1
HCCA - CHPC Exam 3 Questions
and Answers Top Rated A Latest
Versions 2025
What are the subparts of HIPAA part 164? - ANSWER HIPAA - 45
CFR 164, subparts:
Subpart A - General rules
Subpart C - Security
Subpart D - Breach notification
Subpart E - Privacy
7
How do you determine if an organization is a "Covered Entity"? -
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
In addition, business associates of covered entities must follow parts
,of the HIPAA regulations.
This Act established in 1974 was created for government agencies
placing restrictions on how the government can share the
information maintained in Federal systems of records that might
infringe on an individual's privacy rights with other individuals and
agencies. - ANSWER The Privacy Act of 1974
Which of the following is not considered a HIPAA Entity
Designation:
1. Affiliated covered entity
8
2. Entity that performs healthcare and non-healthcare component
activities including both covered and non-covered functions
3. A group health plan
4. Contract arrangement with FEDEX carrier - ANSWER 4. Contract
arrangement with FEDEX carrier
What is Gramm-Leach-Bliley Act (GLBA)? - ANSWER Gramm-Leach-
Bliley Act (GLBA), also known as the Financial Services
Modernization Act of 1999, includes The Financial Privacy Rule and
The Safeguards Rule requires all financial institutions to protect
customer's personal financial information.
What is an OHCA? - ANSWER OHCA (Organized Health Care
Arrangement) it's a clinically integrated care setting where
individuals receive health care from more than one provider.
These are joint arrangements/activities and have an Integrated
Delivery System for easy exchange of PHI data. See 45 CFR 160.103.
OHCAs can also utilize a joint NPP. See 45 CFR § 164.520(d).
ACE (Affiliated Covered Entity) do not have an Integrated Delivery
System because these are legally separate covered entities that are
associated in business, or affiliated as a result of some common
control or ownership.
Both the OHCA and the ACE would allow sharing of PHI across
participating entity lines for treatment, payment, operations
,purposes (TPO).
What's an ACE? - ANSWER ACE (Affiliated Covered Entity)
Legally separate covered entities that share common
control/ownership and designate themselves as a single CE for the
purpose of complying with the HIPAA Privacy standards.
ACEs do not have an Integrated Delivery System, while OHCA do,
and can share a single NPP. See 45 CFR § 164.520(d)
9
ACE example: a health system composed on several affiliated
hospitals.
Both the OHCA and the ACE would allow sharing of PHI across
participating entity lines for treatment, payment, operations
purposes (TPO).
What's a Hybrid Entity? - ANSWER Entity that conducts both
covered functions (or healthcare-functions) and non-covered
functions (other biz/non-healthcare functions) to elect to be a
"hybrid entity."
For instance, a University System that has a research laboratory or
academic medical center.
The post-secondary functions (non-healthcare components) do NOT
need to comply with HIPAA.
The research lab/med center functions (healthcare component)
needs to comply with HIPAA provisions to protect the
use/disclosure of PHI involved.
The transmission of information between two parties to carry out
financial or administrative activities related to health care is called: -
ANSWER Transaction (healthcare transaction).
Few examples of healthcare transactions:
healthcare claims;
, 10
coordination of benefits;
health plan premium payments;
remittance advice (or ETF, electronic fund transfer);
referral certification and authorization
What are examples of a BA? - ANSWER BA (Business Associate) -
performs functions or activities on behalf of a covered entity that
involve access by the business associate to protected health
information.
Examples:
claims processing
data analysis
billing
benefit management
quality assurance
quality improvement
practice management
legal
actuarial
accounting
accreditation
other administrative services
True or False:
A hospital is not required to have a business associate contract with
the specialist to whom it refers a patient and transmits the patient's
medical chart for treatment purposes. - ANSWER TRUE
Remember, use and disclosure of PHI for purposes of TPO requires
no specific authorization
True or False:
HCCA - CHPC Exam 3 Questions
and Answers Top Rated A Latest
Versions 2025
What are the subparts of HIPAA part 164? - ANSWER HIPAA - 45
CFR 164, subparts:
Subpart A - General rules
Subpart C - Security
Subpart D - Breach notification
Subpart E - Privacy
7
How do you determine if an organization is a "Covered Entity"? -
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
In addition, business associates of covered entities must follow parts
,of the HIPAA regulations.
This Act established in 1974 was created for government agencies
placing restrictions on how the government can share the
information maintained in Federal systems of records that might
infringe on an individual's privacy rights with other individuals and
agencies. - ANSWER The Privacy Act of 1974
Which of the following is not considered a HIPAA Entity
Designation:
1. Affiliated covered entity
8
2. Entity that performs healthcare and non-healthcare component
activities including both covered and non-covered functions
3. A group health plan
4. Contract arrangement with FEDEX carrier - ANSWER 4. Contract
arrangement with FEDEX carrier
What is Gramm-Leach-Bliley Act (GLBA)? - ANSWER Gramm-Leach-
Bliley Act (GLBA), also known as the Financial Services
Modernization Act of 1999, includes The Financial Privacy Rule and
The Safeguards Rule requires all financial institutions to protect
customer's personal financial information.
What is an OHCA? - ANSWER OHCA (Organized Health Care
Arrangement) it's a clinically integrated care setting where
individuals receive health care from more than one provider.
These are joint arrangements/activities and have an Integrated
Delivery System for easy exchange of PHI data. See 45 CFR 160.103.
OHCAs can also utilize a joint NPP. See 45 CFR § 164.520(d).
ACE (Affiliated Covered Entity) do not have an Integrated Delivery
System because these are legally separate covered entities that are
associated in business, or affiliated as a result of some common
control or ownership.
Both the OHCA and the ACE would allow sharing of PHI across
participating entity lines for treatment, payment, operations
,purposes (TPO).
What's an ACE? - ANSWER ACE (Affiliated Covered Entity)
Legally separate covered entities that share common
control/ownership and designate themselves as a single CE for the
purpose of complying with the HIPAA Privacy standards.
ACEs do not have an Integrated Delivery System, while OHCA do,
and can share a single NPP. See 45 CFR § 164.520(d)
9
ACE example: a health system composed on several affiliated
hospitals.
Both the OHCA and the ACE would allow sharing of PHI across
participating entity lines for treatment, payment, operations
purposes (TPO).
What's a Hybrid Entity? - ANSWER Entity that conducts both
covered functions (or healthcare-functions) and non-covered
functions (other biz/non-healthcare functions) to elect to be a
"hybrid entity."
For instance, a University System that has a research laboratory or
academic medical center.
The post-secondary functions (non-healthcare components) do NOT
need to comply with HIPAA.
The research lab/med center functions (healthcare component)
needs to comply with HIPAA provisions to protect the
use/disclosure of PHI involved.
The transmission of information between two parties to carry out
financial or administrative activities related to health care is called: -
ANSWER Transaction (healthcare transaction).
Few examples of healthcare transactions:
healthcare claims;
, 10
coordination of benefits;
health plan premium payments;
remittance advice (or ETF, electronic fund transfer);
referral certification and authorization
What are examples of a BA? - ANSWER BA (Business Associate) -
performs functions or activities on behalf of a covered entity that
involve access by the business associate to protected health
information.
Examples:
claims processing
data analysis
billing
benefit management
quality assurance
quality improvement
practice management
legal
actuarial
accounting
accreditation
other administrative services
True or False:
A hospital is not required to have a business associate contract with
the specialist to whom it refers a patient and transmits the patient's
medical chart for treatment purposes. - ANSWER TRUE
Remember, use and disclosure of PHI for purposes of TPO requires
no specific authorization
True or False:
