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HCCA - CHPC Study Detailed Questions And Expert Answers
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HCCA - CHPC Study Detailed Questions And Expert Answers
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HCCA - CHPC Study Detailed Questions AndExpert Answers
What is the purpose of HIPAA? • Protect PHI from unauthorized disclosure/use;
• Prevent fraud, waste and abuse (via Administrative Simplification);
• Make health insurance portable under ERISA;
• Move health care onto a nationally standardized electronic billing platform
HIPAA resides in which CFR section? 45 CFR sections 164.102 through 164.534
What are the subparts of HIPAA part 164? HIPAA - 45 CFR 164, subparts:
Subpart A - General rules
Subpart C - Security
Subpart D - Breach notification
Subpart E - Privacy
How do you determine if an organization is a "Covered Entity"? 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
• 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. 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 4. Contract arrangement with FEDEX
carrier
What is Gramm-Leach-Bliley Act (GLBA)? 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? 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).
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? 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? 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.
https://www.hhs.gov/hipaa/for-professionals/faq/315/when-does-a-covered-
entity-have-discretion-to-determine-covered-functions/index.html#:~:text=For
%20example%2C%20a%20hybrid%20entity,hybrid%20entity's%20health%20care
%20component.
https://privacyruleandresearch.nih.gov/pr_06.asp
The transmission of information between two parties to carry out financial or
administrative activities related to health care is called: Transaction (healthcare
transaction).
Few examples of healthcare transactions:
healthcare claims;
coordination of benefits;
health plan premium payments;
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