COMPLIANCE PROGRAM
ELEMENTS
ELEMENTS
Knowingly billing for services at a level of complexity higher than services actually provided or documented in the medical records
What is Medicare/Medicaid fraud, waste, and abuse?
Protects personal health information and our rights with respect to that information and prevents fraud abuse
What is HIPAA
Agency on Aging
Center for Independent Living
Aging and Disability Resource Center
What are Federally-funded and state-funded entities?
Limits the collection of information about individuals to that which is legally relevant and necessary
What is the Privacy Act
Prohibits physicians from referring Medicare patients for designated health care services to entities with which they have direct or indirect financial relationship
What is Stark Law
Fax cover sheets, technical security measures, encryption software and changing passwords.
What are Information Security Measures?
The patient’s needs cannot be met by the person providing services
The elderly individual’s health is improved sufficiently
What are reasons that warrant discharge from agency
Patient name, DOB, address, telephone number, social security number, diagnosis
What is PHI?
Prohibits knowingly filing a false or fraudulent claim for payment to the government.
What is False Claims Act
Fine of $50,000 and up to one year in jail
What Is fine for a violation of the HIPAA laws?
Use is authorized only with written order by a physician
What is use of physical or chemical restraints?
When a hospital visitor overhears a doctor’s confidential conversation with a nurse or glimpse a patient’s information on a sign-in sheet.
What is incidental disclosures?
Unlawful to give or receive anything of value to another in exchange for a referral or inducement to provide health care services to Medicare or Medicaid.Gloves must be worn at all times when?
What is Anti-Kickback Statute
Doctors, Clinics, Psychologist, Dentists, Chiropractors, Nursing Homes, Home Health Agencies, Pharmacies
Who are people that must Comply with HIPAA Rules?
Answer: Patient’s home folder
What is where the patient can find information about their rights?
The Privacy Rule allows you to share information with whom even without patient consent?
Healthcare professionals involved in the patient's care
All employees must disclose this at the time of hire
What is Conflict Of Interest
What is my responsibility under HIPAA
When can patient refuse care
What is in advance of and during treatment
● Use a password or other user authentication
● Install and enable encryption
● Install and activate remote wiping or remote disabling
● Disable and don’t install or use file sharing applications
These are examples of?
What is Securing Health Information When Using a Mobile Device