Rules & Regulations
The document notifying an individual of a breach
What is breach notification?
The key to receiving coverage and payment from a payer
What is a medical necessity?
The American Health Information Management Association (AIHMA) awards these types of certifications
What is Certified Coding Specialist (CCS) and Certified Coding Specialist–Physician-based (CCS-P)?
An intentional deception or misrepresentation of fact that can result in unauthorized benefit or payment
Fraud
The entity in which to report fraud for investigation
What is the Office of Inspector General (OIG)?
Regulate(s) the use and disclosure of patients' protected health information
What is the HIPAA Privacy Rule?
Higher copayments may be charged for patient visits
What is a specialists' office?
Most important characteristic a medical insurance specialist to possess
What is professionalism?
Actions that are improper, inappropriate, or outside acceptable standards of professional conduct or medically unnecessary
What is abuse?
AKA Professional Liability Insurance
What is Medical Malpractice Insurance?
To take reasonable safeguards to protect PHI
What is the minimum necessary standard?
PPO members who use out-of-network providers may be subjected to
What are higher copayments?
A computerized lifelong health care record for an individual that incorporates data from all sources
What is electronic health record (EHR)?
This law prohibits physicians from referring patients for certain designated health services paid for by Medicare to any entity in which they have a “financial relationship"
What is the Stark Law?
An individual's right to keep healthcare information from being disclosed to others
What is privacy?
Under HIPAA, an organization that electronically transmits patients' protected health information
What is a covered entity?
The part of the revenue cycle in which you are verifying insurance
What is Step 2? (establish financial responsibility for the visit)
Courteous treatment of patients who visit the medical practice
What is etiquette?
PROTECTS FEDERAL HEALTHCARE PROGRAMS FROM FRAUD AND ABUSE BY HEALTHCARE PROVDERS WHO SOLICIT REFERRALS
What is the anti-kickback statute?
The maximum time that a debt can be collected from the time it was incurred or became due
What is statue of limitations?
A list of outstanding bills and for how long a period each has not been paid
What is a patient aging report?
The provider receives reimbursement directly from payer
What are assignment of benefits?
Awarded by the American Academy of Professional Coders (AAPC)
What is Certified Professional Coder (CPC)?
The federal law that governs debt collection practices; prohibits debt collection companies from using abusive, unfair or deceptive practices to collect debts
What is the Fair Debt Collection Practices Act (FDCPA)?
The standard paper claim form used by health care professionals
What is CMS-1500?