HCCA - CHPC Study- 296 Questions (MASTER FLASHCARDS) WITH COMPLETE SOLUTIONS

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. More on HIPAA: HIPAA resides in which CFR section? correct answer: 45 CFR sections 164.102 through 164.534 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 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. 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