CMOM-Practice Management Institute Questions With Complete Solutions.
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CMOM-Practice Management Institute
HIPPA REGULATION: Privacy Overview - 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 - can be held directly accountable by federal or state authority for failure to
comply...
CMOM -Practice Management Institute HIPPA REGULATION: Privacy Overview - ✔✔ There are three major areas addressed in the Privacy Regulation: 1. Use and disclosure of PHI, 2. Pati ent rights 3. Security administrative and physical Business Associates - ✔✔ 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, Collec tion agencies, Consultants and Billing Services. Entities - ✔✔ ex. doctors, hospitals, pharmacy Breach - ✔✔ unauthorized acquisition access, use or disclosure of protected health information, ex. ALGH issue on breach where health info was spread with no co nsents from patients. What is NOT considered a breach? - ✔✔ 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. an d 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 - ✔✔ HIPPA violation at $50,000 per violation and an annual maximu m of $1.5million. What are examples that could not result in HIPPA violation by DHHS? - ✔✔ -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) - ✔✔ 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) - ✔✔ Information that is a subset of health information, including demographic, information collected from an individual. Identifiers - ✔✔ -Email address -Social Security number -Medical record number -Vehicle identifier -Full face photograph The Notice of Priva cy Practices should be... - ✔✔ 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 - ✔✔ the intentional deception or misrepresentation that an i ndividual 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 wer e 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 - ✔✔ 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 sup plies Providing medical unnecessary services
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