HCCA - CHPC Overview
Study online at https://quizlet.com/_3oxud
1. HIPAA became 1996
law
2. What is the pur- • To make health insurance portable under ERISA;
pose of HIPAA? • To move health care onto a nationally standardized electronic billing platform;
and
• To prevent fraud, waste and abuse
3. Intent 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 devel-
opment of a health information system through the establishment of standards
and requirements for the electronic transmission of certain health information.
4. HIPAA resides in 45 CFR sections 164.102 through 164.534
what CFR section
5. Identify the four Section One: 164.102 - 164.318 and 164.530 - 164-534 Organizational Require-
sections in the ments
CFR by location
and topic 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
6. How do you de- - compare the functions of the entity to the three principal types of "covered
termine if organi- entities" (CE),
zation is a CE - determine if the entity electronically transmits one of the nine defined transac-
tions"
7. What are the dif- - Provider
ferent types of - Health Plan
CEs
, HCCA - CHPC Overview
Study online at https://quizlet.com/_3oxud
- Clearing House
- Other Types
8. How is a Provider - "a provider of services (as defined in section 1395x (u) of title XIX)
defined - 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.
9. Does a provider NO
need a standing
facility to be con-
sidered a CE
10. What does An individual or group plan that provides, or pays the cost of, medical care
"Health Plan"
mean? • 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
.
, HCCA - CHPC Overview
Study online at https://quizlet.com/_3oxud
11. What is a Clear- may be a public or private entity that processes
inghouse or facilitates the processing of nonstandard data elements of health information
into standard data
elements.
12. What are other Hybrid, Business Associate
HIPAA Entities Organized Health Care Arrangement
Affiliated Covered Entity
13. What is a Hybrid single legal entity, where
Entity? only some of its divisions or programs meet the
CE definitions and is typical of large entities
14. What is Or- clinically integrated care setting where individuals receive health care from more
ganized Health than one health care provider.
Care Arrange-
ment (OHCA)?
15. What is Affiliated legally distinct entities that share common control or common ownership and
Covered Entity? choose to designate themselves as one affiliated CE for the purposes of complying
with the HIPAA Privacy standard
16. What must a Affil- Be treated as a single CE. Must agree to follow a standard policy and procedure
iated Entity agree
to?
17. What is a Busi- - CE to either get "assurances" for privacy and security standards from their
ness Associate? business partners or to include a BA amendment to a contract.
- where a separate legal entity uses or discloses Individually Identifiable Informa-
tion on behalf of the CE.
18. What are exam- claims processing
ples of a BA? data analysis
Study online at https://quizlet.com/_3oxud
1. HIPAA became 1996
law
2. What is the pur- • To make health insurance portable under ERISA;
pose of HIPAA? • To move health care onto a nationally standardized electronic billing platform;
and
• To prevent fraud, waste and abuse
3. Intent 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 devel-
opment of a health information system through the establishment of standards
and requirements for the electronic transmission of certain health information.
4. HIPAA resides in 45 CFR sections 164.102 through 164.534
what CFR section
5. Identify the four Section One: 164.102 - 164.318 and 164.530 - 164-534 Organizational Require-
sections in the ments
CFR by location
and topic 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
6. How do you de- - compare the functions of the entity to the three principal types of "covered
termine if organi- entities" (CE),
zation is a CE - determine if the entity electronically transmits one of the nine defined transac-
tions"
7. What are the dif- - Provider
ferent types of - Health Plan
CEs
, HCCA - CHPC Overview
Study online at https://quizlet.com/_3oxud
- Clearing House
- Other Types
8. How is a Provider - "a provider of services (as defined in section 1395x (u) of title XIX)
defined - 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.
9. Does a provider NO
need a standing
facility to be con-
sidered a CE
10. What does An individual or group plan that provides, or pays the cost of, medical care
"Health Plan"
mean? • 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
.
, HCCA - CHPC Overview
Study online at https://quizlet.com/_3oxud
11. What is a Clear- may be a public or private entity that processes
inghouse or facilitates the processing of nonstandard data elements of health information
into standard data
elements.
12. What are other Hybrid, Business Associate
HIPAA Entities Organized Health Care Arrangement
Affiliated Covered Entity
13. What is a Hybrid single legal entity, where
Entity? only some of its divisions or programs meet the
CE definitions and is typical of large entities
14. What is Or- clinically integrated care setting where individuals receive health care from more
ganized Health than one health care provider.
Care Arrange-
ment (OHCA)?
15. What is Affiliated legally distinct entities that share common control or common ownership and
Covered Entity? choose to designate themselves as one affiliated CE for the purposes of complying
with the HIPAA Privacy standard
16. What must a Affil- Be treated as a single CE. Must agree to follow a standard policy and procedure
iated Entity agree
to?
17. What is a Busi- - CE to either get "assurances" for privacy and security standards from their
ness Associate? business partners or to include a BA amendment to a contract.
- where a separate legal entity uses or discloses Individually Identifiable Informa-
tion on behalf of the CE.
18. What are exam- claims processing
ples of a BA? data analysis
