Compliance and Risk
This agreement, which often follows an investigation into alleged fraud, requires the company to implement a series of strict compliance obligations over a five-year period to avoid exclusion from federal healthcare programs like Medicare and Medicaid
Corporate Integrity Agreement (CIA)
Specify that Secure Billing Services can only use the PHI for the purposes of billing and claims processing on behalf of the doctor's office.
Business Associate Agreement
A patient, Mr. Robinson is seen at his local HealthTrust primary care clinic for a routine check-up. The provider documents the visit in the central EHR. A few weeks later, Mr. Jones has a sudden medical emergency and is admitted to the main HealthTrust hospital, which is 30 miles away.
Central Model
a query to the HIE, including Alex's name, date of birth, and other demographic information.
Record locator service (RLS)
The hospital's billing department submits a claim to Medicare using a code for a comprehensive physical exam with additional, medically unnecessary tests that were never performed. This inflates the reimbursement amount.
FCA
Aperson, organization, or agency that is subject to the rules of the Health Insurance Portability and Accountability Act (HIPAA) because they handle Protected Health Information (PHI).
Covered Entity
Physician has several types of orders for a "Complete Blood Count (CBC)" and a prescription for "Amoxicillin, 500 mg, three times daily for 10 days."
CPOE
Unstructured text into structured, actionable data that can be used to improve quality of care, patient satisfaction, and public health surveillance.
Text mining
A plan to audit hospitals to see if they are billing for the correct level of E/M services. This is because upcoding (billing for a more expensive service than provided) is a common form of fraud. The plan would specify that they will analyze billing data to identify any unusual patterns.
Office Inspection General (OIG)
a principle that states a covered entity or business associate must make a reasonable effort to limit the use, disclosure, and request of Protected Health Information (PHI) to the minimum necessary to accomplish the intended purpose.
Minimum necessary
When Julie arrives at the emergency room, the attending physician can log into the HIE system. The system uses her identity to pull together her fragmented health information. Within seconds, the doctor can access the recent X-ray report from Carolina Imaging Center and the notes from her primary care visit at Tri-State Family Medicine.
Health Information Exchange
The front office staff member scans a paper referral form from another clinic. The scanned document is just a picture, so the computer can't "read" the text on it.
OCR
Having a direct financial relationship with the physical therapy clinic because they are owners and will profit from its services.
Stark Law Violation
To comply, the hospital has a policy where a patient can "opt-in" to have their name listed in the hospital directory and provide a password or code that they can share with family members.
Opt-In or Opt-Out
A dashboard with daily hospital news, announcements, and a staff directory.
Intranet
Scan the text and automatically identify key terms and concepts. It would recognize "hypertension" and "atrial fibrillation" as a diagnoses
Natural Language Processing (NLP)
A nurse assists a patient to the restroom. On the way back, the patient slips and falls, suffering a minor bruise.
Incident Reporting
Lab results and radiology reports, Discharge summaries, Consultation reports, X-rays and other images.
Minimum necessary
Secure messaging, prescription refills, appointments, lab results
Patient Portal
A broader, more dynamic record that can be shared with other healthcare providers, specialists, and even patients themselves. It contains Lab results from an outside lab as an example.
Electronic Health Record