Social Science Business Insurance
HCCA - CHPC COMPREHENSIVE EXAM
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• 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
What is the purpose of HIPAA?
billing platform
Ref. https://quizlet.com/6202453/hcca-chpc-overview-flash-
cards/
More on HIPAA: https://www.hhs.gov/hipaa/index.html
45 CFR sections 164.102 through 164.534
HIPAA resides in which CFR
section? https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-
C/part-164
HIPAA - 45 CFR 164, subparts:
Subpart A - General rules
Subpart C - Security
What are the subparts of HIPAA Subpart D - Breach notification
part 164? Subpart E - Privacy
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-
C/part-164
, 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
How do you determine if an • Eligibility for a health plan
organization is a "Covered • Health care payment and remittance advice
Entity"? • 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 The Privacy Act of 1974
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.
Which of the following is not 4. Contract arrangement with FEDEX carrier
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
Gramm-Leach-Bliley Act (GLBA), also known as the Financial
What is Gramm-Leach-Bliley Act Services Modernization Act of 1999, includes The Financial
(GLBA)? Privacy Rule and The Safeguards Rule requires all financial
institutions to protect customer's personal financial information.
, 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).
What is an OHCA?
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).
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)
What's an ACE?
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).
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)
What's a Hybrid Entity?
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%20health%20care%20component.
https://privacyruleandresearch.nih.gov/pr_06.asp
HCCA - CHPC COMPREHENSIVE EXAM
QUESTIONS WITH DETAILED VERIFIED AND
100% CORRECT ANSWERS BRAND NEW
EXAM ALREADY GRADED A+!!
Save
Students also studied
Flashcard sets Study guides
Florida 2-20 Agents License Exam Q... NP CERT EXAM - PROFESSIONAL IS... AHIP Study Guide Q
327 terms Teacher 52 terms 100 terms
carolmwnd Preview SSK234 Preview Preview
• 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
What is the purpose of HIPAA?
billing platform
Ref. https://quizlet.com/6202453/hcca-chpc-overview-flash-
cards/
More on HIPAA: https://www.hhs.gov/hipaa/index.html
45 CFR sections 164.102 through 164.534
HIPAA resides in which CFR
section? https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-
C/part-164
HIPAA - 45 CFR 164, subparts:
Subpart A - General rules
Subpart C - Security
What are the subparts of HIPAA Subpart D - Breach notification
part 164? Subpart E - Privacy
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-
C/part-164
, 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
How do you determine if an • Eligibility for a health plan
organization is a "Covered • Health care payment and remittance advice
Entity"? • 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 The Privacy Act of 1974
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.
Which of the following is not 4. Contract arrangement with FEDEX carrier
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
Gramm-Leach-Bliley Act (GLBA), also known as the Financial
What is Gramm-Leach-Bliley Act Services Modernization Act of 1999, includes The Financial
(GLBA)? Privacy Rule and The Safeguards Rule requires all financial
institutions to protect customer's personal financial information.
, 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).
What is an OHCA?
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).
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)
What's an ACE?
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).
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)
What's a Hybrid Entity?
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%20health%20care%20component.
https://privacyruleandresearch.nih.gov/pr_06.asp
