Crcs-I Acronyms

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DHHS

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Department of Health and Human Services

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AFDC

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Aid to Families with Dependent Children

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NIH

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National Institutes of Health

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FDA

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Food and Drug Administration

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CDC

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Centers for Disease Control and Prevention

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ATSDR

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Agency for Toxic Substances and Disease Registry

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IHS

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Indian Health Services

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HRSA

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Health Resources and Services Administration

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SAMHSA

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Substance Abuse and Mental Health Services Administration

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AHRQ

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Agency for Healthcare Research and Quality

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CMS

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Centers for Medicare and Medicaid Services

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ACF

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Administration for Children and Families

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ACL

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Administration for Community Living

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HCFA

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Health Care Financing Administration

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QIO

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Quality Improvement Organization Program

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FOIA

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Freedom of Information Act

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PSDA

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Patient Self Determination Act

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PPACA

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Patient Protection and Affordable Care Act

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CHIP

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Children's Health Insurance Program

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DOJ

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Department of Justice

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OIG

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Office of Inspector General

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CMP

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Civil Monetary Penalties

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HEAT

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Health Care Fraud Prevention and Enforcement Action Team

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CRA

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Credit Reporting Agency

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FDCPA

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Fair Debt Collection Practices Act

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ECOA

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Equal Credit Opportunity Act

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EMTALA

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Emergency Medical Treatment and Active Labor Act

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CLIA

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Clinical Laboratory Improvement Amendment

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HSA

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Health Savings Account

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MSA

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Medical Savings Account

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TJC

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The Joint Commission

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What are the two main governing bodies affecting healthcare change?

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DHHS- Department of Health & Human Services

CMS - Centers for Medicare & Medicaid Services

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What is the federal governmnet's largest grant making agency?

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DHHS - Department of Health & Human Services

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What is called Title XVIII?

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Medicare

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What is called Title XIX

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Medicaid

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What is formerly known as HCFA?

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CMS

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Who administers the QIO program?

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CMS

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What area is required to review all written quality-of service complaints submitted by Medicare beneficiaries or their designated representatives?

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QIO (Quality Improvement Organization program)

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Also known as the Hill-Burton Act

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Hospital Survey & Construction Act & Title I.

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This act was designed to assist hospitals by providing loans for construction projects. Once the hospitals were operational, the funds that were borrowed were to be paid back in the form of charity.

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Hill Burton Act

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What are these?

*to help patients feel more confident in the U.S. healthcare system

* To stress importance of the relationship between the patient and the provider

*To stress the role that patients have to take to get and stay health

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goals of patient bill of rights

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HIPAA

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Health Insurance Portability and Accountability Act

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Also known as the Kennedy-Kassenbaum Bill

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HIPAA

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What act did congress pass to ensure that patients understood their right to participate in decisions about their own healthcare?

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PSDA - Patient Self Determination Act

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What are the 2 types of advance directives?

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* Living Will

*Healthcare power of attorney or durable power of attorney for healthcare

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Explain what a "living will" is

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a document that specifies what treatement a patient does and does not wish to receive; this decision is made when the patient is alert

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Explain what the Healthcare power of attorney advance directive is

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a document that designates someone else to make decisions on the patients behalf if he/she is unable to do so

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What act is commonly called "Obamacare"?

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Patient Protection and Affordable Care Act (PPACA)

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True or False

PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of healthcare.

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True

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The IRS proposed a regulation that became part of the PPACA that affected three areas, what are they?

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*Financial Assistance

*Charging limitations

*Collection Actions

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Consumers have various ways to learn about options available for healthcare. One of the options is thru a "Navigator". How are these Navigators funded?

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through state & federal grant programs

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Non-Navigators perform the same functions as Navigators but they only exist in a _________-______ ____________.

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State-based marketplace . They are funded through seperate grants or contracts administered by the state. The services are free to all consumers.

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The intentional or illegal deception or misrepresentation made for the purpose of personal gain, or to harm or manipulate another person or organization

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Fraud

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The misuse of a person, substance, service, or financial matter such that harm is caused

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Abuse

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What act prohibits making a false record or statement to get a false/fraudulent claim paid by the government, submission of false/fraudulent claims and conspiring to have false/fraudulent claims paid by the government?

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False Claims Act

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If CMS determines the existance of inappropriate behavor from a provider, they can give sanctions against the provider. What are the 3 sanctions that can be given?

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1. Denial or revocation of the provider number application

2. Suspension of Provider Payments

3. Application of Civil Monetary Penalties

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In certain situations, the OIG can exclude healthcare providers from participating in any healthcare program. What are the two types of exclusions?

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1. Mandatory Exclusion

2. Permissive Exclusion

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What uses government resources to help prevent fraud, waste, and abuse in both the Medicare and Medicaid Programs?

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HEAT - Health Care Fraud Prevention & Enforcement Action Team

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Also known as Regulation Z

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Truth in Lending Act

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What act requires the disclosure of annual percentage rate and finance charges before credit is extended?

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Truth in Lending Act

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What act does this fall under?

-pt must notify hospital of error within 60 days of stmnt

-hospital must respond within 30 days

-error must be corrected or explanation sent within 90 days

-if any above not met, collection of account may be forfeited

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Fair Credit Billing Act

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Title VI

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Fair Credit Reporting Act

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What act place additional requirements on the Credit Reporting Agencies?

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Fair Credit Reporting Act

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Title VIII

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Fair Debt Collection Practices Act

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What act prohibits credit discrimination on the basis of race, color, religion, national origin, sex, marital status, age or because someone receives medical assistance?

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Equal Credit Opportunity Act (ECOA)

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ALOS

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Average Length of Stay

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PCP

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Primary Care Physician

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UR

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Utilization Review

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PAT

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Pre-admission testing

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PAS

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Pre-Admission Screening

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DMS

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Diagnostic Medical Screening

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ABN

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Advance Beneficiary Notice

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LCD

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Local Coverage Determination

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NCD

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National Coverage Determination

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ICD

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International Classification of Diseases

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MSP

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Medicare Secondary Payer

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IEQ

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Initial Enrollment Questionnaire

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CWF

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Common Working File

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ADC

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Average Daily Census

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ESRD

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End Stage Renal Disease

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SNF

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Skilled Nursing Facility

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HMO

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Health Maintenance Organization

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PPO

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Preferred Provider Organization

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HICN

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Health Insurance Claim Number

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NAS

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Non-Availability Statement

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CHIP

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Children's Health Insurance program

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COB

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Coordination of Benefits

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VA

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Veterans Affairs

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WHO

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World Health Organization

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NPI

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National Provider Identification

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CPT

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Current Procedural Terminology

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HCPCS

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Healthcare Common Procedure Coding System

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E & M

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Evaluation and Management

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DRG

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Diagnosis Related Group

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APC

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Ambulatory Payment Classification

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MDC

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Major Diagnostic Categories

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MS- DRG

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The MS stands for Medicare Severity

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CAH

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Critical Access Hospital

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RUG

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Resource Utilization Group

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RBRVS

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Resource Based Relative Value Scale

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UCR

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Usual, Customary, and Reasonable

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CDM

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Charge Description Master

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CPU

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Central Processing Unit

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MCE

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Medicare Code Editor

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NCCI

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National Correct Coding Initiative

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MUE

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Medical Unlikely Edits

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CO

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Compliance Officer

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ATB

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Aged Trial Balance

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ADRR

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Average Days of Revenue in Accounts Receivable