HCCA CHPC FULL QUESTIONS AND
CORRECT ANSWERS FINAL PAPER
●● HIPAA CFR section
Answer: 45 CFR sections 164.102 through 164.534.
●● Subparts of HIPAA part 164
Answer: Subpart A - General rules; Subpart C - Security; Subpart D -
Breach notification; Subpart E - Privacy.
●● Covered Entity Determination
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.
●● Defined Transactions
Answer: 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.
●● Business Associates
,Answer: Business associates of covered entities must follow parts of the
HIPAA regulations.
●● Privacy Act of 1974
Answer: Established restrictions on how government agencies can share
information maintained in Federal systems of records that might infringe
on an individual's privacy rights.
●● HIPAA Entity Designation
Answer: Not considered a HIPAA Entity Designation: Contract
arrangement with FEDEX carrier.
●● Gramm-Leach-Bliley Act (GLBA)
Answer: Also known as the Financial Services Modernization Act of
1999, includes The Financial Privacy Rule and The Safeguards Rule
requiring all financial institutions to protect customer's personal
financial information.
●● OHCA
Answer: Organized Health Care Arrangement, a clinically integrated
care setting where individuals receive health care from more than one
provider.
●● ACE
,Answer: 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.
●● ACE Example
Answer: A health system composed of several affiliated hospitals.
●● Hybrid Entity
Answer: Entity that conducts both covered functions (healthcare
functions) and non-covered functions (other biz/non-healthcare
functions) to elect to be a 'hybrid entity.'
●● Hybrid Entity Example
Answer: A University System that has a research laboratory or academic
medical center.
●● HIPAA
Answer: Health Insurance Portability and Accountability Act, which
provides standards for the access, disclosure, transmission, and retention
of PHI.
●● PHI
, Answer: Protected Health Information, which is any information that
can be used to identify an individual and relates to their health status,
provision of health care, or payment for health care.
●● Transaction (healthcare transaction)
Answer: The transmission of information between two parties to carry
out financial or administrative activities related to health care.
●● Examples of healthcare transactions
Answer: Healthcare claims, coordination of benefits, health plan
premium payments, remittance advice (or ETF, electronic fund transfer),
referral certification and authorization.
●● BA (Business Associate)
Answer: Performs functions or activities on behalf of a covered entity
that involve access by the business associate to protected health
information.
●● Examples of Business Associate functions
Answer: Claims processing, data analysis, billing, benefit management,
quality assurance, quality improvement, practice management, legal,
actuarial, accounting, accreditation, and other administrative services.
●● Business Associate contract requirement
CORRECT ANSWERS FINAL PAPER
●● HIPAA CFR section
Answer: 45 CFR sections 164.102 through 164.534.
●● Subparts of HIPAA part 164
Answer: Subpart A - General rules; Subpart C - Security; Subpart D -
Breach notification; Subpart E - Privacy.
●● Covered Entity Determination
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.
●● Defined Transactions
Answer: 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.
●● Business Associates
,Answer: Business associates of covered entities must follow parts of the
HIPAA regulations.
●● Privacy Act of 1974
Answer: Established restrictions on how government agencies can share
information maintained in Federal systems of records that might infringe
on an individual's privacy rights.
●● HIPAA Entity Designation
Answer: Not considered a HIPAA Entity Designation: Contract
arrangement with FEDEX carrier.
●● Gramm-Leach-Bliley Act (GLBA)
Answer: Also known as the Financial Services Modernization Act of
1999, includes The Financial Privacy Rule and The Safeguards Rule
requiring all financial institutions to protect customer's personal
financial information.
●● OHCA
Answer: Organized Health Care Arrangement, a clinically integrated
care setting where individuals receive health care from more than one
provider.
●● ACE
,Answer: 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.
●● ACE Example
Answer: A health system composed of several affiliated hospitals.
●● Hybrid Entity
Answer: Entity that conducts both covered functions (healthcare
functions) and non-covered functions (other biz/non-healthcare
functions) to elect to be a 'hybrid entity.'
●● Hybrid Entity Example
Answer: A University System that has a research laboratory or academic
medical center.
●● HIPAA
Answer: Health Insurance Portability and Accountability Act, which
provides standards for the access, disclosure, transmission, and retention
of PHI.
●● PHI
, Answer: Protected Health Information, which is any information that
can be used to identify an individual and relates to their health status,
provision of health care, or payment for health care.
●● Transaction (healthcare transaction)
Answer: The transmission of information between two parties to carry
out financial or administrative activities related to health care.
●● Examples of healthcare transactions
Answer: Healthcare claims, coordination of benefits, health plan
premium payments, remittance advice (or ETF, electronic fund transfer),
referral certification and authorization.
●● BA (Business Associate)
Answer: Performs functions or activities on behalf of a covered entity
that involve access by the business associate to protected health
information.
●● Examples of Business Associate functions
Answer: Claims processing, data analysis, billing, benefit management,
quality assurance, quality improvement, practice management, legal,
actuarial, accounting, accreditation, and other administrative services.
●● Business Associate contract requirement
