LEMERSON CHAP 1&2

2. record of all charges, payments, and adjustments made on a particular patient's account
3. unique 10 digit identifier assigned to each provider by the National Provider system
5. state specified performance measures for the delivery of health care by medical professionals
6. standards of professional behavior
7. prior authorization from a payer for services to be provided; if preauthorization is not received, the charge is usually not covered
8. organization that assumes the risks of paying for health insurance directly and sets up a fund from which to pay
10. an order of a court for a party to appear to testify in court
11. a method of scrambling transmitted data so it cannot be deciphered without the use of a confidential process or key
12. a medical practice's written plan for training, policies and procedures
14. plan that permits patients to receive medical services from non-network providers; requires larger patient payment

1. person who makes an accusation of fraud or abuse in a qui tam case
2. care that is provided to keep patients healthy or to prevent illness
4. person or organization that performs a function or activity for a covered entity but is not part of the workforce
9. an impermissable use or disclodure under the Privacy Rule that compromises the security or privacy of PHI and also that could pose significant risk of financial, reputational, or other harm to the affected person
13. failure to us an acceptable level of professional skill when giving medical services that results in harm to a patient