HCCA CHPC Exam Review Questions And Answers Latest Updated | 100% Correct. How do you determine if an organization is a "Covered Entity"? - CORRECT ANSWER -
1. compare if the organization meets one of the 3 types of CE (provider, health plan,
clearinghouse)
and
2. determine if the organization...
HCCA - CHPC Exam Questions And Answers Latest Updated 2023-2024 | Complete Guide Graded 100% HCCA - CHPC Study Guide - 296
Questions And Answers Updated
What is the purpose of HIPAA? - CORRECT ANSWER - • 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? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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"? - CORRECT ANSWER -
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. - CORRECT ANSWER - 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 - CORRECT ANSWER - 4. Contract
arrangement with FEDEX carrier
What is Gramm-Leach-Bliley Act (GLBA)? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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%20
entity's%20health%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: - CORRECT ANSWER -
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? - CORRECT ANSWER - 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
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