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What date did HIPAA became law - 1996
What is the purpose of HIPAA? - 1. Protect individuals' PHI
2. Promote high quality healthcare
3. Protect the public's health and well being
HIPAA resides in what CFR section - 45 CFR sections 164.102 through 164.534
Identify the four sections in the CFR by location and topic - 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 - compare the functions of the entity to the three
principal types of "covered entities" (CE)
What are the different types of CEs - - Provider
- Health Plan
- Clearing House
- Other Types
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,How is a Provider defined - Supports medical or health services such as SNFs, home health, hospitals,
physician clinics, etc that transmit in electronic form
Does a provider need a standing facility to be considered a CE - No, a provider does not need a
standing facility to be considered a CE
What is a Health Plan - (1) A healthcare organization that provides or pays the cost of medical care
(2) Includes Medicaid, Medicare, and self funded plans
What is a Clearinghouse - (1) processes health information from a nonstandard data elements of
health information into standard data
elements
(2) includes billing services, health information systems, etc
(3) does NOT include Third Party Administrations ( TPAs)
What are the three Organizational Arrangements - Organized Health Care Arrangement (OHCA)
Affiliated Covered Entities (ACE)
Hybrid Covered Entity (HCE)
What is a Hybrid Covered Entity (HCE) - single covered entity with non-health care components
What is an Organized Health Care Arrangement (OHCA)? - clinically integrated care setting where
individuals receive health care from more than one covered entity
What is an Affiliated Covered Entity (ACE)? - (1) legally separate covered entities that share common
control or common ownership
(2) choose to designate themselves as one affiliated CE for the purposes of complying with the HIPAA
Privacy standard
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, What must a Affiliated Entity agree to? - Be treated as a single CE. Must agree to follow a standard
policy and procedure
What is a Business Associate? - (1) Separate entity working on behalf of the CE providing Treatment,
Payment, and Healthcare Operations (TPO) and/or associated activities requiring access and/or will
create, receive, maintain, and/or transmit PHI
(2) Must have a business associate agreement
Who is allowed to access PHI? - (1) Workforce: employees, volunteers, trainees, and others under
control of the CE
(2) Business Associates: Separate entity working on behalf of the CE providing Treatment, Payment,
and Healthcare Operations (TPO) and/or associated activities requiring access and/or use of PHI
What is an example of a BA? - 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? - -
lack of penalties for non-compliance
- federal penalties could only be levied against the CE
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