Fraud, Waste, Abuse
Over-utilization or inappropriate utilization of services, misuse of resources, or practices that result in unnecessary costs to the Medicaid Program.
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 with ____________ first
What is supervisor and/or privacy officer?
Set of basic requirements for how we do business, anchored in Terros Health values, and help to create an environment where we can do our best work and be proud of that work.
What are Terros Health Guiding Principles?
The name of Terros' Privacy Officer.
Who is Sherry Henson?
Provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards.
What is Abuse?
Access to their record including an electronic copy, request to amend their record, an accounting of who has viewed their record, or confidential communication?
What are client rights?
The agency to whom Terros provides an annual report of any HIPAA breaches.
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?
The 2 types of audits conducted at Terros
What is internal audit and external audit?
Duty to Warn, Audits & Evaluation, Child/Adult Abuse or Neglect, Public Health, Secretary of Health and Human Services, Coordination of Care, Payment for Services are examples.
What are examples of when Terros can release PHI without a consent?
The notification location for 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 signatures?
Integrity, Values, Respect for Diversity, Doing what is right, Appropriate Boundaries, Fairness, Confidentiality, Empowerment, Compassion, 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 rule which addresses the use and disclosure of individuals’ PHI - as well the individuals' rights to understand and control how their health information is used.
What is the Privacy Rule?
The notification locations for breaches involving 500 or more clients.
What are a notice to “prominent media outlets” and the Department of Health & Human Services (HHS)?
Rule that says to only answer the question being asked, and answer the question as specifically as possible
What is the Minimum Necessary Rule?
The assessment is the basis for the treatment plan, which flows into the service delivery and outcome, which is documented in the notes.
What is the Golden Thread?
An agency which provides Terros with external audits
What is MMIC, ADHS/DBHS, CMS (Medicare/ Medicaid), DCS, or 3rd Party Payor?
HIPAA is an acronym for
What is Health Insurance Portability and Accountability Act?
What goes in the email subject line of a message containing PHI?
What is [Secure]?
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?