HCCA - CHPC Study Questions
(MASTER FLASHCARDS) {296 Q & A}
What is the purpose of HIPAA?
• Protect PHI from unauthorized disclosure/use;
• Prevent fraud, waste and abuse (via Administrative Simplification);
• Make health insurance portable under ERISA;
• Move health care onto a nationally standardized electronic billing platform
Ref. https://quizlet.com/6202453/hcca-chpc-overview-flash-cards/
More on HIPAA: https://www.hhs.gov/hipaa/index.html
HIPAA resides in which CFR section?
45 CFR sections 164.102 through 164.534
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
What are the subparts of HIPAA part 164?
HIPAA - 45 CFR 164, subparts:
Subpart A - General rules
Subpart C - Security
Subpart D - Breach notification
Subpart E - Privacy
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
How do you determine if an organization is a "Covered Entity"?
1. compare if the organization meets one of the 3 types of CE (provider, health plan, clearinghouse)
and
2. determine if the organization electronically transmits one of the 9 defined transactions:
• Health claims or equivalent encounter information
• Health claims attachments
• Enrollment and disenrollment in a health plan
• Eligibility for a health plan
• Health care payment and remittance advice
• Health plan premium payments
• First report of injury
• Health claim status
• Referral certification and authorization
,In addition, business associates of covered entities must follow parts of the HIPAA regulations.
https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
This Act established in 1974 was created for government agencies placing restrictions on how the
government can share the information maintained in Federal systems of records that might infringe on
an individual's privacy rights with other individuals and agencies.
The Privacy Act of 1974
Which of the following is not considered a HIPAA Entity Designation:
1. Affiliated covered entity
2. Entity that performs healthcare and non-healthcare component activities including both covered and
non-covered functions
3. A group health plan
4. Contract arrangement with FEDEX carrier
4. Contract arrangement with FEDEX carrier
What is Gramm-Leach-Bliley Act (GLBA)?
Gramm-Leach-Bliley Act (GLBA), also known as the Financial Services Modernization Act of 1999,
includes The Financial Privacy Rule and The Safeguards Rule requires all financial institutions to protect
customer's personal financial information.
What is an OHCA?
OHCA (Organized Health Care Arrangement) it's a clinically integrated care setting where individuals
receive health care from more than one provider.
These are joint arrangements/activities and have an Integrated Delivery System for easy exchange of PHI
data. See 45 CFR 160.103. OHCAs can also utilize a joint NPP. See 45 CFR § 164.520(d).
ACE (Affiliated Covered Entity) do not have an Integrated Delivery System because these are legally
separate covered entities that are associated in business, or affiliated as a result of some common
control or ownership.
Both the OHCA and the ACE would allow sharing of PHI across participating entity lines for treatment,
payment, operations purposes (TPO).
What's an ACE?
ACE (Affiliated Covered Entity)
Legally separate covered entities that share common control/ownership and designate themselves as a
single CE for the purpose of complying with the HIPAA Privacy standards.
ACEs do not have an Integrated Delivery System, while OHCA do, and can share a single NPP. See 45 CFR
§ 164.520(d)
ACE example: a health system composed on several affiliated hospitals.
,Both the OHCA and the ACE would allow sharing of PHI across participating entity lines for treatment,
payment, operations purposes (TPO).
What's a Hybrid Entity?
Entity that conducts both covered functions (or healthcare-functions) and non-covered functions (other
biz/non-healthcare functions) to elect to be a "hybrid entity."
For instance, a University System that has a research laboratory or academic medical center.
The post-secondary functions (non-healthcare components) do NOT need to comply with HIPAA.
The research lab/med center functions (healthcare component) needs to comply with HIPAA provisions
to protect the use/disclosure of PHI involved.
https://www.hhs.gov/hipaa/for-professionals/faq/315/when-does-a-covered-entity-have-discretion-to-
determine-covered-
functions/index.html#:~:text=For%20example%2C%20a%20hybrid%20entity,hybrid%20entity's%20healt
h%20care%20component.
https://privacyruleandresearch.nih.gov/pr_06.asp
The transmission of information between two parties to carry out financial or administrative activities
related to health care is called:
Transaction (healthcare transaction).
Few examples of healthcare transactions:
healthcare claims;
coordination of benefits;
health plan premium payments;
remittance advice (or ETF, electronic fund transfer);
referral certification and authorization
What are examples of a BA?
BA (Business Associate) - performs functions or activities on behalf of a covered entity that involve
access by the business associate to protected health information.
Examples:
claims processing
data analysis
billing
benefit management
quality assurance
quality improvement
practice management
legal
actuarial
accounting
, accreditation
other administrative services
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/business-associates/index.html
True or False:
A hospital is not required to have a business associate contract with the specialist to whom it refers a
patient and transmits the patient's medical chart for treatment purposes.
TRUE
Remember, use and disclosure of PHI for purposes of TPO requires no specific authorization
True or False:
Business Associates After HITECH:
HITECH made business associates directly responsible for HIPAA compliance within their individual
businesses that would not otherwise be subject to HIPAA regulations and penalties
TRUE
Even if no written contract exists between the covered entity and a contracted company performing
services related to handling PHI in some form, the company is deemed a business associate by law. This
deemed status essentially classifies contracted vendors or individuals as business associates solely by the
nature of the services they provide to a covered entity, regardless of whether they intended to be
classified as business associates or were aware of their status as such. HIPAA and HITECH may hold these
vendors to business associate obligations as long as they act as business associates.
Likewise, a subcontractor that creates, receives, maintains, or transmits PHI on behalf of a business
associate is a business associate. A subcontractor of a subcontractor is a business associate as well, and
so on down the line.
Ref. 2023 HCCA Complete Healthcare Compliance Manual
Ref. HITECH Act and OCR's 2013 final rule
True or False:
Under HIPAA and HITECH, individuals or entities who have been identified as business associates are
obligated to enter into a business associate agreement with their contracted covered entities.
TRUE
Business associate agreement mandate under the HIPAA Privacy Rule. There are some exceptions such:
- for purposes of TPO, including payment for health plan premiums
- for determining health plan eligibility and enrollment
- when there is no involvement of use/disclosure of PHI (e.g., building maintenance)
True or False:
Under HIPAA and HITECH, individuals or entities who have been identified as business associates are
obligated to enter into a business associate agreement with their contracted covered entities.
(MASTER FLASHCARDS) {296 Q & A}
What is the purpose of HIPAA?
• Protect PHI from unauthorized disclosure/use;
• Prevent fraud, waste and abuse (via Administrative Simplification);
• Make health insurance portable under ERISA;
• Move health care onto a nationally standardized electronic billing platform
Ref. https://quizlet.com/6202453/hcca-chpc-overview-flash-cards/
More on HIPAA: https://www.hhs.gov/hipaa/index.html
HIPAA resides in which CFR section?
45 CFR sections 164.102 through 164.534
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
What are the subparts of HIPAA part 164?
HIPAA - 45 CFR 164, subparts:
Subpart A - General rules
Subpart C - Security
Subpart D - Breach notification
Subpart E - Privacy
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
How do you determine if an organization is a "Covered Entity"?
1. compare if the organization meets one of the 3 types of CE (provider, health plan, clearinghouse)
and
2. determine if the organization electronically transmits one of the 9 defined transactions:
• Health claims or equivalent encounter information
• Health claims attachments
• Enrollment and disenrollment in a health plan
• Eligibility for a health plan
• Health care payment and remittance advice
• Health plan premium payments
• First report of injury
• Health claim status
• Referral certification and authorization
,In addition, business associates of covered entities must follow parts of the HIPAA regulations.
https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
This Act established in 1974 was created for government agencies placing restrictions on how the
government can share the information maintained in Federal systems of records that might infringe on
an individual's privacy rights with other individuals and agencies.
The Privacy Act of 1974
Which of the following is not considered a HIPAA Entity Designation:
1. Affiliated covered entity
2. Entity that performs healthcare and non-healthcare component activities including both covered and
non-covered functions
3. A group health plan
4. Contract arrangement with FEDEX carrier
4. Contract arrangement with FEDEX carrier
What is Gramm-Leach-Bliley Act (GLBA)?
Gramm-Leach-Bliley Act (GLBA), also known as the Financial Services Modernization Act of 1999,
includes The Financial Privacy Rule and The Safeguards Rule requires all financial institutions to protect
customer's personal financial information.
What is an OHCA?
OHCA (Organized Health Care Arrangement) it's a clinically integrated care setting where individuals
receive health care from more than one provider.
These are joint arrangements/activities and have an Integrated Delivery System for easy exchange of PHI
data. See 45 CFR 160.103. OHCAs can also utilize a joint NPP. See 45 CFR § 164.520(d).
ACE (Affiliated Covered Entity) do not have an Integrated Delivery System because these are legally
separate covered entities that are associated in business, or affiliated as a result of some common
control or ownership.
Both the OHCA and the ACE would allow sharing of PHI across participating entity lines for treatment,
payment, operations purposes (TPO).
What's an ACE?
ACE (Affiliated Covered Entity)
Legally separate covered entities that share common control/ownership and designate themselves as a
single CE for the purpose of complying with the HIPAA Privacy standards.
ACEs do not have an Integrated Delivery System, while OHCA do, and can share a single NPP. See 45 CFR
§ 164.520(d)
ACE example: a health system composed on several affiliated hospitals.
,Both the OHCA and the ACE would allow sharing of PHI across participating entity lines for treatment,
payment, operations purposes (TPO).
What's a Hybrid Entity?
Entity that conducts both covered functions (or healthcare-functions) and non-covered functions (other
biz/non-healthcare functions) to elect to be a "hybrid entity."
For instance, a University System that has a research laboratory or academic medical center.
The post-secondary functions (non-healthcare components) do NOT need to comply with HIPAA.
The research lab/med center functions (healthcare component) needs to comply with HIPAA provisions
to protect the use/disclosure of PHI involved.
https://www.hhs.gov/hipaa/for-professionals/faq/315/when-does-a-covered-entity-have-discretion-to-
determine-covered-
functions/index.html#:~:text=For%20example%2C%20a%20hybrid%20entity,hybrid%20entity's%20healt
h%20care%20component.
https://privacyruleandresearch.nih.gov/pr_06.asp
The transmission of information between two parties to carry out financial or administrative activities
related to health care is called:
Transaction (healthcare transaction).
Few examples of healthcare transactions:
healthcare claims;
coordination of benefits;
health plan premium payments;
remittance advice (or ETF, electronic fund transfer);
referral certification and authorization
What are examples of a BA?
BA (Business Associate) - performs functions or activities on behalf of a covered entity that involve
access by the business associate to protected health information.
Examples:
claims processing
data analysis
billing
benefit management
quality assurance
quality improvement
practice management
legal
actuarial
accounting
, accreditation
other administrative services
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/business-associates/index.html
True or False:
A hospital is not required to have a business associate contract with the specialist to whom it refers a
patient and transmits the patient's medical chart for treatment purposes.
TRUE
Remember, use and disclosure of PHI for purposes of TPO requires no specific authorization
True or False:
Business Associates After HITECH:
HITECH made business associates directly responsible for HIPAA compliance within their individual
businesses that would not otherwise be subject to HIPAA regulations and penalties
TRUE
Even if no written contract exists between the covered entity and a contracted company performing
services related to handling PHI in some form, the company is deemed a business associate by law. This
deemed status essentially classifies contracted vendors or individuals as business associates solely by the
nature of the services they provide to a covered entity, regardless of whether they intended to be
classified as business associates or were aware of their status as such. HIPAA and HITECH may hold these
vendors to business associate obligations as long as they act as business associates.
Likewise, a subcontractor that creates, receives, maintains, or transmits PHI on behalf of a business
associate is a business associate. A subcontractor of a subcontractor is a business associate as well, and
so on down the line.
Ref. 2023 HCCA Complete Healthcare Compliance Manual
Ref. HITECH Act and OCR's 2013 final rule
True or False:
Under HIPAA and HITECH, individuals or entities who have been identified as business associates are
obligated to enter into a business associate agreement with their contracted covered entities.
TRUE
Business associate agreement mandate under the HIPAA Privacy Rule. There are some exceptions such:
- for purposes of TPO, including payment for health plan premiums
- for determining health plan eligibility and enrollment
- when there is no involvement of use/disclosure of PHI (e.g., building maintenance)
True or False:
Under HIPAA and HITECH, individuals or entities who have been identified as business associates are
obligated to enter into a business associate agreement with their contracted covered entities.
