Download HCCA/CHPC Study Questions 2024 | Actual Questions and Answers Latest Updated 2024/2025 (G and more Exams Public Health in PDF only on Docsity!
HCCA/CHPC Study Questions 2024 | Actual Questions and Answers Latest
Updated 2024/2025 (Graded A+)
What is the purpose of HIPAA? - ✔✔• 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? - ✔✔45 CFR sections 164.102 through 164. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part- 164 What are the subparts of HIPAA part 164? - ✔✔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- 164 How do you determine if an organization is a "Covered Entity"? - ✔✔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. https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html 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. - ✔✔The Privacy Act of 1974 Which of the following is not considered a HIPAA Entity Designation:
- Affiliated covered entity
- Entity that performs healthcare and non-healthcare component activities including both covered and non-covered functions
- A group health plan
- Contract arrangement with FEDEX carrier - ✔✔4. Contract arrangement with FEDEX carrier What is Gramm-Leach-Bliley Act (GLBA)? - ✔✔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? - ✔✔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).
https://privacyruleandresearch.nih.gov/pr_06.asp The transmission of information between two parties to carry out financial or administrative activities related to health care is called: - ✔✔Transaction (healthcare transaction). Few examples of healthcare transactions: healthcare claims; coordination of benefits; health plan premium payments; remittance advice (or ETF, electronic fund transfer); referral certification and authorization What are examples of a BA? - ✔✔BA (Business Associate) - performs functions or activities on behalf of a covered entity that involve access by the business associate to protected health information. Examples: claims processing data analysis billing benefit management quality assurance 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. - ✔✔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 - ✔✔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 business associate agreement with their contracted covered entities. - ✔✔TRUE Business associate agreement mandate under the HIPAA Privacy Rule. There are some exceptions such:
- for purposes of TPO, including payment for health plan premiums
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- 162 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. - ✔✔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 laboratory for treatment of the individual. - ✔✔TRUE Remember, use and disclosure of PHI for purposes of TPO requires no specific authorization True or False: Research use/disclosure with individual authorization does not expire or continue until the end of the research study - ✔✔TRUE https://www.hhs.gov/hipaa/for-professionals/special-topics/research/index.html True or False: Research use/disclosure with individual authorization may be combined with an authorization for a different research activity if research related treatment is conditioned on the provision of one of the authorizations - ✔✔TRUE
https://www.hhs.gov/hipaa/for-professionals/special-topics/research/index.html True or False: Research use/disclosure with individual authorization may be combined with other legal permission or consent to participate in the research - ✔✔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. - ✔✔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. - ✔✔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 - ✔✔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
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 - ✔✔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 - ✔✔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 - ✔✔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 Is a covered entity required to provide notice to individuals about its disclosures of PHI to a PHA for public health purposes? - ✔✔Yes. This is in the covered entity's Notice of Privacy Practices (NPP).
The Privacy Rule requires a covered entity to include in its NPP a description of the purposes, which would include public health purposes, for which the covered entity may use or disclose PHI without an individual's authorization. However, the Privacy Rule does not require a business associate (such as an HIE that is a business associate) to provide individuals with a NPP. True of False: OHCAs and ACEs are able to produce a joint Notice of Privacy Practice (NPP) - ✔✔FALSE Explanation: OHCAs are joint arrangements, have an Integrated Delivery System, and therefore agree to abide by the terms of the notice with respect to PHI created or received by the covered entity as part of its participation in the OHCA. 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. - ✔✔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: - ✔✔Corporate integrity Agreements (CIA)
https://www.hhs.gov/hipaa/for-professionals/faq/2046/under-what-circumstances-may-a-covered- entity/index.html https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html 38 U.S.C. 7332 deals with confidentially of patient medical record information related to: a. drug abuse, sexually transmitted diseases, and tuberculosis b. HIV/AIDS status c. drug abuse, alcoholism, infection with the HIV virus, and sickle cell anemia d. mental illness, HIV status, drug and alcohol abuse - ✔✔c. drug abuse, alcoholism, infection with the HIV virus, and sickle cell anemia True or False: The Minimum Necessary is a key concept under the HIPAA security rule - ✔✔FALSE It is a key concept under the PRIVACY Rule. Re: HIPAA Authorization Is there any information we can release to a person who is calling on behalf of a patient who is not authorized in a release form? - ✔✔Patient must be given an "opportunity to agree or object" keeping in mind:
- you can obtain patient's agreement verbally, over the phone, BUT makes notes in file
- only disclose the Minimum Necessary https://thehipaaetool.com/hipaa-authorization-required/ Re: HIPAA Authorization When my patients are being treated for car accident injuries, we often receive requests for PHI from lawyers. I am not sure if we should provide the information and don't know how to decide whether the request is legitimate. How do we validate the request is legitimate? - ✔✔Ensure is a valid HIPAA authorization:
MUST have the authorization 6 core elements and 3 key statements as per 45 CFR § 164.508 (c)(1) and (2) https://www.law.cornell.edu/cfr/text/45/164. Re: HIPAA Authorization One of my long term (dental) patients was recently diagnosed with cancer. His new oncologist's assistant called to request his PHI from our files. I don't know if the patient knows or has authorized this. Can the request be fulfilled? - ✔✔YES, no authorization is required for purposes of TPO. But, ensure the request is in writing including: Covered Entity's name; Patient's name; Date of the event/time of treatment; and Reason for the request. https://thehipaaetool.com/hipaa-authorization-required/ Re: HIPAA Authorization (suspected domestic violence) I strongly suspect that a patient is a victim of domestic violence, although the patient has not confided in me. The abuse seems to be escalating, judging by the injuries I've seen. May I do anything? - ✔✔You may, this may be an exception to the HIPAA Privacy Rule. IF you reasonably believe the patient to be a victim of adult abuse, neglect or violence, you may report to the appropriate government agency. You may also obtain patient's agreement, but not required. ARRA passed in 2009, key items to know: - ✔✔ARRA - also known as "Obama Stimulus" in response to the 2008 recession ARRA mandated government spending, tax cuts, and loan guarantees for financial relief to families. ARRA required hospitals to computerize medical records and modernize HIT systems (HITECH).
https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html The Minimum Necessary DOES NOT apply to? - ✔✔does not apply to: TPO To the individual directly To the HHS Secretary or required by law When authorization is granted Where does Minimum Necessary link to in the Security rule? - ✔✔Role Based Access - can content filters be used to support the privacy concept Who can Deceased Individuals information be released to at anytime? - ✔✔coroners or medical examiners (and Funeral Directors as necessary to carry out their duties with respect to the decedent) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164. Preemption under HIPAA means - ✔✔Federal law states that it preempts or overrides (supersedes) state law on a particular issue, then federal law is the law that must be followed. In general, HIPAA preempts state law that is "contrary" to the federal rule. In many cases, complying with the stronger standard (more stringent) will allow you to comply with both state law and HIPAA. Example 1: if state law gives a provider 10 days to respond to a patient's request for a copy of his medical records, and HIPAA allows 30 days, you can comply with both state and federal law by responding within 10 days. Example 2: if state law requires longer period for record keeping than the federal law, then go with the longer period. https://library.ahima.org/doc?oid=59816#.YlTLkOjMI2w Valid Authorization core elements (see 45 CFR § 164.508(c)(1)): - ✔✔1. meaningful description of the information to be disclosed
- name of the individual/person authorized to make the requested disclosure
- name or other identification of the recipient of the information
- description of each purpose of the disclosure
- expiration date for the authorization
- signature and date of the individual or their personal representative (someone authorized to make health care decisions on behalf of the individual) https://www.law.cornell.edu/cfr/text/45/164. and https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency- preparedness/authorization/index.html Valid Authorization 3 key statements (see 45 CFR § 164.508(c)(2)): - ✔✔The statements are to be included in a valid Authorization:
- A statement of the person's right to revoke the authorization, exceptions to this right, and a description of how to revoke:
- A statement that treatment, payment, enrollment or eligibility for benefits may NOT be conditioned upon signing the authorization;
- A statement regarding the potential that the information disclosed pursuant to the authorization may be re-disclosed by the recipient and, if so, it may no longer be protected by a federal confidentiality law; Note: the person signing the authorization has the right to (or will receive) a copy of the authorization. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164. Fill in the blanks: The three types of AUTHORIZATION: VALID - must have all the 6 required core elements and 3 statements/notices D_______ - lacks any of the required elements/statements, or expiration date has passed, or revoked, etc. C_______ - typically allowed in research studies, this authorization may be combined with another written permission IF it's for the same research related studies - ✔✔Defective; Compound
Research HIPAA Waiver criteria: - ✔✔Research Waiver In order for research to be conducted, it must meet a minimum set of waiver criteria elements. Elements that must be met to meet wavier criteria are:
- the use or disclosure for the research involved minimum risk to the patient;
- the research could not be conducted without proper access to the waiver being approved; and
- the research could not be conducted without proper access to the use of the PHI. 45 CFR 164. (i)(2) What's malicious software? - ✔✔malware, is software that is used to control or take over applications, workstations, or servers, damage/disrupt a system. See Security Rule, definitions - 45 CFR 164. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-C/section-164. A covered entity may use or disclose PHI for TPO...what does TPO stand for - ✔✔Treatment Payment Health Care Operations True or False: Payer/health plans are allowed to use/disclose beneficiary's PHI in activities such as legal services, medical review, and fraud and abuse detection - ✔✔TRUE A provider receives a request from the Social Security Administration for PHI relating to a person's application for benefits. Which of the following is the correct method of release? A. Since it is to a federal agency, an authorization from the patient is not needed, so PHI can be released. B. The provider should review the PHI and make a decision on the minimum necessary and release. C. The provider should notify the patient and obtain a signed authorization prior to release. D. Release the information because the patient signed a consent for treatment. - ✔✔C. The provider should notify the patient and obtain a signed authorization prior to release
Also known as the "Stimulus Act" or the "Recovery Act", enacted in 2009; its main purpose was to create jobs and stimulate economic growth; it also included provisions to promote health information technology - ✔✔American Recovery and Reinvestment Act (ARRA) C.I.A. (HIPAA) stands for? - ✔✔Confidentiality (not available or disclosed to unauthorized person) Integrity (unaltered or destroys in unauthorized manner)) Availability (accessible and usable by authorized person) https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html Comprehensive legislation that ensures access to health coverage for those who change jobs or are temporarily out of work. It also provides the mechanism for funding the Department of Justice and the FBI for health care fraud investigations - ✔✔Health Insurance Portability and Accountability (HIPAA) Ref. https://oig.hhs.gov/reports-and-publications/hcfac/index.asp True or False: The HIPAA Privacy and Security rules were promulgated to make health care interstate commerce equal, thus creating a national health care privacy and security baseline or floor - ✔✔TRUE One of the barriers before HIPAA was signed into law was the lack of access and national standards. The Privacy and Security provisions were integral elements as many States did not have privacy rights or individual right of access to healthcare records. Re: HCCA Privacy Compliance Handbook True or False: The Office for Civil Rights (OCR) is the entity that oversees HIPAA, and the agency's goal is to ensure that patients' health information is properly protected while allowing for the flow of health information needed. OCR also provides excellent guidance on steps to take if an entity experiences a cyberattack. - ✔✔TRUE True or False:
