Exam (elaborations)
HIPAA Questions & Detailed Answers 2024
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HIPAA Questions & Detailed Answers 2024
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"HIPAA"Business Associate - correct answer A person or organization that performs a function
or activity on behalf of a covered entity, but is not part of the covered entity itself.
Business associates, such as law firms and countenance must adhere to HIPAA
standards in order to do business with a covered entity.
Centers For Medicare and Medicaid Services (CMS) (Formaly known as HCFA) -
correct answer The division of health and human services responsible for health care.
CMS is responsible for Medicare and parts of Medicaid. CMS maintains specifications
for various certifications for various certifications and authorizations used by the
Medicare and Medicaid programs. CMS also maintains various code sets.
Consolidated Omnibus Budget Reconciliation Act (COBRA) - correct answer An
amendment to Title 1 of HIPAA that gives employees the right to continue health
coverage as a private payer for a limited period of time once they leave a job.
Covered Entity (CE) - correct answer A health plan, a healthcare clearinghouse, or a
health care provider who transmits any health information in electronic form in
connection with a HIPAA transaction.
Department of Health and Human Services (HHS) - correct answer The federal
department that administers federal programs covering public health and welfare.
Electronic Data Interchange (EDI) - correct answer The electronic exchange of
information between computers, especially the exchange of health information among
physicians and insurance companies.
Group Health Plan (GHP) - correct answer Medical insurance offered to employees and
played for in part or in full by an employer.
,Health Insurance Portability and Accountability Act (HIPAA) of 1996 - correct answer
The federal legislation covering rules regarding the health care industry, specifically how
it is administered and rights of patients in regard to health care coverage and privacy.
Notice of Proposed Rule-Making (NPRM) - correct answer A document that describes
and explains rules that federal Government proposes to adopt at some future date.
Interested parties are invited to subscribe comments, which may then be used in
developing a final regulation.
Office for Civil Rights (OCR) - correct answer The division of Health and Human
Services responsible for enforcing the HIPAA privacy rules. Privacy is considered a civil
right.
Title I The portion of the HIPAA law concerned with health insurance reform. - correct
answer The main purpose of Title I is to ensure continuation of health coverage when
employees change jobs. It also entitles people who leave a job to continue their health
insurance coverage as a private payer for a limited period of time under COBRA.
Title II The portion of the HIPAA law - correct answer known as administrative
simplification. The rules in this section cover administrative, financial, and case
management policies and procedures. It contains strict requirements for the uniform
transfer rules of patient confidentiality.
Designated Record Set (DRS) - correct answer A group of medical records. For
providers, it includes medical and billing records but not other items, such as lab tests.
For a health plan, the designated record set includes enrollment, payment, claim
decisions, and medical management systems of the plan.
Electronic Medical Records (EMR) Or Electronic Health Record (EHR or EMR) - correct
answer Collection of health information that is immediately electronically accessible by
authorized companies.
Notice of Privacy Practices (NPP) - correct answer A document stating the privacy
policies and procedures of a covered entity. (CE)
Protected Health Information (PHI) - correct answer The HIPAA terminology for
individually identifiable health health information in any medium, except such
information maintained in education records covered by the Family Educational Rights
and Privacy Act (FERPA) and employment records.
Release of Information (ROI) - correct answer Release of information (ROI) of a
patient's information.
Treatment. Payment - correct answer and health care operations (TPO), Under HIPAA,
the rule that patient's protected health information may be shared without authorization
for the purposes of treatment, payment, and operations.
,ePHI PHI - correct answer that is stored or transmitted in electronic form.
Administrative Simplification (ASCA) - correct answer The part of HIPAA that gives HHS
the authority to mandate the use of standards for the electronic exchange of health care
data; to specify what medical and administrative codes sets should be used; to require
the use of national identfication systems for health care patients, providers, payers (or
plans), and employers (or sponsors); and to specify the standards to protect the security
and privacy of ePHI. This is Title II.
Claim Adjustment Reason Codes (RC) - correct answer A national administrative code
set that identifies the reasons for any differences, or adjustments, between the original
provider charge for a claim or service and the payer's payment for it.
Current Dental Terminology (CDT) - correct answer HIPAA-mandated code set for
procedures performed in a dental office.
Current Procedural Terminology (CPT) - correct answer HIPAA-mandated procedural
code set developed, owned, and maintained by the American Medical Association.
Designated Standard Maintenance Organization (DSMO) - correct answer An
organization that has been designated by the secretary of HHS to perform those
activities necessary to support the use of a HIPAA standard. Such organizations make
technical corrections to an implementation specification, expand a code set, or
recommend other modifications to keep the standard current.
Health Care Common Procedure Code Systems (HCPCS) - correct answer A
classification system for medical procedures, services, and supplies. It was set up to
give providers a coding system that describes specific products, supplies, and services
patients receive that are not in CPT.
HIPAA Electronic Health Care Transactions and Code Sets (TCS) - correct answer
HIPAA standards governing the electronic exchange of health information using
standard formats and standard code sets
ICD-9-CM International Classification of Diseases - correct answer Ninth Revision,
Clinical Modification., Mandatory code set used by the United States. It provides rules
for selecting and sequencing diagnosis codes in both the inpatient and the outpatient
environments.
National Plan and Provider Enumeration System (NPPES) - correct answer A system
set up by HHS which processes applications for NPI's, assigns them, and then stores
the data and identifying numbers for both health plans and providers.
National Provider Identifier (NPI) - correct answer Under HIPAA, a system for uniquely
identifying all providers of health care services, supplies, and equipment.
, Place of Service (POS) - correct answer Under HIPAA administrative code that
indicates where medical services were provide.
Remittance Advice (RA) - correct answer An electronic message that explains how a
payer arrived at benefits.
Remittance Advice Remark Codes (REM) - correct answer Remark codes maintained
by CMS and used by payers to explain why payments differ from billed amounts.
Administrative Law Judge ( ALJ) - correct answer A judge who presides over complaint
hearing in HHS and makes determinations of penalties.
Certification of Compliance Agreement (CCA) - correct answer An agreement between
the OIG and a health care entity in which the OIG negotiates a compliance agreement
for infractions that are not considered serious.
Civil Money Penalties (CMP) - correct answer Financial penalties imposed by the OIG
for a wide variety of conduct.
Corporate Integrity Agreement (CIA) - correct answer A negotiated agreement between
the OIG and a covered entity (CE) in which the CE agrees to certain obligations in
return for the OIG's agreement not to exclude the CE from participation in federal health
care programs.
Deficit Reduction Act (DRA) of 2005 - correct answer A federal law designed to reduce
fraudulent claims. It encourages states to pass their own false claims acts.
Department of Justice (DOJ) - correct answer The federal government's main law
enforcement division.
False Claims Act (FCA) - correct answer A federal law that prohibits submitting a
fraudulent claim or making a false statement or representation in connection with a
claim.
Office of the Inspector General (OIG) - correct answer Federal agency that investigates
and prosecutes fraud against government health care programs such as Medicare.
HIPAA stands for - correct answer Health Insurance Portability and Accountability Act
What year was the HIPAA act enacted - correct answer 1996
At its core, HIPAA is designed to (5 ANSWERS) - correct answer 1. Make health
insurance more portable (helping workers/families to keep coverage with job changes)
2. Reduce healthcare fraud and abuse (which wastes 1/3 of every healthcare dollar
3. Improve efficiency and effectiveness (of payments and o/ transactions)
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