HCCA CHC – HIPAA exam 1 questions
and answers
Education & training: When designing curriculum for the audit learner✔✔Understand
whether the concepts or ideas will be in concert or in conflict with the learner.
If State law is more/less strict than HIPAA✔✔The more strict law governs
HIPAA stands for✔✔Health Insurance Portability and Accountability Act of 1996
HIPAA is enforced by✔✔OCR, CMS & DOJ
HIPAA General Rule 164.502✔✔A covered entity may not use or disclose protected
health information, except as permitted or required.
HIPAA Covered Entities (160.103)✔✔Health Plans, Providers (including SNFs,
hospitals, clinics, etc.), and Clearlinghouses
HIPAA Use (160.103)✔✔With respect to individually identifiable health information,
the sharing, employment, application, utilization, examination, or analysis of such
information within an entity that maintains such information.
HIPAA Disclosure (160.103)✔✔The release, transfer, provision of, access to, or
divulging in any other manner of information outside the entity holding the
information.
HIPAA Protected Health Information (PHI) (160.103)✔✔Relates to past, present or
future physical or mental health or condition of an individual, provision of health care
to an individual, or payment for the provision of health care to an individual. ALSO, is
there reasonable basis to believe the information can be used to identify an
individual?
Use & Disclosure required by law✔✔2 mandatory disclosures: to the patient with
some exceptions, to the Secretary of DHHS to investigate and alleged privacy
violation
Scenario: A neurologist in Tampa has a patient with a confusing presentation and
would like to get a second opinion. Recently, the neurologist met a retired
neurosurgeon from Michigan who specialized in unusual cases similar to this. The
neurologist would like to talk with the retired neurosurgeon from Michigan. Does the
Payment, Treatment, or Health Operations exception apply?✔✔No, no HIPAA
application because there is no PHI.
Payment, Treatment and Healthcare Operations examples✔✔1) provider can
discuss patient case with colleagues to determine the best course of treatment 2)
health plan can share information with a nursing home regarding payment for
services 3) compliance officer can obtain charts for compliance audits
and answers
Education & training: When designing curriculum for the audit learner✔✔Understand
whether the concepts or ideas will be in concert or in conflict with the learner.
If State law is more/less strict than HIPAA✔✔The more strict law governs
HIPAA stands for✔✔Health Insurance Portability and Accountability Act of 1996
HIPAA is enforced by✔✔OCR, CMS & DOJ
HIPAA General Rule 164.502✔✔A covered entity may not use or disclose protected
health information, except as permitted or required.
HIPAA Covered Entities (160.103)✔✔Health Plans, Providers (including SNFs,
hospitals, clinics, etc.), and Clearlinghouses
HIPAA Use (160.103)✔✔With respect to individually identifiable health information,
the sharing, employment, application, utilization, examination, or analysis of such
information within an entity that maintains such information.
HIPAA Disclosure (160.103)✔✔The release, transfer, provision of, access to, or
divulging in any other manner of information outside the entity holding the
information.
HIPAA Protected Health Information (PHI) (160.103)✔✔Relates to past, present or
future physical or mental health or condition of an individual, provision of health care
to an individual, or payment for the provision of health care to an individual. ALSO, is
there reasonable basis to believe the information can be used to identify an
individual?
Use & Disclosure required by law✔✔2 mandatory disclosures: to the patient with
some exceptions, to the Secretary of DHHS to investigate and alleged privacy
violation
Scenario: A neurologist in Tampa has a patient with a confusing presentation and
would like to get a second opinion. Recently, the neurologist met a retired
neurosurgeon from Michigan who specialized in unusual cases similar to this. The
neurologist would like to talk with the retired neurosurgeon from Michigan. Does the
Payment, Treatment, or Health Operations exception apply?✔✔No, no HIPAA
application because there is no PHI.
Payment, Treatment and Healthcare Operations examples✔✔1) provider can
discuss patient case with colleagues to determine the best course of treatment 2)
health plan can share information with a nursing home regarding payment for
services 3) compliance officer can obtain charts for compliance audits
