Federal Regulations
What is the main government federal agency that handles Federal Regulations?
Center of Medicaid and Medicare Services (CMS).
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What responsibilities do the states have in the healthcare industry?
1.Investigate consumer complaints.
2. Ensure insurance pay enrollee claims.
3. Restrict price increases on premiums
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What year was HIPAA Created?
HIPAA was created in 1996.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What does HITECH stand for?
Health Information Technology for Economic and Clinical Health Act.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
What does ACA stand for?
Affordable Care Act.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
What does the HIPAA privacy rule do?
The HIPAA privacy rule contains national standards that allow physicians practices and hospitals to keep patients private information safe.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.45)
What does the HIPAA Security Rule?
"The HIPAA security rule establishes safeguards to protect PHI."
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.53)
What is the HITECH Act?
"The HITECH Act requires that entities notify affected individuals following the discovery of a breach. "
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.54)
What is the Obnibus Rule?
"The Obnibus Rule is a set of regulations that enhance patients privacy protections and rights to information and the governments ability to enforce HIPAA. "
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg. 58)
What insurance programs does CMS administer?
CMS administers Medicare, Children's health programs, and Medicaid.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What is the name of the law that ensures that insurances accept all qualified providers who participate in their insurance plan?
"any willing provider" laws.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What five titles does HIPAA focus on?
1. Healthcare access, portability and renewability.
2. Preventing healthcare fraud and abuse.
3. Tax Related health provisions
4. Application and enforcement of group health plan requirements.
5. Revenue offsets.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What is the most important rule in the HITECH Act?
Title XIII of the ARRA.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
When was ACA introduced?
2010.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
What must the HIPAA privacy rule cover?
Have a set of privacy practices that are appropriate for healthcare services
Notify patients about their privacy rights.
Train employees so they understand privacy practices.
Safeguard patient records.
Appoint a privacy official responsible for seeing that privacy practices are implemented and followed.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.45)
What does PHI stand for?
Protected Health Information.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.53)
How much time does a facility have to notify patients about a breach?
"A facility has 60 days to notify patients of the breach. "
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.55)
What are the four final rules of the Omnibus Rule?
1. Prohibiting health plans from using or disclosing genetic information for determining insurance coverage.
2. Restating the standard that determines when to report breaches with more objective measures.
3. Increasing the civil monetary penalties for violations.
4. Strengthening previous HIPAA/HITECH rules, such as making BA's directly liable for compliance with privacy and security laws.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.58)
What activities does CMS do to ensure quality healthcare?
1.Regulating all laboratory testing.
2. Prevent discrimination based on health status.
3. Research the effectiveness of various methods of healthcare management, treatment and financing.
4. Evaluating the healthcare facilities and services.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What is HIPAA designed to do?
1. Protect patients private information.
2. Insure health coverage for patients and families when they change or lose jobs.
3. Uncover fraud and abuse.
4. Create standards for electronic transmissions of healthcare transactions.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What does this law promote?
"HITECH promotes the adoption of health information technology mainly using EHR's. "
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
What has ACA fostered the organization of?
ACO Organizations. (accountable care organizations)
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
What type of information does the HIPAA Privacy rule protect?
A few examples could be the patients name, date of birth, social security number, address, e-mail address and phone number.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.45)
What security measures help enforce the HIPAA security rule?
Secure internet connections.
Access control, passwords and log files to keep intruders out.
Backups to replace items in case of damage.
Security policies to handle violations that do occur.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.53)
What is a covered entity?
A covered entity could be a health plan, health plan clearing house, or a healthcare provider that transmits health information electronically.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
What office is HIPAA enforced by?
The Office of Civil Rights.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.58)
What agency is CMS under?
CMS is under The Department of Health & Human Services.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.42)
What does HIPAA stand for?
Health Insurance Portability and Accountability Act.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg. 42)
What does EHR stand for?
Electronic Health Record.
What does the ACA do?
ACA expands health insurance access and affordability.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
Who is responsible for implementing the HIPAA Privacy rule?
An offices designated Privacy Officer.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.45)
What is required in order to enforce the HIPAA Security rule when transmitting electronic records?
Encryptions is the process of encoding information so that a computer or person cannot decode it.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.53)
How is a provider eligible for bonus payments?
"Eligible providers must demonstrate meaningful use of technology. Meaning the EHR should be able to prove quality, patient safety, and efficiency in their healthcare system. "
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)
What does ACO do?
ACO is a network of healthcare physicians jointly accountable for the health of their patients.
Medical Insurance A Revenue Cycle Process Approach, 9th Edition(pg.43)