AAHAM Certification Study Guide

AAHAM Certification Study Guide What are the Federal Agencies that are part of the U.S. Department of Health and Human Services (HHS)? - Centers of Medicare & Medicaid Services (CMS) Office of Inspector General (OIG) What are the HHS Operating Divisions? - National Institutes of Health (NIH) Food and Drug Administration (FDA) Centers of Disease Control and Prevention (CDC) Agency for Toxic Substances and Disease Registry (ATSDR) Indian Health Service (HIS) Health Resources and Services Administration (SAMHSA) Agency for Healthcare Research and Quality (AHRQ) Centers for Medicare and Medicaid Services (CMS) Administration for Children and Families (ACF) Administration for Community Living (ACL) What is the role of the CMS? - CMS is responsible for developing rules and regulations that govern Medicare and Medicaid. They also administer the Quality Improvement Organization (QIO) to monitor and improve quality of care for Medicare beneficiaries. Medicare = Title XVIII 18 Medicaid = Title XIX 19 What is the role of OIG? - Protect the integrity of HHS programs and the health and welfare of the beneficiaries of those programs. They have a major role in investigating fraud and abuse Name major federal regulations and describe their impact in the following areas: - Patient Rights Administrative simplification Data storage and recovery Affordable care Consumer Marketplace Anti-fraud and abuse Telephone consumer protection Credit and Collections Patient anti-dumping Performance Improvement Describe Patient's Bill of Rights? - Developed by the American Hospital Association (AHA) to state expectations that patients and their families can have about how they want to be treated in healthcare situations. It is also known as the plain language brochure called the Patient Care partnership. What are the criteria in the plain language brochure? - High quality hospital care A clean and safe environment Involvement in your care Protection of your privacy Help when leaving the hospital Help with your billing claims What is HIPAA? - The Health Insurance Portability and Accountability Act creates national standards for the safe and accurate exchange of patient information. What is PHI? - Protected Health Information under HIPAA including any data that couple be used individually or in combination to match patient's medical information. How can PHI be shared? - · Can be shared without explicit consent for treatment, payment, or healthcare operations · Cannot be shared for marketing purposed without explicit consent · Cannot be shared with law enforcement agencies without consent or proper notification to the patient, except under court order · Vendors who handle PHI on behalf of providers much sign an agreement that obligates them to treat it on the same basis as covered entities Who does the confidentiality of patient information apply to? - Every employee, not just those dealing with medical records due to the