HCCA - CHPC Overview 2023 March| 154 QUESTIONS| WITH COMPLETE SOLUTIONS

HIPAA became law correct answer: 1996 What is the purpose of HIPAA? correct answer: • To make health insurance portable under ERISA; • To move health care onto a nationally standardized electronic billing platform; and • To prevent fraud, waste and abuse Intent correct answer: purpose of this subtitle to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system, by encouraging the development of a health information system through the establishment of standards and requirements for the electronic transmission of certain health information. HIPAA resides in what CFR section correct answer: 45 CFR sections 164.102 through 164.534 Identify the four sections in the CFR by location and topic correct answer: Section One: 164.102 - 164.318 and 164. Organizational Requirements Section Two: 164.500 - 164.514 Use and Disclosure of Information Section Three: 164.520 - 164.528 Individual's Rights and Penalties Section Four: Interaction with the HIPAA Security Rule How do you determine if organization is a CE correct answer: - compare the functions of the entity to the three principal types of "covered entities" (CE), - determine if the entity electronically transmits one of the nine defined transactions" What are the different types of CEs correct answer: - Provider - Health Plan - Clearing House - Other Types How is a Provider defined correct answer: - "a provider of services (as defined in section 1395x (u) of title XIX) - a provider of medical or other health services (as defined in section 1395x (s) of title XIX) - any other person furnishing health care services or supplies. Does a provider need a standing facility to be considered a CE correct answer: NO What does "Health Plan" mean? correct answer: An individual or group plan that provides, or pays the cost of, medical care • A group health plan, but only if the plan: -- has 50 or more participants -- is administered by an entity other than the employer who established and maintains the plan. • A health insurance issuer • A health maintenance organization • The Medicaid program under title XIX. • A Medicare supplemental policy • A long-term care policy, including a nursing home fixed indemnity policy • An employee welfare benefit plan providing health benefits to the employees of 2 or more employers. • The health care program for active military • The veteran's health care program . • The Civilian Health and Medical Program • The Indian Health Service Program • The Federal Employees Health Benefit Plan . What is a Clearinghouse correct answer: may be a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements. What are other HIPAA Entities correct answer: Hybrid, Business Associate Organized Health Care Arrangement Affiliated Covered Entity What is a Hybrid Entity? correct answer: single legal entity, where only some of its divisions or programs meet the CE definitions and is typical of large entities What is Organized Health Care Arrangement (OHCA)? correct answer: clinically integrated care setting where individuals receive health care from more than one