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CPMA |! Chapter |! 2 |! Exam |! with |!
complete |! solutions
For |! therapy |! services, |! what |! is |! the |! reason |! for |! a |! progress |! note? |! - |! Correct |! answer |! ✔To |! provide |! justification |! for |! the |! medical |! necessity |! of |! treatment |! information. |! Documentation |! requirements |! for |! therapy |! services |! include |! progress |! reports |! which |! provide |! justification |! for |! the |! medical |! necessity |! of |! treatment. |! Information |! required |! in |! the |! progress |! reports |! should |! be |! written |! by |! a |! clinician. What |! must |! be |! included |! in |! a |! business |! associate |! agreement? |! - |! Correct |! answer |! ✔The |! permitted |! and |! required |! uses |! of |! PHI |! by |! the |! business |! associate. |! The |! contract |! must |! describe |! the |! permitted |! and |! required |! uses |! of |! protected |! health |! information |! by |! the |! business |! associate, |! limit |! the |! business |! associate |! from |! using |! or |! further |! disclosing |! the |! protected |! health |! information |! (except |! where |! permitted |! by |! contract |! or |! required |! by |! law), |! and |! require |! the |! business |! associate |! to |! follow |! appropriate |! safeguards |! to |! prevent |! use |! or |! disclosure |! of |! the |! protected |! health |! information, |! except |! as |! expressly |! defined |! in |! the |! contract. What |! information |! does |! a |! privacy |! practice |! notice |! contain? |! - |! Correct |! answer |! ✔Elements |! to |! notify |! individuals |! as |! to |! how |! the |! covered |! entity |! will |! use |! and |! disclose |! the |! PHI. |! A |! privacy |! practice |! notice |! must |! be |! provided |! by |! each |! covered |! entity, |! and |! must |! contain |! certain |! elements |! to |! notify |! individuals |! as |! to |! how |! the |! covered |! entity |! will |! use |! and |! disclose |! the |! individual's |! protected |! health |! information. |! The |! notice |! must |! clearly |! explain |! the |! covered |! entity's |! obligation |! to |! protect |! privacy, |! provide |! a |! notice |! of |! privacy |! practices, |! and |!
abide |! by |! the |! terms |! of |! the |! current |! notice. |! The |! covered |! entity |! must |! also |! inform |! the |! patient |! of |! his |! or |! her |! individual |! rights, |! and |! the |! steps |! to |! follow |! (including |! a |! point |! of |! contact |! for |! further |! information) |! if |! an |! individual |! feels |! his |! or |! her |! privacy |! rights |! have |! been |! violated. Which |! of |! the |! following |! is |! an |! example |! of |! information |! that |! may |! be |! transmitted |! electronically |! and |! covered |! under |! the |! privacy |! rule? |! - |! Correct |! answer |! ✔Claim |! forms. |! All |! health |! care |! providers |! who |! electronically |! transmit |! health |! information |! through |! certain |! transactions |! are |! covered |! entities. |! Some |! examples |! of |! transactions |! that |! may |! be |! submitted |! electronically |! are |! claim |! forms, |! inquiry |! about |! eligibility |! of |! benefits, |! and |! requests |! for |! authorization |! of |! referrals. How |! must |! medical |! records |! be |! retained? |! - |! Correct |! answer |! ✔A |! specific |! requirement |! does |! not |! exist. |! There |! are |! no |! specific |! requirements |! as |! to |! how |! the |! medical |! records |! must |! be |! retained. |! They |! may |! be |! kept |! in |! their |! original |! format, |! or |! reproduced |! in |! a |! way |! that |! is |! legally |! acceptable. |! The |! most |! important |! component |! of |! retention |! is |! that |! the |! record |! is |! protected, |! to |! ensure |! the |! security |! and |! integrity |! of |! the |! records. What |! is |! CHEDDAR? |! - |! Correct |! answer |! ✔An |! optional |! way |! of |! documenting |! E/M |! services. |! CHEDDAR |! is |! a |! format |! that |! can |! be |! (not |! required) |! used |! to |! document |! E/M |! services. |! Chief |! complaint, |! History |! of |! present |! illness, |! Exam, |! Details, |! Drugs |! and |! dosages, |! Assessment, |! Return |! visit |! information |! or |! referral. In |! evaluation |! and |! management |! services, |! what |! does |! the |! A |! stand |! for |! in |! SOAP |! and |! what |! is |! included |! in |! this |! section? |! - |! Correct |! answer |! ✔Assessment; |! the |! provider |! documents |! an |! assessment |! of |! the |! patient's |! condition. |!
Which |! type |! of |! signature |! will |! CMS |! allow |! only |! in |! the |! case |! of |! a |! provider |! with |! a |! proven |! disablity |! affecting |! their |! ability |! to |! provide |! a |! signature? |! - |! Correct |! answer |! ✔Rubber |! Stamp. |! The |! method |! used |! (e.g. |! handwritten |! or |! electronic) |! to |! sign |! an |! order |! or |! other |! medical |! record |! documentation |! for |! medical |! review |! purposes |! in |! determining |! coverage |! is |! not |! a |! relevant |! factor. |! The |! Centers |! for |! Medicare |! & |! Medicaid |! Services |! allows |! rubber |! stamps |! only |! in |! the |! case |! of |! a |! provider |! with |! a |! proven |! disability |! affecting |! their |! ability |! to |! provide |! a |! signature, |! but |! other |! carriers |! may |! still |! allow |! it. If |! a |! covered |! entity |! identifies |! a |! material |! breach |! of |! a |! business |! associate |! agreement, |! and |! it |! is |! not |! possible |! to |! cure |! the |! breach |! or |! end |! the |! violation, |! what |! should |! occur? |! - |! Correct |! answer |! ✔The |! contract |! must |! be |! terminated, |! and |! the |! problem |! reported |! to |! the |! HHS |! Office |! for |! Civil |! rights. |! If |! a |! covered |! entity |! identifies |! a |! material |! breach |! or |! violation |! of |! the |! contract |! or |! agreement, |! reasonable |! steps |! must |! be |! taken |! to |! cure |! the |! breach |! or |! end |! the |! violation. |! If |! that |! is |! not |! possible, |! the |! contract |! must |! be |! terminated, |! and |! the |! problem |! reported |! to |! the |! Department |! of |! Health |! and |! Human |! Services |! (HHS) |! Office |! for |! Civil |! Rights |! (OCR). What |! form |! is |! required |! to |! be |! obtained |! from |! the |! patient |! prior |! to |! completing |! a |! surgical |! procedure? |! - |! Correct |! answer |! ✔Informed |! consent. |! Prior |! to |! a |! patient |! undergoing |! a |! specific |! medical |! intervention, |! state |! law |! requires |! that |! the |! provider |! obtain |! an |! informed |! consent |! for |! treatment. |! This |! form |! is |! signed |! by |! the |! patient |! to |! verify |! that |! the |! patient |! understands |! procedures, |! outcomes, |! and |! options. What |! section |! of |! an |! operative |! report |! typically |! contains |! the |! date |! of |! the |! surgery, |! preoperative |! diagnosis, |! postoperative |! diagnosis, |! and |! operation |! performed? |! - |! Correct |! answer |! ✔Header. |! The |! header |! of |! an |! operative |! note |! is |!
designed |! to |! identify |! the |! patient |! name, |! date |! of |! surgery, |! preoperative |! diagnosis, |! postoperative |! diagnosis, |! the |! procedures |! performed, |! primary |! surgeon, |! assistant |! surgeon(s), |! anesthesia |! administered, |! and |! the |! anesthesiologist.er. Why |! is |! it |! important |! to |! read |! the |! body |! of |! an |! operative |! note |! as |! an |! auditor? |! - |! Correct |! answer |! ✔To |! identify |! if |! the |! details |! in |! the |! documentation |! support |! the |! surgery |! listed |! in |! the |! header, |! if |! additional |! procedures |! have |! been |! performed, |! or |! if |! modifiers |! should |! be |! used. |! Reading |! and |! analyzing |! an |! operative |! report |! requires |! time |! and |! great |! attention |! to |! detail. |! Challenges |! arise |! when |! the |! report |! indicates |! a |! specific |! procedure |! as |! being |! performed |! in |! the |! header, |! but |! the |! details |! in |! the |! body |! of |! the |! note |! do |! not |! support |! that |! procedure, |! or |! indicate |! additional |! procedures |! not |! reported |! in |! the |! title. |! For |! this |! reason, |! it |! is |! very |! important |! to |! read |! the |! entire |! note |! slowly |! and |! carefully. |! Attempt |! to |! gain |! an |! understanding |! of |! the |! entire |! surgical |! case |! before |! taking |! more |! time |! to |! read |! the |! report |! thoroughly |! to |! analyze |! for |! proper |! code |! assignment. What |! is |! appropriate |! to |! document |! in |! a |! radiology |! report |! for |! contrast |! material |! used |! in |! a |! radiologic |! study? |! - |! Correct |! answer |! ✔The |! type |! and |! amount |! of |! contrast |! used, |! along |! with |! the |! route |! of |! administration |! is |! documented. |! Contrast |! material |! may |! be |! used |! to |! enhance |! the |! view |! of |! an |! internal |! structure. |! There |! are |! different |! types |! of |! contrast |! material. |! The |! amount |! and |! type |! of |! contrast |! material |! should |! be |! documented |! in |! the |! radiology |! report |! along |! with |! the |! route |! of |! administration. Which |! section |! of |! an |! operative |! report |! would |! you |! expect |! to |! find |! the |! reason |! or |! medical |! necessity |! for |! the |! procedure? |! - |! Correct |! answer |! ✔Indication |! for |! surgery. |! The |! indication |! typically |! gives |! a |! brief |! history |! outlining |! the |! reasons |! for |! or |! medical |! necessity |! for |! the |! procedure.
answer |! ✔Establish |! their |! own |! standards. |! In |! the |! absence |! of |! specific |! statute |! or |! regulations, |! many |! health |! care |! institutions |! establish |! their |! own |! standards |! or |! requirements |! in |! relation |! to |! the |! content |! of |! a |! medical |! record. What |! standards |! are |! set |! by |! the |! Privacy |! Rule |! set? |! - |! Correct |! answer |! ✔Standards |! for |! how |! protected |! health |! information |! is |! used. |! The |! Privacy |! Rule |! 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. What |! form |! is |! used |! to |! allow |! the |! release |! of |! their |! medical |! records? |! - |! Correct |! answer |! ✔Release |! of |! information. |! Release |! of |! Information—Patients |! allow |! the |! release |! of |! their |! medical |! records |! by |! signing |! this |! form. |! This |! often |! has |! a |! place |! to |! allow |! the |! patient |! to |! designate |! who |! the |! medical |! information |! can |! be |! released |! to. Under |! what |! circumstance |! may |! providers |! use |! or |! disclose |! protected |! health |! information |! without |! patient |! consent? |! - |! Correct |! answer |! ✔Payment, |! treatment, |! or |! operations. |! Permitted |! uses |! and |! disclosures |! of |! protected |! health |! information |! allow |! a |! covered |! entity |! to |! use |! and |! disclose |! certain |! information |! without |! an |! individual's |! authorization, |! for |! treatment, |! payment, |! and |! healthcare |! operation |! activities. What |! is |! considered |! protected |! health |! information |! (PHI)? |! - |! Correct |! answer |! ✔Individually |! identifiable |! health |! information. |! Protected |! health |! information |! is |! "individually |! identifiable |! health |! information." |! It |! includes |! many |! common |! identifiers, |! such |! as |! demographic |! data, |! name, |! address, |! birth |! date, |! and |! social |! security |! number. |! It |! also |! includes |! information |! that |! relates |! to |! an |! individual's |! past, |! present, |! or |! future |! physical |! or |! mental |! health |! or |! condition; |!
the |! provision |! of |! healthcare |! to |! the |! individual; |! or, |! the |! past, |! present, |! or |! future |! payment |! for |! the |! provision |! of |! healthcare |! to |! the |! individual, |! which |! reasonably |! may |! be |! used |! to |! identify |! an |! individual. What |! program |! was |! established |! by |! HIPAA |! to |! combat |! fraud |! and |! abuse |! committed |! against |! all |! health |! plans, |! both |! public |! and |! private? |! - |! Correct |! answer |! ✔Healthcare |! Fraud |! and |! Abuse |! Control |! Program. |! HIPAA |! established |! the |! Healthcare |! Fraud |! and |! Abuse |! Control |! Program, |! a |! far- reaching |! program |! to |! combat |! fraud |! and |! abuse |! in |! healthcare, |! including |! both |! public |! and |! private |! health |! plans. Which |! governing |! body |! is |! responsible |! for |! criminal |! prosecutions |! relating |! to |! the |! Privacy |! Rule? |! - |! Correct |! answer |! ✔Department |! of |! Justice. |! The |! Department |! of |! Justice |! is |! responsible |! for |! criminal |! prosecutions |! under |! the |! Privacy |! Rule. How |! long |! does |! Medicare's |! Conditions |! of |! Participation |! (CoP) |! for |! hospitals |! require |! retention |! of |! medical |! records? |! - |! Correct |! answer |! ✔Five |! years |! after |! the |! closed |! cost |! report. |! The |! Centers |! for |! Medicare |! and |! Medicaid |! Services |! (CMS) |! requires |! hospitals |! to |! retain |! all |! patient |! records |! for |! at |! least |! five |! years |! after |! the |! submission |! of |! their |! closed |! cost |! reports. CMS |! requires |! a |! legible |! identity |! for |! services |! provided/ordered. |! What |! type |! of |! signature |! has |! an |! exception |! for |! CMS? |! - |! Correct |! answer |! ✔Rubber |! Stamp. |! The |! Centers |! for |! Medicare |! & |! Medicaid |! Services |! allows |! rubber |! stamps |! only |! in |! the |! case |! of |! a |! provider |! with |! a |! proven |! disability |! affecting |! their |! ability |! to |! provide |! a |! signature. EXCEPTION |! 4: |! CMS |! would |! permit |! use |! of |! a |! rubber |! stamp |! for |! signature |! in |! accordance |! with |! the |! Rehabilitation |! Act |! of |! 1973 |! in |! the |! case |! of |! an |! author |!
In |! evaluation |! and |! management |! services, |! what |! does |! the |! O |! stand |! for |! in |! SOAP? |! What |! is |! included |! in |! this |! section? |! - |! Correct |! answer |! ✔Objective; |! indicates |! the |! physical |! exam |! findings |! of |! the |! provider. |! O |! is |! the |! objective |! portion |! of |! the |! visit |! which |! indicates |! the |! provider's |! objective |! findings |! during |! the |! exam When |! referring |! to |! radiological |! services, |! what |! is |! the |! requirement |! for |! the |! images |! obtained? |! - |! Correct |! answer |! ✔Retain |! the |! actual |! images. |! Not |! only |! is |! it |! necessary |! to |! retain |! the |! actual |! images |! of |! radiologic |! services, |! it |! is |! also |! important |! that |! a |! written |! report |! is |! obtained, |! to |! include |! the |! indication |! for |! the |! study |! and |! to |! summarize |! the |! findings. |! An |! order |! or |! request |! for |! the |! study |! must |! also |! be |! retained. What |! should |! be |! documented |! in |! the |! radiology |! report |! when |! contrast |! material |! is |! used? |! - |! Correct |! answer |! ✔The |! type |! and |! amount |! of |! contrast |! used, |! along |! with |! the |! route |! of |! administration. |! Contrast |! material |! may |! be |! used |! to |! enhance |! the |! view |! of |! an |! internal |! structure. |! There |! are |! different |! types |! of |! contrast |! material. |! The |! amount |! and |! type |! of |! contrast |! material |! should |! be |! documented |! in |! the |! radiology |! report, |! along |! with |! the |! route |! of |! administration. For |! each |! day |! of |! a |! physical |! therapy |! treatment |! encounter |! provided |! to |! a |! Medicare |! patient, |! what |! should |! be |! documented |! for |! the |! modalities? |! - |! Correct |! answer |! ✔Each |! individual |! modality |! used |! with |! total |! duration |! of |! time |! in |! minutes. |! Treatment |! encounter |! notes |! for |! each |! treatment |! day |! and |! should |! include |! Date |! of |! treatment Treatment, |! intervention, |! or |! activity Total |! timed |! treatment |! by |! individual |! modality |! and |! total |! treatment |! time |! in |! minutes |! (includes |! timed |! codes |! and |! untimed |! codes)
Signature |! and |! professional |! identity |! of |! the |! qualified |! professional |! furnishing |! the |! treatment Additional |! information |! may |! include |! response |! to |! treatment |! or |! changes. If |! a |! covered |! entity |! identifies |! material |! breach |! of |! a |! contract |! agreement |! with |! a |! business |! associate |! and |! the |! contract |! is |! terminated, |! which |! agency |! is |! the |! problem |! reported |! to? |! - |! Correct |! answer |! ✔Office |! for |! Civil |! Rights |! (OCR). |! If |! a |! covered |! entity |! identifies |! a |! material |! breach |! or |! violation |! of |! the |! contract |! or |! agreement, |! reasonable |! steps |! must |! be |! taken |! to |! cure |! the |! breach |! or |! end |! the |! violation. |! If |! that |! is |! not |! possible, |! the |! contract |! must |! be |! terminated |! and |! the |! problem |! reported |! to |! the |! Department |! of |! Health |! and |! Human |! Services |! (HHS) |! Office |! for |! Civil |! Rights |! (OCR) Which |! is |! an |! example |! under |! the |! Privacy |! Rule |! that |! requires |! a |! written |! agreement |! to |! disclose |! protected |! health |! information? |! - |! Correct |! answer |! ✔A |! physician |! sending |! patient's |! treatment |! plan |! to |! marketing |! pharmaceutical |! company. |! The |! privacy |! rule |! includes |! exceptions |! to |! the |! business |! associate |! standard, |! which |! do |! not |! require |! a |! covered |! entity |! to |! have |! a |! written |! agreement |! in |! place |! prior |! to |! disclosing |! protected |! health |! info. |! Examples: |! Disclosure |! by |! a |! covered |! entity |! to |! a |! healthcare |! provider |! for |! treatment |! of |! the |! individual, |! such |! as: |! A |! hospital |! referring |! a |! patient |! to |! a |! specialist |! and |! transmitting |! the |! patient's |! medical |! chart |! for |! treatment |! purposes. |! A |! physician |! sending |! specimens |! to |! a |! lab |! for |! analysis. |! Disclosures |! to |! a |! health |! plan |! sponsor, |! such |! as |! employer, |! by |! a |! group |! health |! plan |! that |! provides |! the |! health |! insurance |! benefits |! or |! coverage |! for |! the |! group |! health |! plan. |! The |! collection |! and |! sharing |! of |! protected |! health |! information |! by |! a |! health |! plan |! that |! is |! a |! public |! benefit |! program, |! such |! as |! Medicare. |! A |! covered |! entity |! must |! obtain |! an |! authorization |! to |! use |! or |! disclose |! PHI |! for |! marketing, |! except |! for |! face-to-face |! marketing |! communications |! between |! a |! covered |! entity |! and |! an |! individual, |! and |! for |! a |! covered |! entity's |! provision |! of |! promotional |! gifts |! of |! nominal |! value.
Why |! is |! the |! CERT |! program |! beneficial |! to |! auditors? |! - |! Correct |! answer |! ✔The |! CERT |! program |! identifies |! errors |! causing |! improper |! payments |! by |! the |! Medicare |! program. |! The |! errors |! found |! can |! ID |! areas |! for |! providers |! to |! improve |! documentation. |! Comprehensive |! Error |! Rate |! Testing |! is |! Medicare |! review |! process |! that |! measures |! improper |! payments |! in |! the |! Medicare |! fee-for-Service |! program. |! Reviewing |! the |! CERT |! program |! results |! can |! help |! ID |! areas |! where |! common |! errors |! are |! found. |! An |! auditor |! can |! use |! this |! info |! to |! provide |! education |! to |! providers |! to |! improve |! documentation |!. SOAP |! is |! a |! common |! format |! used |! to |! document |! in |! the |! medical |! record. |! In |! this |! acronym, |! what |! does |! A |! represent? |! - |! Correct |! answer |! ✔Assessment. |! The |! acronym |! SOAP |! represents |! Subjective, |! Objective, |! Assessment |! and |! Plan. When |! must |! authentication |! of |! a |! report |! by |! physician |! or |! another |! practitioner |! take |! place? |! - |! Correct |! answer |! ✔after |! the |! document |! has |! been |! transcribed |! and |! reviewed. |! The |! system |! that |! utilizes |! auto-authentication |! in |! which |! the |! physician |! or |! other |! practitioner |! authenticates |! a |! report |! before |! it |! has |! been |! transcribed |! is |! not |! consistent |! with |! documentation |! authentication |! requirements. Providers |! and |! suppliers |! that |! have |! been |! approved |! by |! a |! national |! accreditation |! organization |! may |! be |! exempt |! from |! which |! of |! the |! following? |! - |! Correct |! answer |! ✔routine |! state |! survey |! agencies |! to |! determine |! compliance |! with |! Medicare |! conditions. |! Providers |! and |! suppliers |! that |! have |! been |! accredited |! by |! national |! AO |! are |! permitted |! to |! be |! exempt |! from |! routine |! surveys |! to |! determine |! compliance |! with |! Medicare |! conditions. Why |! was |! HIPAA |! created |! - |! Correct |! answer |! ✔to |! provide |! rights |! and |! protections |! for |! participants |! and |! beneficiaries |! of |! group |! health |! plans.
Healthcare |! Fraud |! and |! Abuse |! Control |! Program |! - |! Correct |! answer |! ✔Established |! by |! HIPAA |! to |! combat |! fraud |! and |! abuse |! in |! healthcare, |! which |! includes |! both |! public |! and |! private |! health |! plans. HIPAA |! Administrative |! Simplification |! provision |! requirements |! - |! Correct |! answer |! ✔Sections |! of |! the |! law |! be |! publicized |! to |! explain |! the |! standards |! for |! the |! electronic |! exchange, |! privacy |! and |! security |! of |! health |! information. What |! does |! Privacy |! Rule |! standards |! address |! - |! Correct |! answer |! ✔How |! individual |! PHI |! may |! be |! used. What's |! the |! purpose |! of |! Privacy |! Rule |! - |! Correct |! answer |! ✔To |! protect |! individual |! privacy, |! while |! promoting |! high |! quality |! healthcare |! and |! public |! health |! and |! well-being. Are |! all |! of |! the |! covered |! entities |! require |! to |! follow |! Privacy |! Rule |! - |! Correct |! answer |! ✔Yes. Who |! are |! the |! covered |! entities |! - |! Correct |! answer |! ✔Health |! plans, |! healthcare |! clearinghouses, |! and |! any |! healthcare |! provider |! who |! transmits |! health |! information |! in |! an |! electronic |! format. Covered |! entities |! under |! healthplan |! - |! Correct |! answer |! ✔They |! are |! organizations |! that |! pay |! providers |! on |! behalf |! of |! an |! individual |! receiving |! medical |! care. |! These |! plans |! include: |! health, |! dental, |! vision |! and |! prescription |!
What |! are |! the |! electronic |! transactions |! - |! Correct |! answer |! ✔Transactions |! occur |! through |! electronic |! exchanges, |! which |! allow |! info |! to |! be |! transferred |! between |! two |! parties |! for |! specific |! purposes. |! A |! healthcare |! provider |! will |! send |! a |! claim |! to |! a |! health |! plan |! to |! request |! payment |! for |! medical |! services. Under |! HIPAA |! electronic |! standardized |! transactions |! for |! Electronic |! Data |! Interchange |! are |! - |! Correct |! answer |! ✔Claims, |! encounter |! info, |! remittance |! advice, |! claims |! status, |! eligibility, |! enrollment, |! disenrollment, |! referrals, |! authorizations, |! coordination |! of |! benefits, |! and |! premium |! payment True |! or |! False. |! Under |! HIPAA, |! electronic |! transactions |! must |! use |! the |! adopted |! standard |! and |! adhere |! to |! the |! content |! and |! format |! requirements |! (ASC |! X12N |! or |! NCPDP). |! - |! Correct |! answer |! ✔True What |! are |! the |! standardized |! code |! sets |! for |! diagnoses |! and |! procedures |! under |! HIPAA |! - |! Correct |! answer |! ✔HCPCS |! Level |! II, |! CPT, |! CDT, |! ICD-9, |! ICD-10, |! NDC, In |! addition |! to |! the |! standardization |! of |! the |! codes |! used |! to |! request |! payment |! for |! medical |! services, |! a |! provider |! and |! employers |! must |! use |! for |! all |! transactions |! - |! Correct |! answer |! ✔a |! 10 |! digit |! NPI What |! does |! Business |! associates |! do |! on |! behalf |! of |! another |! person |! or |! organization |! - |! Correct |! answer |! ✔They |! perform |! certain |! functions |! or |! activities |! which |! involve |! the |! use |! or |! disclosure |! of |! individually |! identifiable |! health |! information |! on |! behalf |! of |! another |! person |! or |! organization. |! Claims |! processing, |! administration, |! data |! analysis, |! utilization |! review, |! billing, |! benefit |! management |! and |! re-pricing.
What |! are |! the |! Business |! associate |! services |! provided |! to |! a |! covered |! entity |! - |! Correct |! answer |! ✔Legal, |! actuarial, |! accounting, |! consulting, |! data |! aggregation, |! management, |! administration, |! accreditation |! or |! financial |! services. To |! be |! considered |! a |! Business |! associate |! - |! Correct |! answer |! ✔the |! persons |! or |! organizations |! would |! involve |! the |! use |! or |! disclosure |! of |! PHI |! between |! two |! parties. Business |! associate |! requirements |! under |! HITECH |! - |! Correct |! answer |! ✔An |! organization |! that |! provides |! data |! transmissions |! of |! PHI |! to |! a |! covered |! entity |! and |! that |! requires |! access |! to |! PHI |! routinely, |! such |! as |! Health |! Information |! Exchange |! (HIE) |! Organization, |! will |! be |! treated |! as |! a |! business |! associate. Why |! contract |! is |! required |! between |! business |! associates |! and |! the |! organization |!
- |! Correct |! answer |! ✔To |! impose |! specified |! written |! safeguards |! on |! the |! individually |! identifiable |! health |! information |! used |! or |! disclosed |! by |! the |! business |! associate. What |! business |! associate |! contract |! must |! describe. |! - |! Correct |! answer |! ✔The |! contract |! must |! describe |! the |! permitted |! and |! required |! use |! of |! PHI |! by |! the |! business |! associate, |! limit |! the |! business |! associate |! from |! using |! or |! further |! disclosing |! the |! PHI |! (except |! where |! permitted |! by |! contract |! or |! required |! by |! law), |! and |! require |! the |! business |! associate |! to |! follow |! appropriate |! safeguards |! to |! prevent |! use |! or |! disclosure |! of |! the |! PHI, |! except |! as |! expressly |! defined |! in |! the |! contract.
A |! covered |! entity |! may |! not |! use |! or |! disclose |! PHI |! unless |! - |! Correct |! answer |! ✔The |! privacy |! rule |! permits |! it |! or |! as |! the |! individual |! authorizes |! in |! writing. The |! rule |! requires |! that |! a |! covered |! entity |! must |! disclose |! PHI |! to |! an |! individual |! when |! - |! Correct |! answer |! ✔He |! or |! she |! requests |! his |! or |! her |! own |! info |! or |! to |! HHS |! when |! it |! is |! investigating |! for |! compliance, |! review |! or |! enforcement |! action. Permitted |! uses |! and |! disclosures |! of |! PHI |! allow |! a |! covered |! entity |! to |! use |! and |! disclose |! certain |! info |! without |! an |! individual |! authorization |! in |! the |! following |! situations. |! - |! Correct |! answer |! ✔1. |! To |! the |! individual |! who |! is |! the |! subject |! of |! the |! information
- |! PHI |! may |! be |! used |! by |! a |! covered |! entity |! for |! treatment, |! payment, |! and |! healthcare |! operation |! activities. |!
- |! The |! individual |! may |! grant |! informal |! permission |! by |! being |! asked |! outright, |! giving |! them |! the |! opportunity |! to |! agree |! or |! object |! in |! circumstances |! where |! the |! individual |! is |! not |! capable |! of |! providing |! his |! or |! her |! signature, |! covered |! entities |! are |! expected |! to |! use |! reasonable |! judgement |! in |! situations |! where |! the |! patient |! is |! incapacitated, |! or |! the |! covered |! entity |! is |! not |! available |! to |! provide |! the |! care |! that |! is |! in |! the |! best |! interest |! to |! the |! patient. |!
- |! Incidental |! use |! and |! disclosure |! are |! permitted, |! as |! long |! as |! the |! covered |! entity |! has |! reasonable |! safeguards |! in |! place |! to |! ensure |! that |! the |! information |! being |! shared |! is |! limited |! to |! the |! minimum |! necessary |!. Minimum |! Necessary |! - |! Correct |! answer |! ✔Key |! protection |! of |! HIPAA |! privacy |! rule. |! Requires |! covered |! entities |! to |! take |! reasonable |! steps |! to |! limit |! the |! use |! or |! disclosure |! of |! and |! requests |! for, |! protected |! health |! information |! to |! the |! minimum |! necessary |! to |! accomplish |! the |! intended |! purpose.
When |! the |! minimum |! necessary |! applies |! to |! a |! use |! or |! disclosure |! - |! Correct |! answer |! ✔a |! covered |! entity |! may |! not |! use, |! disclose, |! or |! request |! the |! entire |! medical |! record |! for |! a |! particular |! purpose |! unless |! it |! can |! specifically |! justify |! the |! whole |! record |! as |! the |! amount |! reasonably |! needed |! for |! that |! purpose. Privacy |! Rule |! permits |! use |! and |! disclosure |! of |! the |! PHI |! without |! individual's |! authorization |! or |! permission |! through |! public |! interest |! and |! benefit |! activities. |! There |! are |! 12 |! national |! priority |! purposes. |! - |! Correct |! answer |! ✔1. |! Required |! by |! law
- |! Public |! health |! activities
- |! Victims |! of |! abuse, |! neglect, |! or |! domestic |! violence
- |! Health |! oversight |! activities
- |! Judicial |! and |! administrative |! proceedings
- |! Law |! enforcement |! purposes
- |! Decedents |! (Funeral |! directors |! or |! medical |! examiners)
- |! Cadaveric |! organ, |! eye, |! or |! tissue |! donations
- |! Research |!
- |! Serious |! threat |! to |! health |! and |! safety
- |! Essential |! government |! functions.
- |! Workers' |! compensations. What |! is |! a |! limited |! data |! set. |! - |! Correct |! answer |! ✔PHI |! from |! which |! certain |! specified |! direct |! identifiers |! have |! been |! removed.
