CDEO - Chapter 2 Latest Update(rated A)

CDEO - Chapter 2 Latest Update(rated A) Health Insurance Portability and Accountability Act of 1996 - ANSWER (HIPAA) August 21, 1996 - ANSWER HIPAA was enacted on _________. Kennedy-Kassebaum - ANSWER HIPAA aka as ______ bill, was originally enacted to provide rights and protections for participants and beneficiaries of group health plans.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. Fraud, Abuse - ANSWER HIPAA also established the Healthcare _____ and _____ Control Program, a far-reaching program in healthcare, including both public and private health plans to combat both Administrative Simplification - ANSWER HIPAA _______ provisions required that sections of the law be publicized to explain the standards for the electronic exchange, privacy, and security of health information. August 14, 2002 - ANSWER 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 ______. HHS - ANSWER _____ issued a privacy rule to set a national standard for the protection of certain health information. Privacy Rule - ANSWER The _______ standards address how an individual's protected health information (PHI) may be used. Its purpose is to protect individual privacy, while promoting high-quality healthcare and public health and well-being. - ANSWER flexible, comprehensive - ANSWER The Privacy Rule was designed to be ______ and ______, to allow for the various uses and disclosures the healthcare community must address. All - ANSWER ____ covered entities are required to follow the Privacy Rule. plans, clearinghouses, provider - ANSWER Covered entities are defined as health _____, healthcare ________, and any healthcare _________ who transmits health information in an electronic format. - ANSWER plan - ANSWER 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, 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 - ANSWER 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. - ANSWER providers - ANSWER 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. clearinghouses - ANSWER 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. Transactions - ANSWER _______ occur through electronic exchanges, which allow information to be transferred between two parties for specific purposes. plan - ANSWER A healthcare provider will send a claim to a health _____ to request payment for the medical services he or she provides. HIPAA - ANSWER _____ 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.