HCISPP DOMAIN 1 EXAM QUESTIONS AND ANSWERS
Employer- Sponsored Insurance - CORRECT ANSWER✅✅✅Often called group health insurance, the
employer is responsible for a significant portion of the health care expenses. Group health plans are also
guarantee issue, meaning that a carrier must cover all applicants whose employment qualifies them for
coverage. In addition, these plans typically are able to include a range of plan options from HMO and
PPO plans to additional coverage such as dental, life, and short- and long-term disability.
National Uniform Billing Committee (NUBC) - CORRECT ANSWER✅✅✅a voluntary committee whose
work is coordinated through the offices of the American Hospital Association (AHA) and includes
participation of all the major national provider and payer organizations. The committee was originally
formed to develop a single standard billing format and data set to be used nationwide by institutional
providers and payers for handling health care claims. Today, the Committee monitors and manages the
utilization of this billing form and data set used throughout the industry for billing transactions.
Nationwide Health Information Network Exchange - CORRECT ANSWER✅✅✅is a confederation of
stakeholders at the forefront of health information exchange, including Federal agencies; State,
regional, and local health information organizations; integrated delivery networks, and private
organizations.
HIE governance includes standards, services,
and policies that foster secure health information exchange over the Internet.
National eHealth Collaborative (NeHC) - CORRECT ANSWER✅✅✅has convened the National HIE
Governance Forum at the Office of the National Coordinator for HIT's (ONC) request through ONC's
cooperative agreement with NeHC. One of ONC's governance goals for nationwide health information
exchange is to increase trust among all potential exchange participants in order to mobilize trusted
exchange to support patient health and care.
Metadata - CORRECT ANSWER✅✅✅are generated at various points in the records management life
cycle, providing underlying data to describe the document, specify access controls and rights, provide
retention and disposition instructions, and maintain the record history and audit trail.
Modality - CORRECT ANSWER✅✅✅the channel through which information is transmitted. The main
forms of this include auditory, visual, and tactile.
,Network Management - CORRECT ANSWER✅✅✅monitors network performance and identifies
attacks and failures. Mechanisms include components that enable network administrators to monitor
and restrict resource access.
Office of Civil Rights (OCR) - CORRECT ANSWER✅✅✅the federal agency within HHS with oversight
over HIPAA privacy, security, and breach notification requirements, established a comprehensive audit
protocol that physician practices may wish to consider as they review and update their HIPAA
compliance plans. The their audit protocol contains 170 audit areas (79 Security Rule, 10 Breach
Notification Rule, and 80 Privacy Rule provisions).
This agency's HIPAA Audit program analyzes processes, controls, and policies of selected covered
entities pursuant to the HITECH Act audit mandate. They also established a comprehensive audit
protocol that contains the requirements to be assessed through these performance audits. The entire
audit protocol is organized around modules, representing separate elements of privacy, security, and
breach notification.
Pay for Performance (P4P) - CORRECT ANSWER✅✅✅Also known as, "value-based purchasing," is an
emerging movement in health insurance. Providers under this arrangement are rewarded for meeting
pre-established targets for delivery of health care services. This is a fundamental change from fee-for-
service payment.
Payer - CORRECT ANSWER✅✅✅This term in health care generally refers to entities other than the
patient that finance or reimburse the cost of health services.
Patient Protection and Affordable Care Act of 2010 - CORRECT ANSWER✅✅✅This technical report
catalogues nearly 100 implemented and proposed payment reform programs, classifies each of these
programs into one of 11 payment reform models, and identifies the performance measurement needs
associated with each model. A synthesis of the results suggests near-term priorities for performance
measure development and identifies pertinent challenges related to the use of performance measures
as a basis for payment reform. The report is also intended to create a shared framework for analysis of
future performance measurement opportunities. This report is intended for the many stakeholders
tasked with outlining a national quality strategy in the wake of health care reform legislation.
Organized Health Care Arrangement (OHCA) - CORRECT ANSWER✅✅✅The HIPAA privacy rule also
permits providers that typically provide health care to a common set of patients to designate
themselves as this for purposes of HIPAA. For example, an academic medical center often includes
university-affiliated physicians and a hospital or health system.
, Medicare - CORRECT ANSWER✅✅✅A government program of hospitalization insurance and
voluntary medical insurance for persons aged 65 and over and for certain disabled persons under 65.
Network Security - CORRECT ANSWER✅✅✅This term must protect the computer network and its
services from unauthorized modification, destruction, or disclosure.
Medical Device - CORRECT ANSWER✅✅✅intended for use in the diagnosis of disease or other
conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals.
Types of these include self-care, electronic, diagnostic, surgical, durable medical equipment, acute care,
emergency and trauma, long-term care, storage, and transport.
Integrity - CORRECT ANSWER✅✅✅means maintaining and assuring the accuracy and consistency of
data over its entire life cycle. This means that data cannot be modified in an unauthorized or undetected
manner. This term is violated when a message is actively modified in transit. Information security
systems typically provide this term in messages in addition to data confidentiality.
International Classification of Disease (ICD) - CORRECT ANSWER✅✅✅the most widely recognized
medical classification maintained by the World Health Organization (WHO). Its primary purpose is to
categorize diseases for morbidity and mortality reporting. The United States has used a clinical
modification of this for the additional purposes of reimbursement. The CM in the name means "clinical
modification." It is used by hospitals and other facilities to describe any health challenges a patient has,
from his diagnosis to symptoms to outcomes from treatment, to causes of death. DONT SAY: ICD-10-CM
and ICD-10-PCS group together similar diseases and procedures and organize related entities for easy
retrieval.
Integrating the Healthcare Enterprise (IHE) - CORRECT ANSWER✅✅✅an initiative by health care
professionals and industry to improve the way computer systems in health care share information. This
term promotes the coordinated use of established standards such as DICOM and HL7 to address specific
clinical needs in support of optimal patient care. Systems developed in accordance with this term
communicate with one another better, are easier to implement, and enable care providers to use
information more effectively.
Institutional Review Boards (IRB) - CORRECT ANSWER✅✅✅review plans for research involving
human subjects. Institutions that accept research funding from the federal government must have this
group review all research involving human subjects. The FDA and the Office for Human Research
Employer- Sponsored Insurance - CORRECT ANSWER✅✅✅Often called group health insurance, the
employer is responsible for a significant portion of the health care expenses. Group health plans are also
guarantee issue, meaning that a carrier must cover all applicants whose employment qualifies them for
coverage. In addition, these plans typically are able to include a range of plan options from HMO and
PPO plans to additional coverage such as dental, life, and short- and long-term disability.
National Uniform Billing Committee (NUBC) - CORRECT ANSWER✅✅✅a voluntary committee whose
work is coordinated through the offices of the American Hospital Association (AHA) and includes
participation of all the major national provider and payer organizations. The committee was originally
formed to develop a single standard billing format and data set to be used nationwide by institutional
providers and payers for handling health care claims. Today, the Committee monitors and manages the
utilization of this billing form and data set used throughout the industry for billing transactions.
Nationwide Health Information Network Exchange - CORRECT ANSWER✅✅✅is a confederation of
stakeholders at the forefront of health information exchange, including Federal agencies; State,
regional, and local health information organizations; integrated delivery networks, and private
organizations.
HIE governance includes standards, services,
and policies that foster secure health information exchange over the Internet.
National eHealth Collaborative (NeHC) - CORRECT ANSWER✅✅✅has convened the National HIE
Governance Forum at the Office of the National Coordinator for HIT's (ONC) request through ONC's
cooperative agreement with NeHC. One of ONC's governance goals for nationwide health information
exchange is to increase trust among all potential exchange participants in order to mobilize trusted
exchange to support patient health and care.
Metadata - CORRECT ANSWER✅✅✅are generated at various points in the records management life
cycle, providing underlying data to describe the document, specify access controls and rights, provide
retention and disposition instructions, and maintain the record history and audit trail.
Modality - CORRECT ANSWER✅✅✅the channel through which information is transmitted. The main
forms of this include auditory, visual, and tactile.
,Network Management - CORRECT ANSWER✅✅✅monitors network performance and identifies
attacks and failures. Mechanisms include components that enable network administrators to monitor
and restrict resource access.
Office of Civil Rights (OCR) - CORRECT ANSWER✅✅✅the federal agency within HHS with oversight
over HIPAA privacy, security, and breach notification requirements, established a comprehensive audit
protocol that physician practices may wish to consider as they review and update their HIPAA
compliance plans. The their audit protocol contains 170 audit areas (79 Security Rule, 10 Breach
Notification Rule, and 80 Privacy Rule provisions).
This agency's HIPAA Audit program analyzes processes, controls, and policies of selected covered
entities pursuant to the HITECH Act audit mandate. They also established a comprehensive audit
protocol that contains the requirements to be assessed through these performance audits. The entire
audit protocol is organized around modules, representing separate elements of privacy, security, and
breach notification.
Pay for Performance (P4P) - CORRECT ANSWER✅✅✅Also known as, "value-based purchasing," is an
emerging movement in health insurance. Providers under this arrangement are rewarded for meeting
pre-established targets for delivery of health care services. This is a fundamental change from fee-for-
service payment.
Payer - CORRECT ANSWER✅✅✅This term in health care generally refers to entities other than the
patient that finance or reimburse the cost of health services.
Patient Protection and Affordable Care Act of 2010 - CORRECT ANSWER✅✅✅This technical report
catalogues nearly 100 implemented and proposed payment reform programs, classifies each of these
programs into one of 11 payment reform models, and identifies the performance measurement needs
associated with each model. A synthesis of the results suggests near-term priorities for performance
measure development and identifies pertinent challenges related to the use of performance measures
as a basis for payment reform. The report is also intended to create a shared framework for analysis of
future performance measurement opportunities. This report is intended for the many stakeholders
tasked with outlining a national quality strategy in the wake of health care reform legislation.
Organized Health Care Arrangement (OHCA) - CORRECT ANSWER✅✅✅The HIPAA privacy rule also
permits providers that typically provide health care to a common set of patients to designate
themselves as this for purposes of HIPAA. For example, an academic medical center often includes
university-affiliated physicians and a hospital or health system.
, Medicare - CORRECT ANSWER✅✅✅A government program of hospitalization insurance and
voluntary medical insurance for persons aged 65 and over and for certain disabled persons under 65.
Network Security - CORRECT ANSWER✅✅✅This term must protect the computer network and its
services from unauthorized modification, destruction, or disclosure.
Medical Device - CORRECT ANSWER✅✅✅intended for use in the diagnosis of disease or other
conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals.
Types of these include self-care, electronic, diagnostic, surgical, durable medical equipment, acute care,
emergency and trauma, long-term care, storage, and transport.
Integrity - CORRECT ANSWER✅✅✅means maintaining and assuring the accuracy and consistency of
data over its entire life cycle. This means that data cannot be modified in an unauthorized or undetected
manner. This term is violated when a message is actively modified in transit. Information security
systems typically provide this term in messages in addition to data confidentiality.
International Classification of Disease (ICD) - CORRECT ANSWER✅✅✅the most widely recognized
medical classification maintained by the World Health Organization (WHO). Its primary purpose is to
categorize diseases for morbidity and mortality reporting. The United States has used a clinical
modification of this for the additional purposes of reimbursement. The CM in the name means "clinical
modification." It is used by hospitals and other facilities to describe any health challenges a patient has,
from his diagnosis to symptoms to outcomes from treatment, to causes of death. DONT SAY: ICD-10-CM
and ICD-10-PCS group together similar diseases and procedures and organize related entities for easy
retrieval.
Integrating the Healthcare Enterprise (IHE) - CORRECT ANSWER✅✅✅an initiative by health care
professionals and industry to improve the way computer systems in health care share information. This
term promotes the coordinated use of established standards such as DICOM and HL7 to address specific
clinical needs in support of optimal patient care. Systems developed in accordance with this term
communicate with one another better, are easier to implement, and enable care providers to use
information more effectively.
Institutional Review Boards (IRB) - CORRECT ANSWER✅✅✅review plans for research involving
human subjects. Institutions that accept research funding from the federal government must have this
group review all research involving human subjects. The FDA and the Office for Human Research
