Medical Billing Chapter 5 Key Terms

National standards to protect individuals' medical records and personal health information.

Private information shared between a patient and health care provider.

<p>Hospital-specific administrative claims data.</p> Signup and view all the answers

<p>Information identifiable to an individual, such as name, address, or Social Security Number.</p> Signup and view all the answers

<p>A provision of the False Claims Act allowing a private citizen to sue for fraud.</p> Signup and view all the answers

<p>To store documentation for an established period mandated by law.</p> Signup and view all the answers

<p>A program to find and correct improper Medicare payments.</p> Signup and view all the answers

<p>Guidelines written by administrative agencies.</p> Signup and view all the answers

<p>The patient or representative must sign an authorization.</p> Signup and view all the answers

<p>To document patient information released to authorized requestors.</p> Signup and view all the answers

<p>Provides payments to health plans attracting higher-risk enrollees.</p> Signup and view all the answers

<p>Transfers funds from health plans with lower risk enrollees to those with higher risk.</p> Signup and view all the answers

<p>Controlling access and protecting patient information from alteration or loss.</p> Signup and view all the answers

<p>Health information collected or transmitted electronically.</p> Signup and view all the answers

<p>Physicians' conflicts of interest when referring Medicare patients.</p> Signup and view all the answers

<p>Laws passed by legislative bodies.</p> Signup and view all the answers

<p>An order of the court requiring a witness to appear to testify.</p> Signup and view all the answers

<p>Production of documents required for the court.</p> Signup and view all the answers

<p>The Hospital Outpatient Quality Reporting Program.</p> Signup and view all the answers

<p>To bill for institutional services.</p> Signup and view all the answers

<p>Computer code that creates an encrypted electronic signature.</p> Signup and view all the answers

<p>Illegally assigning a diagnosis code to increase reimbursement.</p> Signup and view all the answers

<p>An individual who discloses misuse of public funds.</p> Signup and view all the answers

<p>A program that reviews billing trends for Medicare services.</p> Signup and view all the answers

<p>Actions inconsistent with accepted, sound medical, business, or fiscal practices.</p> Signup and view all the answers

<p>Electronic format supported for health care claim transactions.</p> Signup and view all the answers

<p>Objective evaluation to determine the accuracy of submitted financial statements.</p> Signup and view all the answers

<p>Document that provides official instruction for the use or disclosure of protected health information.</p> Signup and view all the answers

<p>Nonpublished code edits that were discontinued in 2000.</p> Signup and view all the answers

<p>Unauthorized release of patient information to a third party.</p> Signup and view all the answers

<p>Also called common law; based on a court decision that establishes a precedent.</p> Signup and view all the answers

<p>One-digit character, alphabetic or numeric, used to verify the validity of a unique identifier.</p> Signup and view all the answers

<p>Area of law not classified as criminal.</p> Signup and view all the answers

<p>Requests and screens medical records for payment error prevention.</p> Signup and view all the answers

<p>Includes program issuances and operating instructions for CMS programs.</p> Signup and view all the answers

<p>Provides information about regulations and major policies related to CMS programs.</p> Signup and view all the answers

<p>Also called case law; based on a court decision that establishes a precedent.</p> Signup and view all the answers

<p>Internal policies and procedures that an organization follows to meet mandated requirements.</p> Signup and view all the answers

<p>Assesses and measures improper Medicare fee-for-service payments.</p> Signup and view all the answers

<p>Health and safety regulations health care organizations must meet to participate in Medicare and Medicaid.</p> Signup and view all the answers

<p>Health and safety regulations health care organizations must meet to participate in programs.</p> Signup and view all the answers

<p>Restricting patient information access to those with proper authorization.</p> Signup and view all the answers

<p>Public law governed by statute or ordinance that deals with crimes.</p> Signup and view all the answers

<p>Medical code set maintained and copyrighted by the American Dental Association.</p> Signup and view all the answers

<p>To decode an encoded computer file so that it can be viewed.</p> Signup and view all the answers

<p>Recognition of accreditation organization standards that meet or exceed requirements.</p> Signup and view all the answers

<p>Medicaid Integrity Program (MIP) to combat abuse, fraud, and waste.</p> Signup and view all the answers

<p>Legal proceeding during which a party answers questions under oath.</p> Signup and view all the answers

<p>Application of a mathematical function to create a computer code.</p> Signup and view all the answers

<p>Tools that help measure and track the quality of healthcare services.</p> Signup and view all the answers

<p>A uniform language for electronic data interchange.</p> Signup and view all the answers

<p>To convert information to a secure language format for transmission.</p> Signup and view all the answers

<p>Passed to regulate fraud associated with military contractors during the Civil War.</p> Signup and view all the answers

<p>Medicare administrative contractors to attempt collection of overpayments.</p> Signup and view all the answers

<p>Legal newspaper published every business day by the National Archives.</p> Signup and view all the answers

<p>Data analysis tool for administrative hospital and state-specific data.</p> Signup and view all the answers

<p>Intentional deception or misrepresentation that could result in unauthorized payment.</p> Signup and view all the answers

<p>A team that conducts training among investigators and analysts to combat fraud.</p> Signup and view all the answers

<p>Requires CMS to reduce payments to hospitals with excess readmissions.</p> Signup and view all the answers

<p>Program requiring hospitals to submit quality measures data for Medicare beneficiaries.</p> Signup and view all the answers

<p>Pay for quality data reporting program for outpatient hospital services.</p> Signup and view all the answers

<p>Measures, monitors, and reduces the incidence of Medicare fee-for-service payment errors.</p> Signup and view all the answers

<p>Measures that promote better clinical outcomes and patient experiences of care.</p> Signup and view all the answers

<p>Payment Error Rate Measurement (PERM) program to measure improper payments.</p> Signup and view all the answers

<p>Document containing a list of questions that must be answered in writing.</p> Signup and view all the answers

<p>Subscriber-based question-and-answer forum available through email.</p> Signup and view all the answers

<p>Entities that review provider claims and identify overpayments.</p> Signup and view all the answers

<p>To combat fraud, waste, and abuse in the Medicaid program.</p> Signup and view all the answers

<p>Using another person's information to submit false bills in a medical setting.</p> Signup and view all the answers

<p>Review of claims to determine if services provided are reasonable and necessary.</p> Signup and view all the answers

<p>Organization that contracts with CMS to process claims for Medicare.</p> Signup and view all the answers

<p>Implemented in 2011 to assist with anti-fraud and audit efforts.</p> Signup and view all the answers

<p>Program that authorizes CMS to conduct audits and anti-fraud activities.</p> Signup and view all the answers

<p>Created to improve care quality while reducing unnecessary costs.</p> Signup and view all the answers

<p>Determines Medicare payment adjustments based on a composite performance score.</p> Signup and view all the answers

<p>Representation of text as a single string of digits for electronic signatures.</p> Signup and view all the answers

<p>Identifies prescription drugs and some over-the-counter products.</p> Signup and view all the answers

<p>Unique identifier to be assigned to patients, currently put on hold.</p> Signup and view all the answers

<p>Developed to assign unique identifiers to healthcare providers.</p> Signup and view all the answers

<p>Improves healthcare quality by identifying and disciplining unprofessional behavior.</p> Signup and view all the answers

<p>Unique identifier assigned to healthcare providers as a 10-digit numeric identifier.</p> Signup and view all the answers

<p>Unique identifier assigned to employers for health insurance purposes.</p> Signup and view all the answers

<p>Flat-file format used to bill provider and noninstitutional services.</p> Signup and view all the answers

<p>Funds received in excess of amounts due under Medicare and Medicaid statutes.</p> Signup and view all the answers

<p>Another term for Medicare administrative contractor.</p> Signup and view all the answers

<p>Amends Title IX of the Public Health Service Act for improved patient safety.</p> Signup and view all the answers

<p>Required facilities to identify and reduce improper Medicare payments.</p> Signup and view all the answers

<p>Number of dollars paid in error out of total dollars for inpatient services.</p> Signup and view all the answers

<p>Measures improper payments in Medicaid and CHIP.</p> Signup and view all the answers

<p>Also known as Stark I.</p> Signup and view all the answers

<p>Examines billing practices of physicians and compliance with rules.</p> Signup and view all the answers

<p>Standard established by previous court decisions.</p> Signup and view all the answers

<p>Right of individuals to keep their information from being disclosed.</p> Signup and view all the answers