | Deposition | Legal proceeding during which a party answers questions under oath (but not in a open court) | 8 | |
| 4476521194 | Encrypt | To convert information to a secure language format for transmission | 9 | |
| 4476523741 | False Claims Act (FCA) | Passed by the federal government during the Civil War to regulate fraud associated with military contractors selling supplies and equipment to the Union Army | 10 | |
| 4476525080 | Fraud | Intentional deception or misrepresentation that could result in an unauthorized payment | 11 | |
| 4476527502 | Health Plan Identifier (HPID) | Unique identifier is assigned to third party payers which has 10 numeric positions, including a check digit as the tenth positions | 12 | |
| 4476530162 | Medical Identity theft | Occurs when someone uses another person's name and/or insurance information to obtain medical and/or surgical treatment, prescription drugs, and medical durable equipment | 13 | |
| 4476530163 | Medical Review | Defined by CMS as a review of claims to determine whether services provided are medically reasonable and necessary, as well as to follow up on the effectiveness of previous corrective actions | 14 | |
| 4476533347 | National Drug Code (NDC) | Maintained by the Food and Drug Administration(FDA): identifies prescription drugs and some over the counter products | 15 | |
| 4476534946 | National Individual Identifier | Unique identifier to be assigned to patients has been put on hold. Several bills in Congress would eliminate the requirement to establish a National Individual Identifier | 16 | |
| 4476534947 | National Plan and Provider Enumeration System | Developed by CMA to assign unique identifiers to health care providers (NPI) and health plans (HPID) | 17 | |
| 4476539554 | National Provider Identifier (NPI) | Unique identifier assigned to health care providers as a 10-digit numeric identifier, including a check digit in the last position | 18 | |
| 4476542026 | National Standard Employer Identification Number (EIN) | Unique identifier assigned to employers who, as sponsors of health insurance for their employees, need to be identified in health care transactions; it is the federal employer identification number (EIN) assigned by the Internal Revenue Services and has nine digits with a hyphen | 19 | |
| 4476543872 | National Standard Format (NSF) | Flat file format used to bill provider and non institutional services such as services reported by a general practitioner on a CMS 1500 claim | 20 | |
| 4476543873 | Overpayment | Funds that a provider or beneficiary has received in excess of amounts due and payable under Medicare and Medicaid statutes and regulations | 21 | |
| 4476546942 | Part A/B Medicare administrative contractor | An organization that contracts with CMS to process claims and perform program integrity tasks for Medicare Part A and Part B and DMEPOS | 22 | |
| 4476550844 | Physician Quality Reporting System | The Tax Relief and Health Care Act of 2006 that established financial incentives for eligible professionals who participate in a voluntary quality reporting program | 23 | |
| 4476552585 | Precedent | Standard | 24 | |
| 4476554112 | Privacy | Right of individuals to keep their information from being disclosed to others | 25 | |
| 4476554113 | Privacy Act of 1974 | Forbids the Medicare regional payer from disclosing the status of any unassigned claim beyond the following: date the claim was received by the payer: date the claim was paid, denied or suspended or general reason the claim was suspended | 26 | |
| 4476555526 | Privacy rule | HIPAA provision that creates national standards to protect individuals' medical records and other personal health information | 27 | |
| 4476558158 | Privileged communication | Private information shared between a patient and health care provider; disclosure must be in accordance with HIPAA and/or individual state provisions regarding the privacy and security of protected health information (PHI) | 28 | |
| 4476559885 | Protected health information (PHI) | Information that is identifiable to an individual such as name, address, telephone numbers, date of birth, Medicaid ID number, medical record number, Social Security number and name of employer | 29 | |
| 4476571490 | Qui Tam | It is a provision of the False Claims Act that allows a private citizen to file a lawsuit in the name of the US government, charging fraud by government contractors and other entities | 30 | |
| 4476574704 | Recovery Audit Contractor program (RAC) | Mandated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 to find and correct improper Medicare payments paid to health care providers participating in fee for service Medicare | 31 | |
| 4476571491 | Regulations | Guidelines written by administrative agencies | 32 | |
| 4476577146 | Release of information (ROI) | Used to document patient information released to authorized requestors | 33 | |
| 4476577147 | Security | Involves the safekeeping of patient information by controlling access to hard copy and computerized records protecting patient information from alteration, destruction, tampering or loss | 34 | |
| 4476578758 | Statutes | Also called statutory law, laws passed by legislative bodies | 35 | |
| 4476578759 | Statutory law | See above statutes | 36 | |
| 4476580597 | Subpoena | An order of the court that requires a witness to appear at a particular time and place to testify | 37 | |
| 4476580598 | Subpoena duces tecum | Requires documentation (e.g. patient record) to be produced | 38 | |
| 4476582615 | UB-04 | Insurance claim or flat file used to bill institutional services, such as services performed in hospitals | 39 | |
| 4476582914 | Upcoding | Assignment of an ICD 10 CM diagnosis code that does not match patient record documentation for the purpose of illegally increasing reimbursement | 40 |
