HIPAA skill module Flashcards
covered entity CE
a health plan, a health care clearinghouse, or a health care provider that transmits any health information in electronic form in connection with a HIPAA transaction
current procedural terminology
a medical code set maintained and copyrighted by the American Medical Association that has been selected for use under HIPAA for non-institutional and non-dental professional transactions
disclosure
release or divulgence of information by an entity to people or organizations outside of that entity
electronic data interchange EDI
the transfer of routine information or transactions from one computer to another in a standard format, using standard communications protocols
health information
any information, whether oral or recorded in any form or medium, that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse and relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual
HIPAA written authorization
a document that must be signed by a patient, explains the uses and disclosures a covered entity may make without the individual’s authorization as permitted by the Privacy Rule, and states that any other uses or disclosures will be made only with the individual’s written authorization
individual identifiable health information
information transmitted or maintained in any form or medium, which is held by a covered entity or its business associate, and that identifies an individual or offers a reasonable basis for identification; is created or received by a covered entity or an employer; relates to a past, present, or future physical or mental condition, provision of health care, or payment for health care
informed consent
a person’s agreement to allow an action, such as surgery or an invasive diagnostic procedure, based on full disclosure of risks, benefits, alternatives, and consequences of refusal; patient must be informed of the risks, benefits, and alternative treatments that may be available, and risks associated with refusing the proposed procedure
International Classification of Diseases ICD
a medical code set, with CM indicating “clinical modification” and PCS indicating “procedure coding system,” maintained by the World Health Organization (WHO), the primary purpose of which is to classify causes of death; a U.S. extension, maintained by the NCHS within the CDC, identifies morbidity factors, or diagnoses; the ICD-10-CM codes have been selected for use in the HIPAA transactions
Joint Commission
an organization that accredits health care organizations; in the future, the Joint Commission may play a role in certifying these organizations’ compliance with the HIPAA A/S requirements
National Drug Code NDC
a medical code set maintained by the Food and Drug Administration that contains codes for drugs that are FDA-approved; the Secretary of HHS adopted this code set as the standard for reporting drugs and biologics on standard transactions
National Payer ID
a system for uniquely identifying all organizations that pay for health care services, also known as Health Plan ID, or Plan ID
National Provider ID NPI
a system for uniquely identifying all providers of health care services, supplies, and equipment
privacy officer
a person appointed to receive and be responsible for complaints about privacy policies and procedures required by HIPAA’s Privacy Rule
protected health information
information transmitted or maintained in any form or medium, which is held by a covered entity or its business associate, and that identifies an individual or offers a reasonable basis for identification; is created or received by a covered entity or an employer; relates to a past, present, or future physical or mental condition, provision of health care, or payment for health care
