1
HCCA–CHPC Exam 2026: Actual Exam &
Study Guide with Complete Questions and
Detailed Answers
HIPAA became law - ANSWER 1996
What is the purpose of HIPAA? - ANSWER • 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 - ANSWER 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 - ANSWER 45 CFR sections 164.102
through 164.534
Identify the four sections in the CFR by location and topic - ANSWER 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 - ANSWER - 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 - ANSWER - Provider
, 2
- Health Plan
- Clearing House
- Other Types
How is a Provider defined - ANSWER - "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 - ANSWER NO
What does "Health Plan" mean? - ANSWER 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 - ANSWER may be a public or private entity that
processes
or facilitates the processing of nonstandard data elements of health information
into standard data
elements.
, 3
What are other HIPAA Entities - ANSWER Hybrid, Business Associate
Organized Health Care Arrangement
Affiliated Covered Entity
What is a Hybrid Entity? - ANSWER 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)? - ANSWER clinically
integrated care setting where individuals receive health care from more than one
health care provider.
What is Affiliated Covered Entity? - ANSWER 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? - ANSWER Be treated as a single CE.
Must agree to follow a standard policy and procedure
What is a Business Associate? - ANSWER - 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.
What are examples of a BA? - ANSWER claims processing
data analysis
billing
benefit management
quality assurance
quality improvement
practice management
legal
actuarial
accounting
accreditation
other administrative services
What has been the main complaint with holding a BA accountable under the 2000
Privacy Rule? - ANSWER - lack of penalties for non-compliance
, 4
- federal penalties could only be levied against the CE
Which new regulation corrected shot comings of the HIPAA 2000 regulation
concerning BAs? - ANSWER Health Information Technology
for Economic and Clinical Health (HITECH)
Who is know responsible for privacy and security of BAs? - ANSWER The
Business Associate, legal liability for violations, and possible penalties, flow
directly to the entity that violates.
What nine transaction are used to determine if a organization is a CE? - ANSWER
• 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
What format must information be to determine if it is covered? - ANSWER any
format - electronic or papaer
What is Information? - ANSWER every piece of
information your entity has in its possession or
has access too.
What is Health Information? - ANSWER any information, whether oral or
recorded in any form or medium, that is created or received by a health care
provider, health plan, public health authority, employer, life insurer, school or
university, or health care clearinghouse, and relates to the past, present, or future
physical or mental health or condition of an individual. This includes the provision
of health care to an individual, or the past, present, or future payment for the
provision of health care to an individual.
What is Individually Identifiable Health Information
(IIHI)? - ANSWER information that is a subset
of health information, including demographic
HCCA–CHPC Exam 2026: Actual Exam &
Study Guide with Complete Questions and
Detailed Answers
HIPAA became law - ANSWER 1996
What is the purpose of HIPAA? - ANSWER • 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 - ANSWER 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 - ANSWER 45 CFR sections 164.102
through 164.534
Identify the four sections in the CFR by location and topic - ANSWER 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 - ANSWER - 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 - ANSWER - Provider
, 2
- Health Plan
- Clearing House
- Other Types
How is a Provider defined - ANSWER - "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 - ANSWER NO
What does "Health Plan" mean? - ANSWER 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 - ANSWER may be a public or private entity that
processes
or facilitates the processing of nonstandard data elements of health information
into standard data
elements.
, 3
What are other HIPAA Entities - ANSWER Hybrid, Business Associate
Organized Health Care Arrangement
Affiliated Covered Entity
What is a Hybrid Entity? - ANSWER 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)? - ANSWER clinically
integrated care setting where individuals receive health care from more than one
health care provider.
What is Affiliated Covered Entity? - ANSWER 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? - ANSWER Be treated as a single CE.
Must agree to follow a standard policy and procedure
What is a Business Associate? - ANSWER - 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.
What are examples of a BA? - ANSWER claims processing
data analysis
billing
benefit management
quality assurance
quality improvement
practice management
legal
actuarial
accounting
accreditation
other administrative services
What has been the main complaint with holding a BA accountable under the 2000
Privacy Rule? - ANSWER - lack of penalties for non-compliance
, 4
- federal penalties could only be levied against the CE
Which new regulation corrected shot comings of the HIPAA 2000 regulation
concerning BAs? - ANSWER Health Information Technology
for Economic and Clinical Health (HITECH)
Who is know responsible for privacy and security of BAs? - ANSWER The
Business Associate, legal liability for violations, and possible penalties, flow
directly to the entity that violates.
What nine transaction are used to determine if a organization is a CE? - ANSWER
• 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
What format must information be to determine if it is covered? - ANSWER any
format - electronic or papaer
What is Information? - ANSWER every piece of
information your entity has in its possession or
has access too.
What is Health Information? - ANSWER any information, whether oral or
recorded in any form or medium, that is created or received by a health care
provider, health plan, public health authority, employer, life insurer, school or
university, or health care clearinghouse, and relates to the past, present, or future
physical or mental health or condition of an individual. This includes the provision
of health care to an individual, or the past, present, or future payment for the
provision of health care to an individual.
What is Individually Identifiable Health Information
(IIHI)? - ANSWER information that is a subset
of health information, including demographic
