How do you determine if an organization is a "Covered Entity"? - ANSWER--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 Guide - 300 Questions And
Answers 100% Verified
• 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
In addition, business associates of covered entities must follow parts of the HIPAA regulations.
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. - ANSWER--The Privacy Act of 1974
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 - ANSWER--4. Contract arrangement with FEDEX carrier
What is Gramm-Leach-Bliley Act (GLBA)? - ANSWER--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.
What is an OHCA? - ANSWER--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).
, HCCA - CHPC Study Guide - 300 Questions And
Answers 100% Verified
ACE (Affiliated Covered Entity) do not have an Integrated Delivery System because these are legally
separate covered entities that are associated in business, or affiliated 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).
What's an ACE? - ANSWER--ACE (Affiliated 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 affiliated hospitals.
Both the OHCA and the ACE would allow sharing of PHI across participating entity lines for treatment,
payment, operations purposes (TPO).
What's a Hybrid Entity? - ANSWER--Entity that conducts both covered functions (or healthcare-
functions) and non-covered functions (other biz/non-healthcare functions) to elect to be a "hybrid
entity."
For instance, a University System that has a research laboratory or academic medical center.
The post-secondary functions (non-healthcare components) do NOT need to comply with HIPAA.
The research lab/med center functions (healthcare component) needs to comply with HIPAA provisions
to protect the use/disclosure of PHI involved.
The transmission of information between two parties to carry out financial or administrative activities
related to health care is called: - ANSWER--Transaction (healthcare transaction).
Few examples of healthcare transactions:
healthcare claims;
coordination of benefits;
health plan premium payments;
remittance advice (or ETF, electronic fund transfer);
referral certification and authorization
What are examples of a BA? - ANSWER--BA (Business Associate) - performs functions or activities on
behalf of a covered entity that involve access by the business associate to protected health information.
Examples:
claims processing
data analysis
billing
benefit management
quality assurance
quality improvement
practice management
legal
actuarial
accounting
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