HCCA - CHPC Overview ACTUAL
QUESTIONS AND CORRECT ANSWERS
HIPAA became law - CORRECT ANSWERS✅✅1996
What is the purpose of HIPAA? - CORRECT ANSWERS✅✅• To make health insurance
portable under ERISA;
• To move health care onto a nationally standardized electronic billing platform; and
• To prevent fraud, waste and abuse
Intent - CORRECT ANSWERS✅✅purpose of this subtitle to improve the Medicare
program under title XVIII of the Social Security Act, the Medicaid program under title XIX
of such Act, and the efficiency and effectiveness of the health care system, by encouraging
the development of a health information system through the establishment of standards and
requirements for the electronic transmission of certain health information.
HIPAA resides in what CFR section - CORRECT ANSWERS✅✅45 CFR sections 164.102
through 164.534
Identify the four sections in the CFR by location and topic - CORRECT
ANSWERS✅✅Section One: 164.102 - 164.318 and 164.530 - 164-534 Organizational
Requirements
Section Two: 164.500 - 164.514 Use and Disclosure of Information
Section Three: 164.520 - 164.528 Individual's Rights and Penalties
Section Four: Interaction with the HIPAA Security Rule
How do you determine if organization is a CE - CORRECT ANSWERS✅✅- compare the
functions of the entity to the three principal types of "covered entities" (CE),
- determine if the entity electronically transmits one of the nine defined transactions"
,What are the different types of CEs - CORRECT ANSWERS✅✅- Provider
- Health Plan
- Clearing House
- Other Types
How is a Provider defined - CORRECT ANSWERS✅✅- "a provider of services (as defined
in section 1395x (u) of title XIX)
- a provider of medical or other health services (as defined in section 1395x (s) of title XIX)
- any other person furnishing health care services or supplies.
Does a provider need a standing facility to be considered a CE - CORRECT
ANSWERS✅✅NO
What does "Health Plan" mean? - CORRECT ANSWERS✅✅An individual or group plan
that provides, or pays the cost of, medical care
• A group health plan, but only if the plan:
-- has 50 or more participants
-- is administered by an entity other than the employer who established and maintains the
plan.
• A health insurance issuer
• A health maintenance organization
• The Medicaid program under title XIX.
• A Medicare supplemental policy
• A long-term care policy, including a nursing
home fixed indemnity policy
• An employee welfare benefit plan providing health benefits to the employees of 2 or more
employers.
• The health care program for active military
• The veteran's health care program .
• The Civilian Health and Medical Program
• The Indian Health Service Program
, • The Federal Employees Health Benefit Plan
.
What is a Clearinghouse - CORRECT ANSWERS✅✅may be a public or private entity that
processes
or facilitates the processing of nonstandard data elements of health information into standard
data
elements.
What are other HIPAA Entities - CORRECT ANSWERS✅✅Hybrid, Business Associate
Organized Health Care Arrangement
Affiliated Covered Entity
What is a Hybrid Entity? - CORRECT ANSWERS✅✅single legal entity, where
only some of its divisions or programs meet the
CE definitions and is typical of large entities
What is Organized Health Care Arrangement (OHCA)? - CORRECT
ANSWERS✅✅clinically integrated care setting where individuals receive health care from
more than one health care provider.
What is Affiliated Covered Entity? - CORRECT ANSWERS✅✅legally distinct entities that
share common control or common ownership and choose to designate themselves as one
affiliated CE for the purposes of complying with the HIPAA Privacy standard
What must a Affiliated Entity agree to? - CORRECT ANSWERS✅✅Be treated as a single
CE. Must agree to follow a standard policy and procedure
What is a Business Associate? - CORRECT ANSWERS✅✅- CE to either get "assurances"
for privacy and security standards from their business partners or to include a BA amendment
to a contract.
- where a separate legal entity uses or discloses Individually Identifiable Information on
behalf of the CE.
QUESTIONS AND CORRECT ANSWERS
HIPAA became law - CORRECT ANSWERS✅✅1996
What is the purpose of HIPAA? - CORRECT ANSWERS✅✅• To make health insurance
portable under ERISA;
• To move health care onto a nationally standardized electronic billing platform; and
• To prevent fraud, waste and abuse
Intent - CORRECT ANSWERS✅✅purpose of this subtitle to improve the Medicare
program under title XVIII of the Social Security Act, the Medicaid program under title XIX
of such Act, and the efficiency and effectiveness of the health care system, by encouraging
the development of a health information system through the establishment of standards and
requirements for the electronic transmission of certain health information.
HIPAA resides in what CFR section - CORRECT ANSWERS✅✅45 CFR sections 164.102
through 164.534
Identify the four sections in the CFR by location and topic - CORRECT
ANSWERS✅✅Section One: 164.102 - 164.318 and 164.530 - 164-534 Organizational
Requirements
Section Two: 164.500 - 164.514 Use and Disclosure of Information
Section Three: 164.520 - 164.528 Individual's Rights and Penalties
Section Four: Interaction with the HIPAA Security Rule
How do you determine if organization is a CE - CORRECT ANSWERS✅✅- compare the
functions of the entity to the three principal types of "covered entities" (CE),
- determine if the entity electronically transmits one of the nine defined transactions"
,What are the different types of CEs - CORRECT ANSWERS✅✅- Provider
- Health Plan
- Clearing House
- Other Types
How is a Provider defined - CORRECT ANSWERS✅✅- "a provider of services (as defined
in section 1395x (u) of title XIX)
- a provider of medical or other health services (as defined in section 1395x (s) of title XIX)
- any other person furnishing health care services or supplies.
Does a provider need a standing facility to be considered a CE - CORRECT
ANSWERS✅✅NO
What does "Health Plan" mean? - CORRECT ANSWERS✅✅An individual or group plan
that provides, or pays the cost of, medical care
• A group health plan, but only if the plan:
-- has 50 or more participants
-- is administered by an entity other than the employer who established and maintains the
plan.
• A health insurance issuer
• A health maintenance organization
• The Medicaid program under title XIX.
• A Medicare supplemental policy
• A long-term care policy, including a nursing
home fixed indemnity policy
• An employee welfare benefit plan providing health benefits to the employees of 2 or more
employers.
• The health care program for active military
• The veteran's health care program .
• The Civilian Health and Medical Program
• The Indian Health Service Program
, • The Federal Employees Health Benefit Plan
.
What is a Clearinghouse - CORRECT ANSWERS✅✅may be a public or private entity that
processes
or facilitates the processing of nonstandard data elements of health information into standard
data
elements.
What are other HIPAA Entities - CORRECT ANSWERS✅✅Hybrid, Business Associate
Organized Health Care Arrangement
Affiliated Covered Entity
What is a Hybrid Entity? - CORRECT ANSWERS✅✅single legal entity, where
only some of its divisions or programs meet the
CE definitions and is typical of large entities
What is Organized Health Care Arrangement (OHCA)? - CORRECT
ANSWERS✅✅clinically integrated care setting where individuals receive health care from
more than one health care provider.
What is Affiliated Covered Entity? - CORRECT ANSWERS✅✅legally distinct entities that
share common control or common ownership and choose to designate themselves as one
affiliated CE for the purposes of complying with the HIPAA Privacy standard
What must a Affiliated Entity agree to? - CORRECT ANSWERS✅✅Be treated as a single
CE. Must agree to follow a standard policy and procedure
What is a Business Associate? - CORRECT ANSWERS✅✅- CE to either get "assurances"
for privacy and security standards from their business partners or to include a BA amendment
to a contract.
- where a separate legal entity uses or discloses Individually Identifiable Information on
behalf of the CE.
