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CDEO - Chapter 2 questions and answers
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CDEO - Chapter 2 questions and answers CDEO - Chapter 2 questions and answers CDEO - Chapter 2 questions and answers
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CDEO - Chapter 2(HIPAA) - Ans Health Insurance Portability and Accountability Act of 1996
HIPAA was enacted on _________. - Ans August 21, 1996
HIPAA aka as ______ bill, was originally enacted to provide rights and protections for participants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. - Ans Kennedy-Kassebaum
HIPAA also established the Healthcare _____ and _____ Control Program, a far-reaching program in
healthcare, including both public and private health plans to combat both - Ans Fraud, Abuse
HIPAA _______ provisions required that sections of the law be publicized to explain the standards
for the electronic exchange, privacy, and security of health information. - Ans Administrative
Simplification
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 ______. - Ans August 14,
2002
_____ issued a privacy rule to set a national standard for the protection of certain health
information. - Ans HHS
The _______ standards address how an individual's protected health information (PHI) may be used.
Its purpose is to protect individual - Ans Privacy Rule
- Ans privacy, while promoting high-quality healthcare and public health and well-being.
The Privacy Rule was designed to be ______ and ______, to allow for the various uses and
disclosures the healthcare community must address. - Ans flexible, comprehensive
____ covered entities are required to follow the Privacy Rule. - Ans All
Covered entities are defined as health _____, healthcare ________, and any healthcare _________
who transmits health - Ans plans, clearinghouses, provider
- Ans information in an electronic format.
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, - Ans plan
- Ans 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
- Ans 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.
,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. - Ans providers
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. - Ans
clearinghouses
_______ occur through electronic exchanges, which allow information to be transferred between
two parties for specific purposes. - Ans Transactions
A healthcare provider will send a claim to a health _____ to request payment for the medical
services he or she provides. - Ans plan
_____ 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. - Ans HIPAA
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—
ancillary services and procedures); CPT® (Current Procedural Terminology—physician's procedures);
CDT® (Current Dental Terminology—dental procedures); ICD-9 (International Classification of
Diseases-9th revision— diagnosis and inpatient hospital procedures); ICD-10 (International
Classification of Diseases-10th Revision, which replaced ICD-9 on October 1, 2015); and NDC
(National Drug Codes). - Ans HIPAA
In addition to the standardization of the codes used to request payment for medical services, a
_______ for employers and providers must be used on all transactions. - Ans unique identifier
_______ perform certain functions or activities, which involve the use or disclosure of individually
identifiable health information, on behalf of another person or organization, without being a
member of the entity's workforce. These services include claims processing or administration, data
analysis, utilization review, billing, benefit management, and re-pricing. - Ans Business associates
_______ associate services to a covered entity are limited to legal, actuarial, accounting, consulting,
data aggregation, management, administrative, accreditation, or financial services. - Ans Business
To be considered a business associate, the persons or organizations would involve the use or
disclosure of ________ between the two parties. - Ans protected health information
, A covered entity ____ be a business associate of another covered entity. - Ans can
HITECH - Ans Health Information Technology for Economic and Clinical Health Act
The ______ enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, also
specifies that an organization that provides data transmission of PHI to a covered entity and that
requires access to PHI routinely, such as a Health Information Exchange Organization, will be treated
as a business associate. - Ans HITECH
A _______ is required between business associates to impose specified written safeguards on the
individually identifiable health information used or disclosed by the business associate. It must
describe the permitted and required uses of protected health information by the business associate,
limit the business associate from using or further disclosing the protected health information (except
where permitted by - Ans contract
- Ans contract or required by law), and require the business associate to follow appropriate
safeguards to prevent use or disclosure of the protected health information, except as expressly
defined in the contract.
Covered entities may not contractually authorize a business associate to make any use or disclosure
of protected health information that would violate the _______ - Ans privacy rule
Words or phrases contained in brackets are intended as either _____ language or as ______ to the
users of these sample provisions. - Ans optional, instructions
The following terms used in this Agreement shall have the same meaning as those terms in the
_____ Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Healthcare Operations,
Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required
by Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and
Use. - Ans HIPAA
______ shall generally have the same meaning as the term "business associate" at 45 CFR 160.103,
and in reference to the party to this agreement - Ans Business Associate
_______ shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part
160 and Part 164. - Ans HIPAA
Not use or disclose __________ other than as permitted or required by the Agreement or as
required by law - Ans protected health information
Use appropriate ________, and comply with Subpart C of 45 CFR Part 164 with respect to electronic
protected health information, to prevent use or disclosure of protected health information other
than as provided for by the Agreement - Ans safeguards
________ to covered entity any use or disclosure of protected health information not provided for
by the Agreement of which it becomes aware, including breaches of unsecured protected health
information as required at 45 CFR 164.410, and any security incident of which it becomes aware; -
Ans report
ensure that any _______ that create, receive, maintain, or transmit protected health information on
behalf of the business associate agree to the same restrictions, conditions, and requirements that
apply to the business associate with respect to such information; - Ans subcontractors
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