CDEO - CHAPTER 2 EXAM
QUESTIONS WITH CORRECT
ANSWERS
Health Insurance Portability and Accountability Act of 1996 - Correct Answers -(HIPAA)
August 21, 1996 - Correct Answers -HIPAA was enacted on _________.
Kennedy-Kassebaum - Correct Answers -HIPAA aka as ______ bill, was originally
enacted to provide rights and protections for participants and beneficiaries of group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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -_____ issued a privacy rule to set a national standard for the
protection of certain health information.
Privacy Rule - Correct Answers -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. -
Correct Answers -
,flexible, comprehensive - Correct Answers -The Privacy Rule was designed to be
______ and ______, to allow for the various uses and disclosures the healthcare
community must address.
All - Correct Answers -____ covered entities are required to follow the Privacy Rule.
plans, clearinghouses, provider - Correct Answers -Covered entities are defined as
health _____, healthcare ________, and any healthcare _________ who transmits
health
information in an electronic format. - Correct Answers -
plan - Correct Answers -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 - Correct Answers -
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. - Correct Answers -
providers - Correct Answers -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 - Correct Answers -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 - Correct Answers -_______ occur through electronic exchanges, which
allow information to be transferred between two parties for specific purposes.
plan - Correct Answers -A healthcare provider will send a claim to a health _____ to
request payment for the medical services he or she provides.
HIPAA - Correct Answers -_____ 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.
HIPAA - Correct Answers -Under _______, electronic transactions must use the
adopted standard and adhere to the content and format requirements of ASC X12N or
NCPDP (used for certain pharmacy transactions) for each transaction. An additional
rule was adopted to standardize the code sets for diagnoses and procedures. These
code sets include: HCPCS (Healthcare Common Procedure Coding System—ancillary
services and procedures); CPT® (Current Procedural Terminology—physician's
procedures); CDT® (Current Dental Terminology—dental procedures); ICD-9
(International Classification of Diseases-9th revision— diagnosis and inpatient hospital
procedures); ICD-10 (International Classification of Diseases-10th Revision, which
replaced ICD-9 on October 1, 2015); and NDC (National Drug Codes).
unique identifier - Correct Answers -In addition to the standardization of the codes used
to request payment for medical services, a _______ for employers and providers must
be used on all transactions.
Business associates - Correct Answers -_______ perform certain functions or activities,
which involve the use or disclosure of individually identifiable health information, on
behalf of another person or organization, without being a member of the entity's
workforce. These services include claims processing or administration, data analysis,
utilization review, billing, benefit management, and re-pricing.
Business - Correct Answers -_______ associate services to a covered entity are limited
to legal, actuarial, accounting, consulting, data aggregation, management,
administrative, accreditation, or financial services.
protected health information - Correct Answers -To be considered a business associate,
the persons or organizations would involve the use or disclosure of ________ between
the two parties.
can - Correct Answers -A covered entity ____ be a business associate of another
covered entity.
QUESTIONS WITH CORRECT
ANSWERS
Health Insurance Portability and Accountability Act of 1996 - Correct Answers -(HIPAA)
August 21, 1996 - Correct Answers -HIPAA was enacted on _________.
Kennedy-Kassebaum - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -_____ issued a privacy rule to set a national standard for the
protection of certain health information.
Privacy Rule - Correct Answers -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. -
Correct Answers -
,flexible, comprehensive - Correct Answers -The Privacy Rule was designed to be
______ and ______, to allow for the various uses and disclosures the healthcare
community must address.
All - Correct Answers -____ covered entities are required to follow the Privacy Rule.
plans, clearinghouses, provider - Correct Answers -Covered entities are defined as
health _____, healthcare ________, and any healthcare _________ who transmits
health
information in an electronic format. - Correct Answers -
plan - Correct Answers -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 - Correct Answers -
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. - Correct Answers -
providers - Correct Answers -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 - Correct Answers -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 - Correct Answers -_______ occur through electronic exchanges, which
allow information to be transferred between two parties for specific purposes.
plan - Correct Answers -A healthcare provider will send a claim to a health _____ to
request payment for the medical services he or she provides.
HIPAA - Correct Answers -_____ 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.
HIPAA - Correct Answers -Under _______, electronic transactions must use the
adopted standard and adhere to the content and format requirements of ASC X12N or
NCPDP (used for certain pharmacy transactions) for each transaction. An additional
rule was adopted to standardize the code sets for diagnoses and procedures. These
code sets include: HCPCS (Healthcare Common Procedure Coding System—ancillary
services and procedures); CPT® (Current Procedural Terminology—physician's
procedures); CDT® (Current Dental Terminology—dental procedures); ICD-9
(International Classification of Diseases-9th revision— diagnosis and inpatient hospital
procedures); ICD-10 (International Classification of Diseases-10th Revision, which
replaced ICD-9 on October 1, 2015); and NDC (National Drug Codes).
unique identifier - Correct Answers -In addition to the standardization of the codes used
to request payment for medical services, a _______ for employers and providers must
be used on all transactions.
Business associates - Correct Answers -_______ perform certain functions or activities,
which involve the use or disclosure of individually identifiable health information, on
behalf of another person or organization, without being a member of the entity's
workforce. These services include claims processing or administration, data analysis,
utilization review, billing, benefit management, and re-pricing.
Business - Correct Answers -_______ associate services to a covered entity are limited
to legal, actuarial, accounting, consulting, data aggregation, management,
administrative, accreditation, or financial services.
protected health information - Correct Answers -To be considered a business associate,
the persons or organizations would involve the use or disclosure of ________ between
the two parties.
can - Correct Answers -A covered entity ____ be a business associate of another
covered entity.
