test Flashcards
(36 cards)
Service that is reasonable and necessary for the treatment of the patient’s illness
medical necessity
Money paid for work or a service
remuneration
Includes specifications for quality control, quality assurance, patient test management, and personnel and proficiency testing
Clinical lab improvement act
An intentionally deceptive action designed to provide the perpetrator with an unlawful gain or to deny a right to a victim
fraud
fine
A monetary penalty imposed in criminal matters
requisition
An order for a specific laboratory service or test
medicare
The federal health insurance program for: people who are 65 or older, certain younger people with disabilities, people with End-Stage Renal Disease
protected health information
considered to be individually identifiable info relating to the past, present, or future health status of an individual
release of info
process of providing access to protected health info to a person or entity authorized to receive/review it
compliance
formalized monitoring of an organization’s adherance to laws and regulations
confidentiality
the state of keeping of being kept secret or private
double billing
to charge different accounts for the same expenses
medicaid
a public health insurance program in the US that provides health care coverage to low-income families/individuals
invasive procedure
when skin or mucous membranes and connective tissues are incised, or an instrument is sliced through a natural body orifice
best practices
the most efficient & effective way of accomplishing a task, process, or activity. known to produce good outcomes if followed.
tort
an act/omission that gives rise to injury or harm to another & amounts to a civil wrong for which courts impose liability
private health insurance
medical coverage purchased directly by an individual
anti-kickback law
prohibits the knowing & willful payment or offer of any remuneration directly or indirectly in return for inducing, referring, or soliciting services, including laboratory testing paid for by a federal health program
syncope
temporary loss of consciousness (fainting)
stark law
forbids a physician from referring a sample to a laboratory if the physician or an immediate family member has a financial interest
upcoding
to assign an inaccurate billing code to a medical procedure/treatment to increase reimbursement
ICD-10
list of diagnosis codes for illnesses
false claims act
prohibits knowingly presenting a false claim to the gov’t
current procedural terminology
manual listing a coding of procedures & services performed by physicians
