HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS)
STUDY GUIDE
1. What is the purpose of HIPAA?: • Protect PHI from unauthorized disclosure/use;
• Prevent fraud, waste and abuse (via Administrative Simplification);
• Make health insurance portable under ERISA;
• Move health care onto a nationally standardized electronic billing platform
Ref. https://quizlet.com/6202453/hcca-chpc-overview-flash-cards/ More
on HIPAA: https://www.hhs.gov/hipaa/index.html
2. HIPAA resides in which CFR section?: 45 CFR sections 164.102 through 164.534
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
3. What are the subparts of HIPAA part 164?: HIPAA - 45 CFR 164,
subparts: Subpart A - General rules
Subpart C - Security
Subpart D - Breach notification
Subpart E - Privacy
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
4. How do you determine if an organization is a "Covered Entity"?: 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
,HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS)
STUDY GUIDE
• 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
,HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS)
STUDY GUIDE
In addition, business associates of covered entities must follow parts of the HIPAA regulations.
https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
5. 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.: The Privacy Act of 1974
6. Which of the following is not considered a HIPAA Entity Designation:
1. Affiliated covered entity
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: 4. Contract arrangement with FEDEX carrier
7. What is Gramm-Leach-Bliley Act (GLBA)?: 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.
8. What is an OHCA?: 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 (Aflliated Covered Entity) do not have an Integrated Delivery System because these are legally separate covered
entities that are associated in business, or aflliated 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).
, HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS)
STUDY GUIDE
9. What's an ACE?: ACE (Aflliated 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) ACE example: a health system composed on several aflliated hospitals.
STUDY GUIDE
1. What is the purpose of HIPAA?: • Protect PHI from unauthorized disclosure/use;
• Prevent fraud, waste and abuse (via Administrative Simplification);
• Make health insurance portable under ERISA;
• Move health care onto a nationally standardized electronic billing platform
Ref. https://quizlet.com/6202453/hcca-chpc-overview-flash-cards/ More
on HIPAA: https://www.hhs.gov/hipaa/index.html
2. HIPAA resides in which CFR section?: 45 CFR sections 164.102 through 164.534
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
3. What are the subparts of HIPAA part 164?: HIPAA - 45 CFR 164,
subparts: Subpart A - General rules
Subpart C - Security
Subpart D - Breach notification
Subpart E - Privacy
https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
4. How do you determine if an organization is a "Covered Entity"?: 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
,HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS)
STUDY GUIDE
• 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
,HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS)
STUDY GUIDE
In addition, business associates of covered entities must follow parts of the HIPAA regulations.
https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
5. 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.: The Privacy Act of 1974
6. Which of the following is not considered a HIPAA Entity Designation:
1. Affiliated covered entity
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: 4. Contract arrangement with FEDEX carrier
7. What is Gramm-Leach-Bliley Act (GLBA)?: 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.
8. What is an OHCA?: 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 (Aflliated Covered Entity) do not have an Integrated Delivery System because these are legally separate covered
entities that are associated in business, or aflliated 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).
, HCCA - CHPC STUDY QUESTIONS (MASTER FLASHCARDS)
STUDY GUIDE
9. What's an ACE?: ACE (Aflliated 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) ACE example: a health system composed on several aflliated hospitals.
