HCCA CHC Exam Prep Questions with Answers
Protected Health Information - Answer-Information that
1. relates to past, present, or current condition, treatment/care, or payment.
2. Reasonably identifiable
3. Maintained in any form by CE.
De-identified PHI - Answer-excludes all 18 identif...
Protected Health Information - Answer-Information that
1. relates to past, present, or current condition, treatment/care, or payment.
2. Reasonably identifiable
3. Maintained in any form by CE.
De-identified PHI - Answer-excludes all 18 identifiers
Policy - Answer-General guideline or guiding prinicple
Procedure - Answer-How to implement a policy / process
Genetic Information Nondiscrimination Act (GINA) - Answer-U.S act that prohibits
discrimination against individuals on the basis of their genetic information in both
employment and health insurance.
ERISA (Employee Retirement Income Security Act) - Answer-Federal law that sets
minimum standards for most voluntarily established pension and health plans in private
industry to provide protection for individuals in these plans.
Sarbanes-Oxley Act - Answer-Federal legislation passed in 2002 that sets higher ethical
standards for public corporations and accounting firms. Key provisions limit conflict-of-
interest issues and require financial officers and CEOs to certify the validity of their
financial statements.
Yates Memo - Answer-Establishes need for individual accountability - that then cycles
upwards through management.
Baseline Audit - Answer-a systemic inspection of records, polices, and procedures with
the goal to establish a set of benchmarks for comparison of future inspections.
Concurrent Audit - Answer-An inspection of records, polices, and procedures at a given
point in time which identified potential problems are audited as they arise.
Retrospective Audit - Answer-An audit of historical events.
Balanced Budget Act of 1997 - Answer-Legislation containing major reform of the
Medicare and Medicaid programs especially in the areas of home health and patient
, transfers. Mandated permanent exclusion from participation in feudally funded health
care program (3 strikes you're out).
Caremark International Derivative Litigation - Answer-settlement of Caremark
international in which an imposed CIA precluded Caremark from providing health care in
certain forms for 5 years. Suggests failure of corporate director to attempt in good faith
to institute compliance and ethics program may be a breach of fiduciary obligation.
Civil Monetary Penalties Law - Answer-Regulations which apply to any claims for an
item or service that was not provided as claimed or that was knowingly submitted as
false which provides guidelines for the levying of fines for such offenses
Corporate Integrity Agreement - Answer-a negotiated settlement between organization
and the government in which the provider accepts no liability but will implement a strict
plan of government-supervised corrective action.
Culpability Score - Answer-Part of the federal sentencing guidelines, a system that adds
points for aggravating factors and subtracts points for mitigating factors that then
determine fine. Mitigating factors: the existence of an effective compliance and ethics
program; and self-reporting, cooperation, or acceptance of responsibility.
Equal Employment Opportunity Commission - Answer-U.S. agency created to end
discrimination based on race, religion, sex or national origin - they review and
investigate charges of discrimination.
Fiscal Intermediary - Answer-A person or organization, under agreement with HHS,
processes claims, provides services, or issues payments on behalf of private, federal,
and state benefit programs.
General Services Administration - Answer-the federal agency that manages the federal
governments property and records.
HITECH - Answer-Privacy laws related to electronic transmission of health information.
designed to encourage health care providers to adopt health information technology that
establish EHRs in a standardized manner that protects PHI. O
Occupational Safety and Health Administration (OSHA) - Answer-A comment of DOL,
that develops and administers standards related to well-being of workers.
OCR (Office of Civil Rights) - Answer-Component of DHHS, teaches workers bout
health information privacy, confidentiality laws, and investigates civil rights, health info
privacy compliance, and then enforces those regulations (Civilly).
safe harbors - Answer-explicit regulatory exceptions to otherwise legally prohibited
conduct - they specify certain joint ventures and arrangements that do not violate laws.
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