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CDEO - Chapter 2 Questions with Correct Answers
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CDEO - Chapter 2 Questions with Correct Answers
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CDEO - Chapter 2 Questions with Correct AnswersHealth Insurance Portability and Accountability Act of 1996 Correct
Answer-(HIPAA)
August 21, 1996 Correct Answer-HIPAA was enacted on _________.
Kennedy-Kassebaum Correct Answer-HIPAA aka as ______ bill, was
originally enacted to provide rights and protections for participants and
beneficiaries of group health plans. Under this law, exclusions for
preexisting conditions were limited, and discrimination against
employees and dependents based on their health status were prohibited.
Fraud, Abuse Correct Answer-HIPAA also established the Healthcare
_____ and _____ Control Program, a far-reaching program in
healthcare, including both public and private health plans to combat both
Administrative Simplification Correct Answer-HIPAA _______
provisions required that sections of the law be publicized to explain the
standards for the electronic exchange, privacy, and security of health
information.
August 14, 2002 Correct Answer-Congress did not enact privacy
legislation within the specified time governed by HIPAA. The U.S.
Department of Health and Human Services (HHS) developed a proposed
rule, which was released for comment on November 3, 1999. Many
comments were received, and modifications were made to the rule. The
modifications were published and released in final form on ______.
,HHS Correct Answer-_____ issued a privacy rule to set a national
standard for the protection of certain health information.
Privacy Rule Correct Answer-The _______ standards address how an
individual's protected health information (PHI) may be used. Its purpose
is to protect individual
privacy, while promoting high-quality healthcare and public health and
well-being. Correct Answer-
flexible, comprehensive Correct Answer-The Privacy Rule was designed
to be ______ and ______, to allow for the various uses and disclosures
the healthcare community must address.
All Correct Answer-____ covered entities are required to follow the
Privacy Rule.
plans, clearinghouses, provider Correct Answer-Covered entities are
defined as health _____, healthcare ________, and any healthcare
_________ who transmits health
information in an electronic format. Correct Answer-
plan Correct Answer-Health ______ covered entities are organizations
that pay providers on behalf of an individual receiving medical care.
,These plans include health, dental, vision, and prescription drug insurers.
Some examples include health maintenance organizations (HMOs),
Medicare, Medicaid,
and Medicare supplement insurers, as well as employer, government,
and church-sponsored group health plans. There are exceptions: An
employer who solely establishes and maintains the plan with fewer than
50 participants is exempt. Two types of government-funded programs
Correct Answer-
are not health plans: food stamps and community health centers. Insurers
providing only worker's compensation, automobile insurance, and
property and casualty insurance are not considered to be health plans.
Correct Answer-
providers Correct Answer-All healthcare ________ who electronically
transmit health information through certain transactions are covered
entities. Some examples of transactions that may be submitted
electronically are claim forms, inquiries about the eligibility of benefits,
and requests for authorization of referrals. Simply using electronic
technology, such as sending emails, does not mean a healthcare provider
is a covered entity; the transmission must be in connection with a
standard transaction. The rule applies to all, regardless of whether they
transmit the transactions directly, or use a billing service or other third
party to transmit on their behalf. They are defined as providers of
services, such as hospitals, and providers of medical or health services,
such as physicians, dentists, and other practitioners who furnish, bill, or
receive payment for healthcare.
, clearinghouses Correct Answer-Healthcare ________ include billing
services, repricing companies, and community health management
information systems that process nonstandard information, received
from another entity, into a standard (ie, standard format or data content)
or vice versa. In most instances, healthcare clearinghouses receive
individually identifiable information for processing services to a health
plan or healthcare provider as a business associate. In these cases, only
certain provisions are applicable to the clearinghouses' uses and
disclosures of protected health information.
Transactions Correct Answer-_______ occur through electronic
exchanges, which allow information to be transferred between two
parties for specific purposes.
plan Correct Answer-A healthcare provider will send a claim to a health
_____ to request payment for the medical services he or she provides.
HIPAA Correct Answer-_____ regulations standardized transactions for
Electronic Data Interchange (EDI) of healthcare data. These transactions
are: claims and encounter information, payment and remittance advice,
claims status, eligibility, enrollment and disenrollment, referrals and
authorizations, coordination of benefits, and premium payment.
HIPAA Correct Answer-Under _______, electronic transactions must
use the adopted standard and adhere to the content and format
requirements of ASC X12N or NCPDP (used for certain pharmacy
transactions) for each transaction. An additional rule was adopted to
standardize the code sets for diagnoses and procedures. These code sets
include: HCPCS (Healthcare Common Procedure Coding System—
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