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 things that count as PHI
What are name, telephone number, social security number, address (3 digits of zip code), or client ID?
What goes in the subject line of an email message containing PHI?
The word [secure]
Special consideration must be given to release PHI involving ______ (name one of four). A general consent is not sufficient.
Substance use, Psychiatric service, Communicable diseases (e.g., TB, STDs), HIV information
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?
The privacy officer for Terros.
Who is Sherry Henson?
Terros' 3 core values.
What are Integrity, Compassion, Empowerment?
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?
2 types of audits at Terros
What is internal audit and external audit?
The _______ Rule establishes a set of national standards for the protection of PHI. It addresses the use and disclosure of PHI.
What is the Privacy Rule?
Medical necessity is demonstrated in the assessment. The assessment is coupled with the treatment plan. The treatment plan flows into the service delivery, and the results of this are documented in the record.
The Golden Thread
Paper ROIs require client ______ and _______.
What are initials and signatures?
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)?
Duty to Warn, Audits & Evaluation, Child or Adult Abuse or Neglect, Public Health, Secretary of Health and Human Services, Coordination of Care, and Payment for Services, are examples of ______.
Releases of PHI permitted without the patient's consent.
The client rights violation involved, when a therapist offers to pay a client, who used to paint houses, $500 to paint his house, when the client reported needing $500 or he would lose his housing.
Exploitation
With regard to medical records, the rule that says to only answer the question being asked, and answer the question as specifically as possible
What is Minimum Necessary?
One of the companies that provide Terros with external audits.
What is Mercy Care, ADHS/DBHS, CMS (Medicare/ Medicaid), DCS, or 3rd Party Payor?
HIPAA is an acronym for _______.
What is Health Insurance Portability and Accountability Act?
•Foundation for the company culture.
•Set basic requirements for how we do business.
•Link between Terros Health’s Values and Vision and the everyday actions and behaviors.
•Help to create an environment where we can do our best work and be proud of that work
What are the Guiding Principles?
The two parts that comprise a service
What are the actual service and the documentation about the service?