CDEO - Chapter 2; Questions & Answers
Health Insurance Portability and Accountability Act of 1996 Correct Answer-
(HIPAA)
August 21, 1996 Correct Answer-HIPAA was enacted on _________.
Kennedy-Kassebaum Correct Answer-HIPAA aka as ______ bill, was originally
enacted to provide rights and protections for participants and beneficiaries of
group health plans. Under this law, exclusions for preexisting conditions were
limited, and discrimination against employees and dependents based on their
health status were prohibited.
Fraud, Abuse Correct Answer-HIPAA also established the Healthcare _____
and _____ Control Program, a far-reaching program in healthcare, including both
public and private health plans to combat both
Administrative Simplification Correct Answer-HIPAA _______ provisions
required that sections of the law be publicized to explain the standards for the
electronic exchange, privacy, and security of health information.
August 14, 2002 Correct Answer-Congress did not enact privacy legislation
within the specified time governed by HIPAA. The U.S. Department of Health
and Human Services (HHS) developed a proposed rule, which was released for
comment on November 3, 1999. Many comments were received, and
modifications were made to the rule. The modifications were published and
released in final form on ______.
HHS Correct Answer-_____ issued a privacy rule to set a national standard for
the protection of certain health information.
, CDEO - Chapter 2; Questions & Answers
Privacy Rule Correct Answer-The _______ standards address how an
individual's protected health information (PHI) may be used. Its purpose is to
protect individual
privacy, while promoting high-quality healthcare and public health and well-
being. Correct Answer-
flexible, comprehensive Correct Answer-The Privacy Rule was designed to be
______ and ______, to allow for the various uses and disclosures the healthcare
community must address.
All Correct Answer-____ covered entities are required to follow the Privacy
Rule.
plans, clearinghouses, provider Correct Answer-Covered entities are defined
as health _____, healthcare ________, and any healthcare _________ who
transmits health
information in an electronic format. Correct Answer-
plan Correct Answer-Health ______ covered entities are organizations that
pay providers on behalf of an individual receiving medical care. These plans
include health, dental, vision, and prescription drug insurers. Some examples
include health maintenance organizations (HMOs), Medicare, Medicaid,
, CDEO - Chapter 2; Questions & Answers
and Medicare supplement insurers, as well as employer, government, and
church-sponsored group health plans. There are exceptions: An employer who
solely establishes and maintains the plan with fewer than 50 participants is
exempt. Two types of government-funded programs Correct Answer-
are not health plans: food stamps and community health centers. Insurers
providing only worker's compensation, automobile insurance, and property and
casualty insurance are not considered to be health plans. Correct Answer-
providers Correct Answer-All healthcare ________ who electronically
transmit health information through certain transactions are covered entities.
Some examples of transactions that may be submitted electronically are claim
forms, inquiries about the eligibility of benefits, and requests for authorization
of referrals. Simply using electronic technology, such as sending emails, does not
mean a healthcare provider is a covered entity; the transmission must be in
connection with a standard transaction. The rule applies to all, regardless of
whether they transmit the transactions directly, or use a billing service or other
third party to transmit on their behalf. They are defined as providers of services,
such as hospitals, and providers of medical or health services, such as
physicians, dentists, and other practitioners who furnish, bill, or receive
payment for healthcare.
clearinghouses Correct Answer-Healthcare ________ include billing services,
repricing companies, and community health management information systems
that process nonstandard information, received from another entity, into a
standard (ie, standard format or data content) or vice versa. In most instances,
healthcare clearinghouses receive individually identifiable information for
processing services to a health plan or healthcare provider as a business
associate. In these cases, only certain provisions are applicable to the
clearinghouses' uses and disclosures of protected health information.
, CDEO - Chapter 2; Questions & Answers
Transactions Correct Answer-_______ occur through electronic exchanges,
which allow information to be transferred between two parties for specific
purposes.
plan Correct Answer-A healthcare provider will send a claim to a health
_____ to request payment for the medical services he or she provides.
HIPAA Correct Answer-_____ regulations standardized transactions for
Electronic Data Interchange (EDI) of healthcare data. These transactions are:
claims and encounter information, payment and remittance advice, claims
status, eligibility, enrollment and disenrollment, referrals and authorizations,
coordination of benefits, and premium payment.
HIPAA Correct Answer-Under _______, electronic transactions must use the
adopted standard and adhere to the content and format requirements of ASC
X12N or NCPDP (used for certain pharmacy transactions) for each transaction.
An additional rule was adopted to standardize the code sets for diagnoses and
procedures. These code sets include: HCPCS (Healthcare Common Procedure
Coding System—ancillary services and procedures); CPT® (Current Procedural
Terminology—physician's procedures); CDT® (Current Dental Terminology—
dental procedures); ICD-9 (International Classification of Diseases-9th revision—
diagnosis and inpatient hospital procedures); ICD-10 (International Classification
of Diseases-10th Revision, which replaced ICD-9 on October 1, 2015); and NDC
(National Drug Codes).
unique identifier Correct Answer-In addition to the standardization of the
codes used to request payment for medical services, a _______ for employers
and providers must be used on all transactions.
