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HCCA - CHPC Study Questions and Answers 2024 LATEST VERSION
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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.

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  • May 22, 2024
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  • 2023/2024
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HCCA - CHPC Study Questions and Answers Already Passed


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-

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