HCCA - CHPC STUDY GUIDE - 296 QUESTIONS AND CORRECT ANSWERS WELL EXPLAINED

HCCA - CHPC STUDY GUIDE - 296 QUESTIONS AND CORRECT ANSWERS WELL EXPLAINED 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 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