Chapter 5 - External Forces: Regulatory and Accreditation Influences Flashcards
Compliance
P. 125
Adherence to rules – for instance, regulations and standards; also refers to the culture of an organization to provide high-quality, cost-effective, efficient healthcare that operates within the requirements of regulatory, accreditation, and other requirements.
Covered entity
P. 131
Any healthcare provider or contractor that transmits in electronic form any individually identifiable health information.
Clearinghouse
P. 131
An organization or entity public or private that processes data into a standardized billing format and checks for inconsistencies or other errors in the claims data.
Business associate
P. 131
An individual or organization with which a covered entity contract to perform functions or duties that involve the use or disclosure of individually identifiable health information.
Individually identifiable health information
P. 131
Data that identify a patient, such as name, address, date of birth, and gender.
Privacy
P. 131
The right to be left alone and to expect that one’s health information is available only to those who have a need to access it.
Protected health information (PHI)
P. 131
Any piece of data that identifies a patient as well as the clinical data tied to the patient.
Notice of privacy practices (NPP)
P. 131
Written notification, which must be signed by the patient/legal representative, that communicates how PHI is used, disclosures made without the need for authorization, the patient’s rights regarding PHI, the persons to whom PHI may be released, and the covered entity’s legal duties with respect to that information.
Security rule
P. 132
The HIPAA rule that protect PHI through standard procedures and methods of storage, access, and transmission, as well as through auditing for security breaches.
National provider identifier (NPI) number
P. 132
A unique 10-digit number that identifies each care provider on all administrative or financial transactions – for instance, claim forms.
Health Plan identifier (HPID)
P. 132
Unique identifier assigned to every health plan that controls its own business activities, actions, or policies or that is controlled by entities that are not health plans; the effective dates for use of the HPID are November 5, 2014, for large plans and November 5, 2015, for small plans.
Omnibus Final Rule to the HITECH Act
P. 134
Legislation that updates and clarifies the requirements in the HITECH Act.
Accounting of disclosures
P. 135
A listing of all disclosures of a patient’s PHI, including those for treatment, payment, and healthcare operations.
Deemed status
P. 137
By virtue of achieving accreditation status, a facility is also in compliance with the CoP.
Critical access Hospital (CAH)
P. 137
A hospital that has no more than 25 impatient beds; maintains an annual average length of stay of 96 hours or less for acute inpatient care; offers 24-hour seven-day-a-week emergency care; and is located in a rural area at least 35 miles’ drive away from any other hospital or other Critical Access Hospital; the CoP regulations for CAHs differ from those for Hospitals that are not CAHs.
