Fraud, Waste, Abuse
Overutilization of services- generally not considered to be caused by criminally negligent actions but rather a misuse of resources, mismanagement, inappropriate actions and inadequate oversight
What is Waste?
2 examples of PHI
What are name, telephone number, social security number, address (3 digits of zip code), or client ID?
If a potential breach is identified, staff discuss this with ____________ first.
What is supervisor and/or privacy officer?
A person's access to their medical record, an accounting of who has viewed their record, and the ability to request the mode of communication that we use with them are examples of _____ _____.
What are client rights?
The Vice President of Compliance and Internal Audit and the Privacy Officer.
Who is Sherry Henson?
Payment for items or services when there is no legal entitlement to that payment, and the healthcare provider has not knowingly and/or intentionally misrepresented facts to obtain payment
What is Abuse?
A client has the right to ________, with regard to their medical record.
What is access their record including an electronic copy, request to amend their record, an accounting of who has viewed their record, or confidential communication?
Terros provides an annual report of any HIPAA breaches to this agency.
What is the Department of Health & Human Services (HHS)?
The name of the policy that says we provide a place for staff to internally report possible unlawful, discriminatory, or dishonest conduct without fear of retaliation.
What is the Whistleblower Policy?
Terros' 3 core values
What are Integrity, Compassion, Empowerment?
2 types of the audits that happen at Terros
What is internal audit and external audit?
An example of a release of client information, which does not need a consent.
What is:
Duty to Warn, Audits & Evaluation, Child or Adult Abuse or Neglect, Public Health, Secretary of Health and Human Services, Coordination of Care, or Payment for Services
Required notification location for HIPAA breaches involving ten or more clients where the client(s) could not be reached for notification...
What is a conspicuous website posting or notice in major print or broadcast media?
Paper ROIs require client ______ and _______.
What are initials and signature?
Integrity, values, respect for diversity, doing what is right, fairness, confidentiality, empowerment, compassion, and responsibility.
What are Ethics?
Name of the Office that audits states and agencies that provide behavioral health services and who are paid with federal (Title XIX =Medicaid=AHCCCS) dollars.
What is Office of the Inspector General (OIG)?
The Privacy Rule address the use and disclosure of individuals’ _________
What is Protected Health Information (PHI)?
Required notification locations and agency for HIPAA breaches involving 500 or more clients
What is are “prominent media outlets” and the Department of Health & Human Services (HHS)?
Rule that says to only answer the question being asked and to answer the question as specifically as possible.
What is Minimum Necessary?
The assessment provides the basis for the treatment plan, which is connected to the service, which is connected to the outcome and documentation.
What is the Golden Thread?
One of the agencies/companies that conducts external audits for Terros.
What is MMIC, ADHS/DBHS, CMS (Medicare/ Medicaid), DCS, or 3rd Party Payor?
HIPAA is an acronym for this law.
What is Health Insurance Portability and Accountability Act?
It goes in the subject line of an email containing PHI to a non-Terros email address.
What is the word [Secure] in square brackets?
The two parts that comprise a service
What are the actual service and the documentation about the service?
Year that Terros was created
What is 1969?