HCCA-CHPC EXAM LATEST ACTUAL EXAM 80
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS)
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Terms in this set (87)
HIPAA became law 1996
• To make health insurance portable under ERISA;
What is the purpose of • To move health care onto a nationally standardized
HIPAA? electronic billing platform; and
• To prevent fraud, waste and abuse
purpose of this subtitle to improve the Medicare
program under title XVIII of the Social Security Act, the
Medicaid program under title XIX of such Act, and the
efficiency and effectiveness of the health care system,
Intent
by encouraging the development of a health information
system through the establishment of standards and
requirements for the electronic transmission of certain
health information.
HIPAA resides in what CFR 45 CFR sections 164.102 through 164.534
section
Section Two: 164.500 - 164.514 Use and Disclosure of
Identify the four sections in
Information
the CFR by location and
topic
Section Three: 164.520 - 164.528 Individual's Rights and
Penalties
Section Four: Interaction with the HIPAA Security Rule
- compare the functions of the entity to the three
How do you determine if principal types of "covered entities" (CE),
organization is a CE - determine if the entity electronically transmits one of
the nine defined transactions"
- Provider
What are the different types - Health Plan
of CEs - Clearing House
- Other Types
- "a provider of services (as defined in section 1395x (u)
of title XIX)
- a provider of medical or other health services (as
How is a Provider defined
defined in section 1395x (s) of title XIX)
- any other person furnishing health care services or
supplies.
Does a provider need a NO
standing facility to be
considered a CE
, An individual or group plan that provides, or pays the
cost of, medical care
• A group health plan, but only if the plan:
-- has 50 or more participants
-- is administered by an entity other than the employer
who established and maintains the plan.
• A health insurance issuer
• A health maintenance organization
• The Medicaid program under title XIX.
What does "Health Plan"
• A Medicare supplemental policy
mean?
• A long-term care policy, including a nursing
home fixed indemnity policy
• An employee welfare benefit plan providing health
benefits to the employees of 2 or more employers.
• The health care program for active military
• The veteran's health care program .
• The Civilian Health and Medical Program
• The Indian Health Service Program
• The Federal Employees Health Benefit Plan
.
may be a public or private entity that processes
or facilitates the processing of nonstandard data
What is a Clearinghouse
elements of health information into standard data
elements.
Hybrid, Business Associate
What are other HIPAA
Organized Health Care Arrangement
Entities
Affiliated Covered Entity
single legal entity, where
What is a Hybrid Entity? only some of its divisions or programs meet the
CE definitions and is typical of large entities
What is Organized Health clinically integrated care setting where individuals
Care Arrangement receive health care from more than one health care
(OHCA)? provider.
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