CMOM-Practice Management Institute Questions and Answers 100% A+ Graded Excel

CMOM-Practice Management Institute Questions and Answers 100% A+ Graded Excel HIPPA REGULATION: Privacy Overview - CORRECT ANSWER-There are three major areas addressed in the Privacy Regulation: 1. Use and disclosure of PHI, 2. Patient rights 3. Security administrative and physical Business Associates - CORRECT ANSWER-can be held directly accountable by federal or state authority for failure to comply with HIPAA statutory or regulations. ex. IT techs, Janitors, Cleaning Services, Vendors, Collection agencies, Consultants and Billing Services. Entities - CORRECT ANSWER-ex. doctors, hospitals, pharmacy Breach - CORRECT ANSWER-unauthorized acquisition access, use or disclosure of protected health information, ex. ALGH issue on breach where health info was spread with no consents from patients. What is NOT considered a breach? - CORRECT ANSWER-1. Where an authorized person who received the health info. cannot reasonably have been able to retain it. 2. If an unintentional acquisition, access, or use occurs within the scope of employ. and info doesn't go any further. 3. If it is an inadvertent disclosure that occurs within a facility, and the information does not go any further. Tiered Increase in Civil Monetary Penalties - CORRECT ANSWER-HIPPA violation at $50,000 per violation and an annual maximum of $1.5million. What are examples that could not result in HIPPA violation by DHHS? - CORRECT ANSWER--Overheard phone or nursing station conversation -Joint treatment areas -Sign-in sheets -Calling names in reception areas -Hospital rounds Solutions would be to speak quietly, cubicles, curtains, dividers, asking patients to step back, or closing doors. Health Information (PHI) - CORRECT ANSWER-Any info. whether oral or recorded in any form or medium that is created or received by a health care provider, health, plan public health authority, employer, life insurer, school or university, or health care clearinghouse, and related to the past, present or future physical or mental health or condition. Individual Identifiable Health Information (IIHI) - CORRECT ANSWER-Information that is a subset of health information, including demographic, information collected from an individual. Identifiers - CORRECT ANSWER--Email address -Social Security number -Medical record number -Vehicle identifier -Full face photograph The Notice of Privacy Practices should be... - CORRECT ANSWER-In a written language, tape, or video that the patient understands, be clearly posted in the practice or facility, and if applicable, on the practice website. Fraud - CORRECT ANSWER-the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowingly that the deception could result in some unauthorized benefit to himself/herself or some other person. ex. Billing for services that were not furnished and or supplies that were not provided -Billing for services as if performed by a particular entity when they were, in fact, performed by another entity not eligible to be paid by Medicare -Using in incorrect or inappropriate provider number ni order to be paid (using a deceased provider number to defraud Medicare). Abuse - CORRECT ANSWER-describes practices that either directly or indirectly result in unnecessary costs to the Medicare Program. Acts committed knowingly, willfully and intentionally. ex. Charging in excess for services or supplies Providing medical unnecessary services Whistleblower - CORRECT ANSWER-or the "qui tam" provision as it is formally called allows a person that has knowledge of a false claim against the government to bring an action against the suspected wrongdoer on behalf of the U.S. government. Relator - CORRECT ANSWER-a person that files a qui tam suit on behalf of the government and may share a percentage of the recovery realized from a successful action ex. patient, disgruntled former employee or other business contact. OIG Compliance Plan - CORRECT ANSWER-There are seven steps