Medical billing part 2 Flashcards

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