Term
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Definition
| Limited Liability Company |
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Term
Advantage of LLC:
-protects business owner’s personal assets against “___”
claims that result from business operations. Ex: ??
-“tort” can be from ___ harm or ___ harm or breach of ___, failure to conform to a standard of care, or “strict liability” in which pt experiences harm that is not the fault of the ___ |
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Definition
| tort; some one falls; negligent; intentional; duty; provider |
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Term
| single owner or if fail to formally establish an entity to own the business |
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Definition
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Term
| have less limited liability (less protective) than LLC |
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Definition
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Term
| partnership that offers more asset protection than partnership |
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Definition
| Limited liability partnership (LLP) |
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Term
| private or civil wrong or injury, other than a breach of contract, for which the court provides a remedy (e.g. action for damages) |
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Definition
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Term
| owners are liable for actions of employees |
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Definition
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Term
| embezzlement, forgery, fraud, larceny |
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Definition
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Term
| ___ & ___ are better than partnerships & sole proprietorships (personal communication, Tom Adler, Attorney/CPA) |
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Definition
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Term
COMPENSATION & BENEFITS:
-Base salary & additional compensation formula relative to each owner’s ___
-Allocate compensation on a ___ rated basis each year; works well when all have comparable (and positive) productivity 401(k)
-Simplified Employee Pension Plans “SEPs”
-SIMPLE IRA plans
-Flexible benefit plans, aka “cafeteria” plans allow workers to
contribute pretax $ to ___ ___ & other non-covered ___ ___ (deductibles, co-pays) |
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Definition
| productivity; pro; group insurance; health costs |
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Term
| what most other providers would typically do in a similar situation; what is considered to be “best” practice |
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Definition
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Term
| ___ ___ insurance insures against malpractice |
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Definition
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Term
| What are 2 professional liability insurance examples for audiologists? |
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Definition
| Healthcare Providers Service Organization (HPSO) and Mercer |
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Term
ANTI-KICKBACK STATUTE:
-___ law
-___ & makes ___ any offer, payment, solicitation, or receipt of value for influencing referrals to providers for services or items covered by Medicare or Medicaid |
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Definition
| Federal; Prohibits; criminal |
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Term
Stark Laws:
-___ law
-Prohibits referrals by physicians in which the referring MD has a direct or indirect ___ interest for “designated” health services covered by Medicare or Medicaid
-Example: violation if a physician was an owner of a medical imaging business and referred his/her patients to only that business for imaging studies (basically _____________) |
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Definition
| Federal; financial; referring to yourself |
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Term
False Claims Act:
-___ law (that dates back to the US Civil War)
-Allows any citizen to bring a claim for ___ billing of the federal government |
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Definition
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Term
VIOLATIONS FALSE CLAIMS ACT:
-Filing claims for services not ___
-Filing claims for services not ___ ___
-Billing for ___-___ services
-Not billing with the correct ___ ___
-___ a diagnosis
-“___”- billing for service at a higher rate |
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Definition
| rendered; medically necessary; non-covered ; provider #; Falsifying; upcoding |
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Term
| when a trusted person steals funds, files, or other items of value from the practice; premeditated crime done methodically |
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Definition
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Term
| ___% of embezzlements are committed by 10% of work force; costs $___billion per year |
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Definition
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Term
Possible Clues for Embezzlement:
-Hard to ___ who will embezzle
-Employees with excessive ___; gambling debt
-Employees who make major ___ changes; living beyond
their means
-Employees who ask about ___ (overly enthusiastic)
-___ employee
-___ attitude; want to work alone
-Do not take ___ ___; do not want others to take over their ___ |
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Definition
| predict; debt; lifestyle; processes; Disgruntled; Hostile; time off; duties |
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Term
| Summarize 3 recommended protections against embezzlement |
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Definition
1. Create a climate of accountability (look at financial procedures)
2. Do background check before hiring
3. Sign & verify all checks, including payroll |
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Term
| Billing for services without a license |
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Definition
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Term
Compensation and Benefits:
-Base salary & additional compensation formula relative to each owner’s ___
-Allocate compensation on a ___ rated basis each year; works well when all have ___ (and positive) productivity
-___ benefit plans, aka “cafeteria” plans allow workers to
contribute pretax $ to group insurance & other non-covered
health costs (deductibles, co-pays) |
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Definition
| productivity; pro; comparable; Flexible |
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Term
Changed how providers create, share, use & disclose health
information |
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Definition
| Health Insurance Portability and Accountability Act (HIPPA) |
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Term
| What are some covered entities under HIPPA? |
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Definition
| Health plans, healthcare clearinghouses, and any providers who transmit health information |
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Term
| Addresses who can have access to protected health information (PHI) |
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Definition
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Term
Concerned with only those who should have access to
records actually do have access |
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Definition
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Term
any information created or received by a provider that relates to the past, present, or future physical or mental health condition of a patient, or the past, present, or future payment
for the provision of health care to a patient, or the provision of
healthcare to a patient |
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Definition
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Term
| individually identified health information held or disclosed by a practice regardless of how it is communicated (electronically, verbally, or written) |
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Definition
| Protected health information (PHI) |
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Term
| PHI that is created, maintained, or transmitted in electronic form |
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Definition
| Electronic protected health information (EPHI) |
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Term
| a person or entity that is not a member of a practice’s workforce who uses or discloses PHI to carry out functions on the practice’s behalf |
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Definition
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Term
| HIPAA requires that CE has ___ ___ agreement |
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Definition
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Term
| What are some examples of audiology BAs? |
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Definition
| billing and collection agencies, IT services, consultants. |
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