HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS) QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

HCCA - CHPC STUDY QUESTIONS
(MASTER FLASHCARDS) QUESTIONS
AND ANSWERS WITH SOLUTIONS 2024
WhatHisHtheHpurposeHofHHIPAA?H-HANSWERHH•HProtectHPHIHfromHunauthorizedHdisclosure/use;

•HPreventHfraud,HwasteHandHabuseH(viaHAdministrativeHSimplification);

•HMakeHhealthHinsuranceHportableHunderHERISA;

•HMoveHhealthHcareHontoHaHnationallyHstandardizedHelectronicHbillingHplatform



Ref.Hhttps://quizlet.com/6202453/hcca-chpc-overview-flash-cards/

MoreHonHHIPAA:Hhttps://www.hhs.gov/hipaa/index.html



HIPAAHresidesHinHwhichHCFRHsection?H-HANSWERHH45HCFRHsectionsH164.102HthroughH164.534



https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164



WhatHareHtheHsubpartsHofHHIPAAHpartH164?H-HANSWERHHHIPAAH-H45HCFRH164,Hsubparts:

SubpartHAH-HGeneralHrules

SubpartHCH-HSecurity

SubpartHDH-HBreachHnotification

SubpartHEH-HPrivacy



https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164



HowHdoHyouHdetermineHifHanHorganizationHisHaH"CoveredHEntity"?H-
HANSWERHH1.HcompareHifHtheHorganizationHmeetsHoneHofHtheH3HtypesHofHCEH(provider,HhealthHplan,Hclearin

ghouse)

and

2.HdetermineHifHtheHorganizationHelectronicallyHtransmitsHoneHofHtheH9HdefinedHtransactions:

•HHealthHclaimsHorHequivalentHencounterHinformation

,•HHealthHclaimsHattachments

•HEnrollmentHandHdisenrollmentHinHaHhealthHplan

•HEligibilityHforHaHhealthHplan

•HHealthHcareHpaymentHandHremittanceHadvice

•HHealthHplanHpremiumHpayments

•HFirstHreportHofHinjury

•HHealthHclaimHstatus

•HReferralHcertificationHandHauthorization



InHaddition,HbusinessHassociatesHofHcoveredHentitiesHmustHfollowHpartsHofHtheHHIPAAHregulations.

https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html



ThisHActHestablishedHinH1974HwasHcreatedHforHgovernmentHagenciesHplacingHrestrictionsHonHhowHtheHgove
rnmentHcanHshareHtheHinformationHmaintainedHinHFederalHsystemsHofHrecordsHthatHmightHinfringeHonHanHi
ndividual'sHprivacyHrightsHwithHotherHindividualsHandHagencies.H-HANSWERHHTheHPrivacyHActHofH1974



WhichHofHtheHfollowingHisHnotHconsideredHaHHIPAAHEntityHDesignation:

1.HAffiliatedHcoveredHentity

2.HEntityHthatHperformsHhealthcareHandHnon-
healthcareHcomponentHactivitiesHincludingHbothHcoveredHandHnon-coveredHfunctions

3.HAHgroupHhealthHplan

4.HContractHarrangementHwithHFEDEXHcarrierH-HANSWERHH4.HContractHarrangementHwithHFEDEXHcarrier



WhatHisHGramm-Leach-BlileyHActH(GLBA)?H-HANSWERHHGramm-Leach-
BlileyHActH(GLBA),HalsoHknownHasHtheHFinancialHServicesHModernizationHActHofH1999,HincludesHTheHFinanci
alHPrivacyHRuleHandHTheHSafeguardsHRuleHrequiresHallHfinancialHinstitutionsHtoHprotectHcustomer'sHpersona
lHfinancialHinformation.



WhatHisHanHOHCA?H-
HANSWERHHOHCAH(OrganizedHHealthHCareHArrangement)Hit'sHaHclinicallyHintegratedHcareHsettingHwhereHind

ividualsHreceiveHhealthHcareHfromHmoreHthanHoneHprovider.H

,TheseHareHjointHarrangements/activitiesHandHhaveHanHIntegratedHDeliveryHSystemHforHeasyHexchangeHofHP
HIHdata.HSeeH45HCFRH160.103.HOHCAsHcanHalsoHutilizeHaHjointHNPP.HSeeH45HCFRH§H164.520(d).



ACEH(AffiliatedHCoveredHEntity)HdoHnotHhaveHanHIntegratedHDeliveryHSystemHbecauseHtheseHareHlegallyHsep
arateHcoveredHentitiesHthatHareHassociatedHinHbusiness,HorHaffiliatedHasHaHresultHofHsomeHcommonHcontrolH
orHownership.



BothHtheHOHCAHandHtheHACEHwouldHallowHsharingHofHPHIHacrossHparticipatingHentityHlinesHforHtreatment,H
payment,HoperationsHpurposesH(TPO).



What'sHanHACE?H-HANSWERHHACEH(AffiliatedHCoveredHEntity)

LegallyHseparateHcoveredHentitiesHthatHshareHcommonHcontrol/ownershipHandHdesignateHthemselvesHasHa
HsingleHCEHforHtheHpurposeHofHcomplyingHwithHtheHHIPAAHPrivacyHstandards.



ACEsHdoHnotHhaveHanHIntegratedHDeliveryHSystem,HwhileHOHCAHdo,HandHcanHshareHaHsingleHNPP.HSeeH45HCF
RH§H164.520(d)



ACEHexample:HaHhealthHsystemHcomposedHonHseveralHaffiliatedHhospitals.



BothHtheHOHCAHandHtheHACEHwouldHallowHsharingHofHPHIHacrossHparticipatingHentityHlinesHforHtreatment,H
payment,HoperationsHpurposesH(TPO).



What'sHaHHybridHEntity?H-HANSWERHHEntityHthatHconductsHbothHcoveredHfunctionsH(orHhealthcare-
functions)HandHnon-coveredHfunctionsH(otherHbiz/non-
healthcareHfunctions)HtoHelectHtoHbeHaH"hybridHentity."



ForHinstance,HaHUniversityHSystemHthatHhasHaHresearchHlaboratoryHorHacademicHmedicalHcenter.

TheHpost-secondaryHfunctionsH(non-healthcareHcomponents)HdoHNOTHneedHtoHcomplyHwithHHIPAA.

TheHresearchHlab/medHcenterHfunctionsH(healthcareHcomponent)HneedsHtoHcomplyHwithHHIPAAHprovisions
HtoHprotectHtheHuse/disclosureHofHPHIHinvolved.




https://www.hhs.gov/hipaa/for-professionals/faq/315/when-does-a-covered-entity-have-discretion-to-
determine-covered-

, functions/index.html#:~:text=For%20example%2C%20a%20hybrid%20entity,hybrid%20entity's%20healt
h%20care%20component.



https://privacyruleandresearch.nih.gov/pr_06.asp



TheHtransmissionHofHinformationHbetweenHtwoHpartiesHtoHcarryHoutHfinancialHorHadministrativeHactivitiesHr
elatedHtoHhealthHcareHisHcalled:H-HANSWERHHTransactionH(healthcareHtransaction).



FewHexamplesHofHhealthcareHtransactions:

healthcareHclaims;

coordinationHofHbenefits;

healthHplanHpremiumHpayments;

remittanceHadviceH(orHETF,HelectronicHfundHtransfer);

referralHcertificationHandHauthorization



WhatHareHexamplesHofHaHBA?H-HANSWERHHBAH(BusinessHAssociate)H-
HperformsHfunctionsHorHactivitiesHonHbehalfHofHaHcoveredHentityHthatHinvolveHaccessHbyHtheHbusinessHassoc

iateHtoHprotectedHhealthHinformation.

Examples:

claimsHprocessing

dataHanalysis

billing

benefitHmanagement

qualityHassurance

qualityHimprovement

practiceHmanagement

legal

actuarial

accounting

accreditation