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HCCA - CHPC Study Questions (MASTER FLASHCARDS)/302 Q’s and A’s
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HCCA - CHPC Study Questions(MASTER FLASHCARDS)/302 Q’s and
A’s
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%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: - -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
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