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HCCA |- |CHPC |Study |Questions |With |
Answers
What |is |the |purpose |of |HIPAA? |- |CORRECT |ANSWERS |✔✔• |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 Ref. |https://quizlet.com/6202453/hcca-chpc-overview-flash-cards/ More |on |HIPAA: |https://www.hhs.gov/hipaa/index.html HIPAA |resides |in |which |CFR |section? |- |CORRECT |ANSWERS |✔✔ 45 | CFR |sections |164.102 |through |164. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part- What |are |the |subparts |of |HIPAA |part |164? |- |CORRECT |ANSWERS | ✔✔HIPAA |- | 45 |CFR |164, |subparts: Subpart |A |- |General |rules Subpart |C |- |Security
Subpart |D |- |Breach |notification Subpart |E |- |Privacy https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part- How |do |you |determine |if |an |organization |is |a |"Covered |Entity"? |- | CORRECT |ANSWERS |✔✔1. |compare |if |the |organization |meets |one | of |the | 3 |types |of |CE |(provider, |health |plan, |clearinghouse) and
- |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.
What |is |an |OHCA? |- |CORRECT |ANSWERS |✔✔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? |- |CORRECT |ANSWERS |✔✔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? |- |CORRECT |ANSWERS |✔✔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.
quality |improvement practice |management legal actuarial accounting accreditation other |administrative |services https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/ business-associates/index.html True |or |False: A |hospital |is |not |required |to |have |a |business |associate |contract | with |the |specialist |to |whom |it |refers |a |patient |and |transmits |the | patient's |medical |chart |for |treatment |purposes. |- |CORRECT | ANSWERS |✔✔TRUE Remember, |use |and |disclosure |of |PHI |for |purposes |of |TPO |requires | no |specific |authorization True |or |False: Business |Associates |After |HITECH: HITECH |made |business |associates |directly |responsible |for |HIPAA | compliance |within |their |individual |businesses |that |would |not |
otherwise |be |subject |to |HIPAA |regulations |and |penalties |- |CORRECT | ANSWERS |✔✔TRUE Even |if |no |written |contract |exists |between |the |covered |entity |and |a | contracted |company |performing |services |related |to |handling |PHI |in | some |form, |the |company |is |deemed |a |business |associate |by |law. | This |deemed |status |essentially |classifies |contracted |vendors |or | individuals |as |business |associates |solely |by |the |nature |of |the | services |they |provide |to |a |covered |entity, |regardless |of |whether | they |intended |to |be |classified |as |business |associates |or |were | aware |of |their |status |as |such. |HIPAA |and |HITECH |may |hold |these | vendors |to |business |associate |obligations |as |long |as |they |act |as | business |associates. Likewise, |a |subcontractor |that |creates, |receives, |maintains, |or | transmits |PHI |on |behalf |of |a |business |associate |is |a |business | associate. |A |subcontractor |of |a |subcontractor |is |a |business | associate |as |well, |and |so |on |down |the |line. Ref. | 2023 |HCCA |Complete |Healthcare |Compliance |Manual Ref. |HITECH |Act |and |OCR's | 2013 |final |rule True |or |False: Under |HIPAA |and |HITECH, |individuals |or |entities |who |have |been | identified |as |business |associates |are |obligated |to |enter |into |a |
under |the | 3 |types |of |CE |(health |plans, |clearinghouses, |and | providers) HIPAA |provide |standards |for |the |access, |disclosure, |transmission, | and |retention |of |PHI, |and |created |a |national |baseline |for |health | information |Privacy |and |Security. |At |the |state |level, |they |can |also | develop |health |information |statutes |but |only |adding |higher |or | more |restrictive |standards |than |the |Federal |HIPAA |rules. |This |is | referred |as: a. |HIPAA |status b. |HIPAA |assurance c. |HIPAA |preemption d. |HIPAA |state |law |- |CORRECT |ANSWERS |✔✔c. |HIPAA |preemption What |is |the |intent |of |HIPAA? a. |standardize |healthcare |billing |and |coding |to |comply |with | national |accounting |principles b. |increase |payment |from |providers |given |the |rising |cost |of | healthcare |and |fraud |violations c. |allow |group |health |plans |collect |premiums |after |individual |has | left |a |job/employer d. |improve |healthcare |programs |and |data |flow |between |providers | to |data |mine |for |fraudulent |behavior |- |CORRECT |ANSWERS |✔✔d. | improve |healthcare |programs |and |data |flow |between |providers |to | data |mine |for |fraudulent |behavior
The |intent |of |HIPAA |is |to |improve |healthcare |programs |and |the | delivery |of |services |through |the |two |largest |health |plans |in |the |U.S., |This |is |accomplished |by |improved |data |flows |that |leads |to |better | outcomes |using |national |standards |formats |and |specific | transactions |to |increase |accuracy |and |rapid |way |to |data |mine |ad | detect |fraudulent |behavior. The |specific |data |flows |are |outlined |in |the |Transaction |& |Code |Set | Rules | 45 |CFR |162.100 |- |162. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part- True |or |False: A |physician |is |required |to |have |a |business |associate |contract |with | a |laboratory |as |a |condition |of |disclosing |protected |health | information |for |the |treatment |of |an |individual. |- |CORRECT | ANSWERS |✔✔FALSE Remember, |use |and |disclosure |of |PHI |for |purposes |of |TPO |requires | no |specific |authorization True |or |False: A |hospital |laboratory |is |not |required |to |have |a |business |associate | contract |to |disclose |protected |health |information |to |a |reference |
Research |use/disclosure |with |individual |authorization |may |be | combined |with |other |legal |permission |or |consent |to |participate |in | the |research |- |CORRECT |ANSWERS |✔✔TRUE https://www.hhs.gov/hipaa/for-professionals/special-topics/research/ index.html True |of |False: Is |it |possible |for |a |facility |with |multiple |provider |functions |to |have | certain |isolated |providers |or |groups |who |are |subject |to |Part |2, | while |the |facility |as |a |whole |is |not |subject |to |Part |2. |For |example, | a |large |facility |may |have |primary |care |providers |and |a |separate | unit |that |provides |SUD |services. |- |CORRECT |ANSWERS |✔✔TRUE Explanation: The |SUD |unit |is |subject |to |Part |2, |but |the |rest |of |the |facility |is |not. True |or |False: An |individual |provider |who |works |in |a |general |medical |facility | could |also |be |a |Part | 2 |program |IF |the |provider's |primary |function | is |to |provide |SUD |services. |- |CORRECT |ANSWERS |✔✔TRUE Explanation: For |example, |a |primary |care |physician |who |provides |medication- assisted |treatment |would |only |meet |the |requirement |if |providing | services |to |persons |with |SUD |is |their |primary |function. |However, |If | a |patient |were |to |receive |both |primary |care |and |SUD |treatment, |the |SUD |providers |are |still |subject |to |Part | 2 |and |could |not |share |
information |with |the |patient's |primary |care |provider |without | consent. True |or |False: A |program |or |facility |that |provides |both, |SUD |services |and |Mental | Health |Services, |and |a |patient |has |been |admitted |to |receiving |both | services, |his/her |records |will |be |subject |to |the |Part | 2 |regulations |- | CORRECT |ANSWERS |✔✔FALSE Explanation: Mental |health |information |is |not |subject |to |the |standards |in | 42 | CFR |Part | 2 |and |can |be |shared |without |consent |for |treatment | purposes, |including |care |coordination, |as |allowed |under |HIPAA. | More |details. Only |records |or |information |about |patients |receiving |SUD |services | will |be |subject |to |Part | 2 |and |its |use/disclosure |is |more |restrictive. | However, |to |allow |appropriate |mental/behavioral |health |information | sharing |with |SUD |information, |a |Qualified |Service |Organization | Agreement |(QSOA) |would |be |needed |as |defined |in | 42 |CFR | 2.11 |"Qualified |service |organization" |section. What |are |the | 4 |federal |regulations |and/or |government |agencies | that |govern |the |privacy |of |individually |identifiable |info |in |research |- | CORRECT |ANSWERS |✔✔1. |HHS-FDA |(protections |of |human |subject | and |IRBs)
- |HHS-NIH |(certificate |of |confidentiality)
- |HHS-Office |of |Human |Research |Protections |(Common |Rule)
What |is |a |research |IRB?
- |Institutional |Research |Board
- |A |group |of |executives |that |review |all |research |activities | conducted |by |the |Board |of |Directors
- |A |group |of |individuals |that |review |proposed |research |to |protect | the |privacy |of |subjects
- |Can |make |changes |to |the |research |or |alter |its |content |as |they | seemed |appropriate |- |CORRECT |ANSWERS |✔✔3. |A |group |of | individuals |that |review |proposed |research |to |protect |the |privacy |of | subjects An |individual |must |authorize |these |marketing |communications | before |they |can |occur, |except: a. |when |the |communication |is |not |for |the |purpose |of |providing | treatment |advice b. |communication |from |a |health |insurer |to |promote |their | products/services c. |communication |in |training |material |using |their |photo d. |hospital |uses |its |patient |list |to |announce |the |arrival |of |a |new | specialty |group |in |general |mailing |- |CORRECT |ANSWERS |✔✔Except: d. |hospital |uses |its |patient |list |to |announce |the |arrival |of |a |new | specialty |group | This |activity |does |not |meet |the |"marketing" |definition, |for |instance, | the |disclosure |of |PHI |in |this |example |is |not |for |exchange |of | remuneration, |or |to |encourage |use |of |product, |promote |services.
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/ marketing/index.html True |or |False: It |is |important |that |when |contracting |with |payers |or |health |plans | they |follow |not |only |the |HIPAA |security |but |also |the |privacy |rule |to | protect |beneficiaries |PHI |including |use/disclosure |during |payer's | marketing |activities |- |CORRECT |ANSWERS |✔✔TRUE Which |of |the |following |requires |a |Business | Associate |contract/agreement: a. |independent |medical |transcriptionist b. |entities |that |participate |in |an |OHCA |(organized |healthcare | arrangement) c. |when |a |provider |simply |accepts |a |discounted |rate |to |participate | in |the |health |plan's |network d. |US |Postal |Services |or |private |carriers |- |CORRECT |ANSWERS |✔✔a. | independent |medical |transcriptionist explanation: |this |is |an |outsourced |service |that |handles |PHI |on | behalf |of |the |CE. |The |transcriptionist |is |performing |an |activity |for | the |CE |that |contains |PHI |and |a |BAA |is |required |to |ensure |proper | use |and |disclosure. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/ business-associates/index.html
ACEs |are |legally |separate |covered |entities |working |together |and | unable |to |use |a |joint |NPP |and |they |might |still |have |separate |EHRs, | separate |HIM/ROI |functions, |etc. |and |therefore, |the |PHI |data |is |not | create |or |receive |in |the |same |manner. See | 45 |CFR | 164.520(d) |https://www.law.cornell.edu/cfr/text/45/164. True |or |False: It |is |your |last |day |at |your |pediatric |clinical |site |and |you |are |saying | goodbye |to |all |of |your |favorite |patients. |You |take |a |picture |on |your | phone |of |a |few |of |the |patients |posing |together |and |later |post |it |to | your |private |blog |as |an |illustration |of |your |last |day. |Since |your | blog |is |private |and |can |only |be |accessed |by |those |who |know |the | URL, |you |are |not |in |violation |of |HIPAA |regulations. |- |CORRECT | ANSWERS |✔✔FALSE Fill |in |the |blank: In |the |mid-1990s, |OIG |began |to |require |providers |settling |civil | health |care |fraud |cases |to |enter |into |specific |type |of |agreements | as |a |condition |for |OIG |not |pursuing |exclusion. |These |agreements | are |referred |as: |- |CORRECT |ANSWERS |✔✔Corporate |integrity | Agreements |(CIA) The |foundation |for |establishing |a |good |relationship |with |a |vendor | is |the |Contract. |A |contract |is |an |exchange |of |promise, |services |for |
money, |with |a |specific |remedy |for |breach |of |contract. |What |are | some |of |the |key |basic |elements |to |contracts. |- |CORRECT |ANSWERS | ✔✔Basic |key |elements |to |contacts |include: I. |Agreement |(Offer |and |Acceptance) II. |Capacity |to |contract |(ability |to |perform, |ask |for |proof, |bios |of | staff |that |will |perform |the |critical |services) III. |Consideration |(remuneration |must |be |defined) IV. |Legal |purpose |(legal |requirements, |defined |measures |including | subcontractors |responsibilities) V. |Legality |of |form |(use |key |legal |language |or |clauses, |assurances) VI. |Intention |to |create |legal |relations |(statement |of |parties |intent | to |be |"legally |bound" |to |abide |to |mandates) VII. |Consent |to |contract |(required |signatures) VIII. |Mistakes, |undue |influence |(if |things |go |wrong, |list |alternative | options) True |or |False: Regarding |vendor |relations, |the |privacy |professional |must |ensure | that |the |contract |supports |the |privacy |profile. |This |includes |clearly | outlining |privacy |impacts, |clauses, |mandates, |remedies |from |the | vendor's |services |to |ensure |expectations |are |met, |even |when | things |go |wrong. |- |CORRECT |ANSWERS |✔✔TRUE
