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24 Cards in this Set
- Front
- Back
griswoldvs conneticut |
patients possescertain rights that affectt delivery of medical services |
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first amendment third amendmnt |
freedom of speech not to be quatered in thier own home as a soilder |
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fourth amdment 5th |
right to be secure in your own home against unreasonable seraches the miranda righ was derived from this amenment no one should be subjected to same offence twice. be deprived of life liberty without due process law. |
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14th amend |
equal rights \ |
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hippa in 1996 |
federal law passed to protect privacy and other health care rights for patients helps keep continuous health care insu. for selves and dependents when they change jobs help cost from rising |
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covered entities |
health care providers and clearing houses that transmit hi[[a transactions electonically and must comply with HIPPA standards and rules patiens are not coverd entitiesany physcian or health care practioner no matter how small that files an electronic claim is a covered entitiy and must use HIPPA code set standards |
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covered transactions |
electronic exchanges between tow covered using HIPP transaction standards |
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designated record notice of privacy practice NPP |
records maintained by or for a HIPPA covered entity a written document detailing a health care providrs privacy practices |
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hitech Health information tech. for economic and clinic help |
HITECH enhanced the enforcement of HIPAA and extended provisions of HIPAA to business associates. HITECH was enacted in 2009 as part of the American Recovery and Reinvestment Act to promote the adoption of health information technology. This added more technical requirements to hospitals and doctors who were using electronic health records. A section of HITECH also improved provisions of HIPAA.
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protected heatlth info PHI |
information that contains one or more of patient identifiers. |
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de identify |
once a patients reords has been de identified it can be shareed meaning stipping the record from name social, address from personal info. |
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treatment payment and heath care operations TPO |
quilifed providers disclosure of PHI to obtain reimbusment and activites and transactions health care operations meaning refered to HIPPA aproved activites and transactions. |
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HIPPA rules |
contains four sets of standards code sets terms that provide for uniforally meaning can be read easier of billing and reord keeping.
Privacy rule must have permission to share to types of permission representitives from hhs and also to patient 11 permisions
standard is general requirment rule is a document that incudes the standards
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limited data set |
certian identidiers have been removed |
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hippa rule standards coninued |
3 security rule under hippa to protect patient info using prodeures such as security officer ,passwords,risk assesment etc 4 national identifiers standards proved unique identifiers for electronic transmissions |
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state laws HIPPA |
COMPIENCES and procedures must be conssitaant state and federal laws. |
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patient rights |
acces to medical recods and the right to copy them request for amendment to desinate record set rewuest to be contacted at an alternative location request for further restictions on who has acess tp PHI right to file a complaint |
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EMATALA the emergency medical treatment and active labor act |
The Emergency Medical Treatment and Active Labor Act (EMTALA), also known as the “Patient Anti-Dumping” statute, is a Federal statute intended to prevent Medicare-participating hospitals with dedicated emergency departments from refusing to treat people based on their insurance status or ability to pay. The core objective of EMTALA is to protect patients seeking emergency care who might otherwise go untreated and be left without a remedy. Although EMTALA’s focus is upon preventing disparate treatment of patients who cannot pay for treatment, EMTALA applies to all patients whether or not eligible for Medicare benefits. (42 U.S.C. § 1395dd(a)). The specific requirements of the statute are detailed in regulations that have been the subject of frequent regulatory action and court decisions.
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false claims act |
The False Claims Act (31 U.S.C. §§ 3729–3733, also called the "Lincoln Law") is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal Government's primary tool in combating fraud against the Government.
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anti kick back law |
he federal Anti-Kickback Statute (“Anti-Kickback Statute”) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal health care program business. See 42 U.S.C. § 1320a-7b. The Anti-Kickback Statute is broadly drafted and establishes penalties for individuals and entities on both sides of the prohibited transaction. Conviction for a single violation under the Anti-Kickback Statute may result in a fine of up to $25,000 and imprisonment for up to five (5) years. See 42 U.S.C. § 1320a-7b(b). In addition, conviction results in mandatory exclusion from participation in federal health care programs.
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contros HIPPA WATCH DOG Centers for Medicare and medicade |
COMPLAIN to CMS |
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stark law |
The Stark law is a limitation on certain physician referrals. It prohibits physician referrals of designated health services ("DHS") for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity. 42 U.S.C. 1395nn. A financial relationship includes ownership, investment interest, and compensation arrangements. 42 U.S.C. 1395nn(h)(5). The term “referral” is defined more broadly than merely recommending a vendor of DHS to a patient. Instead, the term “referral” means, for Medicare Part B services, “the request by a physician for the item or service” and, for all other services, “the request or establishment of a plan of care by a physician which includes the provision of the designated health service
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crininal heath care fraud statue |
State laws on healthcare fraud differ considerably. State healthcare fraud laws typically fall into one of three types; false claims laws, self-referral laws, and anti-kickback laws. Some states have laws that address all three types of activity, while others may have only one or two, and some may have none at all.
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rico |
RICO. The Racketeer Influenced and Corrupt Organizations Act ("RICO"), 18 U.S.C. 1961 et seq., recently has become quite prominent in health care fraud prosecutions, although it can serve as the basis for a civil cause of action as well. Simply because the statute appears to be directed at organized crime does not mean that it should not be reviewed by even small-scale providers
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