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HCCA - CHPC Overview Latest 2023 Graded A+ $16.49   Add to cart

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HCCA - CHPC Overview Latest 2023 Graded A+

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HIPAA became law 1996 What is the purpose of HIPAA? • 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 purpose of this subtitle to improve the Medicare program un...

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  • October 20, 2023
  • 28
  • 2023/2024
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HCCA - CHPC Overview Latest 2023
Graded A+
HIPAA became law ✔✔1996




What is the purpose of HIPAA? ✔✔• 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 ✔✔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 ✔✔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),

- determine if the entity electronically transmits one of the nine defined transactions"




What are the different types of CEs ✔✔- Provider


- Health Plan

- Clearing House

- Other Types




How is a Provider defined ✔✔- "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 ✔✔NO




What does "Health Plan" mean? ✔✔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

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