Regulatory and Privacy
This federal law protects patient health information and sets rules for who can access it.
What is HIPAA (Health Insurance Portability and Accountability Act)?
This refers to following proper medical standards when caring for patients, including staying within your training and license.
What is Scope of Practice?
This process involves reviewing documentation, billing, or operations to ensure rules and policies are being followed.
What is an Audit?
This term describes information that can identify a patient, such as name, DOB, or medical record number.
What is Protected Health Information (PHI)?
This type of supervision requires the provider to be physically present in the office and immediately available when clinical staff are assisting them.
What is Direct Supervision?
This common audit method uses a small sample of records to identify patterns or potential risks without reviewing every case.
What is Sampling?
Accessing a patient’s medical record without a work-related reason—even if you don’t share it—is considered this type of violation.
What is an Unauthorized Access (or Privacy Violation)?
Performing duties that require independent medical decision-making without proper licensure or supervision may expose the organization to this major regulatory risk.
What is Practicing Medicine Without a License (or Improper Delegation)?
When errors identified in an audit are projected across a larger population of claims to estimate financial impact, this is called:
What is Statistical Extrapolation?