HIPAA

Question 1

Protects Privacy and Security of Certain Health info

Answer 1

HIPAA

Question 2

Establishes national standards for protection of certain health info

Answer 2

Privacy Rule

Question 3

Establish a nation set of security standards for protecting certain health info held or transferred in electronic form

Answer 3

Security Rule

Question 4

A person that performs certain Fx or activities that involve use or disclosure of protected health info on behalf of/provides services to entity

Answer 4

Business associate.

Question 5

Business associates may include

Answer 5

claims, data analysis, billing.

Question 6

Individually identifiable health info.

what does this include

Answer 6

Protected health information

Demographics.

Question 7

When is Pt authorization not required for disclosure of PHI

Answer 7

needed for Tx
for family/friends involved in care
to insure public health/safety
prevent danger
disclosure in facility directories.

Question 8

An adequate privacy notice includes

Answer 8

heading
statement of uses/ rights/ entity’s duties
explanation of how to complain
contact information.

Question 9

e-PHI not available or disclosed to unauthorized

Answer 9

Confidentiality.

Question 10

Requires HIPAA covered entities to provide notification following a breach of unsecured protect health Info.

Answer 10

Breach notification rule.

Question 11

impermissible use or disclosure under privacy rules that compromises security of PHI

Answer 11

Breach.

Question 12

HIPAA considerations for PT Practice

Answer 12

Patient identification
Eval Procedure
Sign in/out
Physical layout of facility
computer security

Question 13

Penalty for violating HIPAA

Answer 13

civil (fines)
or
criminal sanction (jail)

Question 14

Causes of improper payment

Answer 14

incorrect documentation/coding

not justifying services

Question 15

How is fraud prevented

Answer 15

gov targets ppl by using profiling techniques.

Question 16

Knowingly performing something wrong

Answer 16

fraud

Question 17

inadvertent mistake

Answer 17

abuse

Question 18

Documenting that you did something that you didnt do or omitting something
that you did do that would support payment

Answer 18

false claims act

Question 19

Cant pay other HCP or business for patient referrals (payment in
exchange for referrals)

Answer 19

Anti-kickback Statute

Question 20

(For physicians); cant profit from a business that they have

an ownership in) (ex. Cant profit if they perform more MRIs or prescribe more meds)

Answer 20

Physician Self-referral law

Question 21

Imposed penalties for fraud

Answer 21

Criminal health care fraud statute

Question 22

Alerting a higher authority about something fraudulent being performed
(protects the person who blows the whistle against retaliation)

Answer 22

Whistle blower statute

Question 23

compliance officer whos job is to ensure that you are following the rules

Answer 23

compliance program

Question 24

Top compliance issues in PT

Answer 24

Documentation/payment rules

Question 25

who gives PT services that can be billed in medicare

Answer 25

PT/PTA/Physician/NPPs

Question 26

Physician can bill PT services incident to their scope of practice (physicians are legally entitled to
bill the services provided by individuals-PT/PTA)

Answer 26

incident to

Question 27

What types of payment for referrals is acceptable under Medicare?

Answer 27

Any kind of equitable sharing of profits that come out of patient referral