MBC review

Health Insurance Portability & Accountability Act of 1996

• HIPAA
• HIPAA Title I
• HIPAA Title II
• OSHA

Insurance Reform - to provide continuous insurance coverage for workers & their dependents when they change or lose their jobs

• HIPAA
• HIPAA Title I
• HIPAA Title II
• OSHA

Administrative Simplification - to reduce costs by standardizing health-related financial and administrative activities electronically & implementation of privacy and security procedures to prevent misuse of health information

• HIPAA Title II
• HIPAA Title I
• HIPAA
• OSHA

False Claims Act - federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim

• HIPAA
• HIPAA Title I
• HIPAA Title II
• FCA

National Correct Coding Initiative - developed by CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payments

• HIPAA
• NCCI
• HIPAA Title II
• HIPAA Title I

knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits

• fraud
• abuse
• malpractice
• ethics

incidents or practices that are inconsistent with the accepted medical business or fiscal practices in the industry

• fraud
• malpractice
• abuse
• ethics

protected health information

• use of PHI for operation
• use of PHI for payment
• use of PHI for treatment
• PHI

use of patient PHI without specific authorization can only used be for treatment, payment, operation

• TPI
• TPO
• TOS
• TOP

primarily for the purpose of discussion of the patient's case with other providers

• use of PHI for operation
• use of PHI for payment
• use of PHI for treatment