HCCA - CHPC Overview questions and
answers
HIPAA became law✔✔1996
What is the purpose of HIPAA?✔✔• 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✔✔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✔✔45 CFR sections 164.102 through 164.534
Identify the four sections in the CFR by location and topic✔✔Section One: 164.102 -
164.318 and 164.530 - 164-534 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✔✔- 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✔✔- Provider
- Health Plan
- Clearing House
- Other Types
How is a Provider defined✔✔- "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✔✔NO
What does "Health Plan" mean?✔✔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✔✔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✔✔Hybrid, Business Associate
Organized Health Care Arrangement
Affiliated Covered Entity
What is a Hybrid Entity?✔✔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)?✔✔clinically integrated care
setting where individuals receive health care from more than one health care
provider.
What is Affiliated Covered Entity?✔✔legally distinct entities that share common
control or common ownership and choose to designate themselves as one affiliated
CE for the purposes of complying with the HIPAA Privacy standard
What must a Affiliated Entity agree to?✔✔Be treated as a single CE. Must agree to
follow a standard policy and procedure
What is a Business Associate?✔✔- CE to either get "assurances" for privacy and
security standards from their business partners or to include a BA amendment to a
contract.
- where a separate legal entity uses or discloses Individually Identifiable Information
on behalf of the CE.
answers
HIPAA became law✔✔1996
What is the purpose of HIPAA?✔✔• 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✔✔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✔✔45 CFR sections 164.102 through 164.534
Identify the four sections in the CFR by location and topic✔✔Section One: 164.102 -
164.318 and 164.530 - 164-534 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✔✔- 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✔✔- Provider
- Health Plan
- Clearing House
- Other Types
How is a Provider defined✔✔- "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✔✔NO
What does "Health Plan" mean?✔✔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✔✔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✔✔Hybrid, Business Associate
Organized Health Care Arrangement
Affiliated Covered Entity
What is a Hybrid Entity?✔✔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)?✔✔clinically integrated care
setting where individuals receive health care from more than one health care
provider.
What is Affiliated Covered Entity?✔✔legally distinct entities that share common
control or common ownership and choose to designate themselves as one affiliated
CE for the purposes of complying with the HIPAA Privacy standard
What must a Affiliated Entity agree to?✔✔Be treated as a single CE. Must agree to
follow a standard policy and procedure
What is a Business Associate?✔✔- CE to either get "assurances" for privacy and
security standards from their business partners or to include a BA amendment to a
contract.
- where a separate legal entity uses or discloses Individually Identifiable Information
on behalf of the CE.
