Compliance 101
This high-level staff member's role includes oversight of the organization's compliance program.
What is the Chief Compliance Officer
Sections of this act deal with the protection of patient information or protected health information (PHI).
What is HIPAA
Every year billions of dollars are improperly spent because of____.
What is Fraud, Waste and Abuse.
True or False Icario has a Compliance, Privacy and Security Committee.
What is True.
True or False. Reward and incentive programs can be used to incentivize member enrollment.
What is False.
Some of the essential elements of this include: established compliance standards and procedures, oversight by high-level personnel, and reasonable methods to achieve compliance with standards, including monitoring systems and hotlines.
What is effective compliance program
This acronym, H.I.P.A.A. stands for:
A. Health Incident Personal and Accessibility Act
B. Health Insurance Portability and Accountability Act
C. Health Insurance Profit and Protection Act
D. Health Industry Patient Advocacy Act
What is B. Health Insurance Portability and Accountability Act
Who is responsible for reporting cases of Fraud, Waste and Abuse?
What is EVERYONE!
True or False Icario is not HITRUST certified,
What is False.
True or False Enrollees must receive the SAME reward for completing the SAME activity, regardless of whether or not they have been compliant with the activity in the past.
What is True.
This is a set of guidelines that outlines ethical conduct for all employees. All employees are required to read and attest to this document. What is______?
What is Code of Conduct
This role is required by the privacy rules effective April 14, 2003, and helps to ensure that privacy of health information is being protected at the organization.
What is the Privacy Officer
An intentional deception, false statement or misrepresentation made by a person with the knowledge that the deception could result in unauthorized benefit to oneself or another person.
What is Fraud.
Security incidents, actual, or suspected need to be reported immediately to___.
What is the Information Security Officer, Privacy Officer and your manager.
Which activities may Icario not reward:
A. Activation, Health outcomes, or federally mandated survey, or Medicare Part D benefits
B. Health activities and HRA's
C. Choosing an appropriate care setting
What is A. Activation, Health outcomes, or federally mandated survey, or Medicare Part D benefits.
Is a formal review of compliance against a particular set of standards (e.g. policies and procedures, laws, regulations. What is___.
What is Audit
What does PII stand for?
What is Personal Identifiable Information
Overusing services or other practices that directly or indirectly result in unnecessary costs to any health care benefit program
What is Waste.
This is another name for unsolicited e-mail messages?
What is spam.
True or False Icario may reward for completion of health care activities.
What is True.
Icario must comply with this government agency's regulations set forth in its Medicare program.
What is CMS
What Act widens the scope of privacy and security protections available under HIPAA.
A. HIHS (Health, Information and Human Services)
B. HTIS (Health Technology Innovation Services)
C. HITECH (Health Information Technology for Economic and Clinical Health)
What is C. HITECH (Health Information Technology for Economic and Clinical Health
Actions that directly or indirectly result in unnecessary costs to Medicare or Medicaid. Involves paying for items or services inappropriately, but not intentionally.
What is Abuse.
True or False. Compliance and Security Privacy applies only to Icario full-time employees.
What is False.
Digital- based programs are allowed, but must provide an ______ of earning or claiming rewards.
What is Alternative Method.