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24 Cards in this Set

  • Front
  • Back

griswoldvs conneticut

patients possescertain rights that affectt delivery of medical services

first amendment


third amendmnt

freedom of speech




not to be quatered in thier own home as a soilder

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.

14th amend



equal rights \

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

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

covered transactions

electronic exchanges between tow covered using HIPP transaction standards


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

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.

protected heatlth info PHI

information that contains one or more of patient identifiers.

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.

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.

HIPPA rules
Health insu. Portibility and acountability
act

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


limited data set

certian identidiers have been removed

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

state laws HIPPA

COMPIENCES and procedures must be conssitaant state and federal laws.

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



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.

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.

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.

contros HIPPA


WATCH DOG


Centers for Medicare and medicade



COMPLAIN to CMS

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

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.

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