COMPLIANCE 101
An impermissible use or disclosure that compromises the security or privacy of PHI.
What is a breach?
This law makes it illegal for people to knowingly submit false statements or in order to collect money from the government.
What is the False Claims Act (FCA)?
There are this many CPT codes for a PT Evaluation.
What is 3?
HIPAA rule that limits when and how an entity can disclose PHI.
What is the Privacy Rule?
CMS
What is Center for Medicare and Medicaid Services?
This is a set of guidelines that outlines ethical behavior for employees.
What is a Code of Conduct?
This law prohibits remuneration in exchange for referrals of Federal Health Care program business.
What is the Anti-Kickback Statute (AKS)?
Agile utilizes this many unit calculation rule sets.
What is 2?
Rule that requires covered entities to have reasonable safeguards to protect e-PHI.
What is the Security Rule?
PHI
What is Protected Health Information?
Generally defined as excessive or improper use of services or actions that are inconsistent with acceptable business or medical practice.
What is Abuse?
This federal law governs patient privacy and how covered entities handle PHI.
What is HIPAA?
You must reach this point before you bill a timed unit.
What is the midpoint?
Rule that requires covered entities to disclose breaches to the government.
What is the Breach Notification Rule?
OIG
What is the Office of the Inspector General?
The name for the person who exposes information or activity that is deemed illegal, dishonest, or violates professional or clinical standards.
What is a Whistleblower?
This law prohibits doctors from referring patients with Medicare to an entity they (or a close family member) own
What is Stark (Physician Self-Referral Law)?
Ratio of provider:patient required to bill Medicare Part B.
What is 1:1?
How much PHI a covered entity can disclose.
What is the minimum necessary?
NPP
What is a Notice of Privacy Practices?
Under the Social Security Act, this is the action that the OIG, among other agencies, have the right to impose for a variety of reasons, including a conviction for Medicare or Medicaid fraud.
What is Exclusion?
This law is also known as "Lincoln's Law."
What is the False Claims Act.
Medicare Part B requires a Progress Note every ____ visits.
What is 10?
Covered entities must immediately notify the government when a breach exceeds this number of individuals.
What is 500?
OCR
What is the Office of Civil Rights?