Legislative Terminology Tutor
| Operation Restore Trust:
The governments program to combat Medicare Fraud and Abuse.
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OIG: This is the Office of the Inspector General. They are the police for HCFA |
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| Audit-This is like a physical examination, but more painful. This is what happens when someone is suspected of fraudulent billing. The unique thing about being suspected, is that that can anyone can report you. Those being asked to report include Senior Citizens ($1000 reward), and 3rd Party payers. (also known as Audit contractors.) |  |
HCFA-This is the government agency in charge of reimbursing healthcare providers for services. They also set the tone for reimbursement that for profit organization like to model themselves after. |  + + =
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| Audit Contractor: An organization, usually an insurance company, or an HMO, that the government independently contracts with to do secret independent audits on healthcare providers that they provide reimbursement to. |  |
HIPAA:
A legislative directive from 1996 that congress imposed. It addresses issues surrounding the confidentiality of patient records. These proposed rules would require all entities to notify patients when their medical records are accessed by anyone. Implementation would also address security rules for information systems. The estimated cost of implementing HIPAA regulations is three times the cost of what Y2K cost healthcare. |
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| Audit Bonus: Also referred to by some as a "bounty". This is the incentive the government provides to Audit contractors that provide productive leads. |
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GAF:
Geographic Adjustment Factor. Used by the government to adjust for the difference in cost to practice medicine in a certain geographic location. |
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| ABN: Also know as Advance Beneficiary Notice. This is states that a Medicare beneficiary has certain coverage, and if the treating physician places an order for lab or treatment that isn't covered, then they must discuss the uncovered item with the patient and have the patient sign the "menu" to identify that the patient understands an uncovered expense is being generated. | |||
| E.M.T.A.L.A: This is the Emergency Medical Treatment and Labor Act. This is the law that states Emergency Departments and their staff must treat all comers. This essentially established emergency departments and their staffs as America's health care safety net. | |||
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DOJ: Dept of Justice |
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| UB92 | |||
| SAFE HARBOR | |||
| HL7 | |||
| APG | |||
| APC | |||
| HEDIS: Health Plan Employer Data and Information Set. Performance Standards that are useful for employs to compare health plans. | |||
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