HCCA - CHPC Study Guide with Answers (300 Solved Questions)

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What is the purpose of HIPAA? - ANSWER--• 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? - ANSWER--45 CFR sections 164.102 through 164.534

What are the subparts of HIPAA part 164? - ANSWER--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"? - ANSWER--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
HCCA - CHPC Study Guide - 300 Questions And
Answers 100% Verified

• 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

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. - ANSWER--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 - ANSWER--4. Contract arrangement with FEDEX carrier

What is Gramm-Leach-Bliley Act (GLBA)? - ANSWER--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? - ANSWER--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).

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Subject
Health Care Compliance Association