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HCCA - CHPC Overview Latest 2023 Graded A+

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HCCA - CHPC Overview Latest 2023 Graded A+ HIPAA became law ✔✔1996 What is the purpose of HIPAA? ✔✔• To make health insurance portable under ERISA; • To move health care onto a nationa... lly standardized electronic billing platform; and • To prevent fraud, waste and abuse Intent ✔✔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, 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 section ✔✔45 CFR sections 164.102 through 164.534 Identify the four sections in the CFR by location and topic ✔✔Section One: 164.102 - 164.318 and 164.530 - 164-534 Organizational Requirements Section Two: 164.500 - 164.514 Use and Disclosure of Information Section Three: 164.520 - 164.528 Individual's Rights and Penalties Section Four: Interaction with the HIPAA Security Rule How do you determine if organization is a CE ✔✔- compare the functions of the entity to the three principal types of "covered entities" (CE), - determine if the entity electronically transmits one of the nine defined transactions" What are the different types of CEs ✔✔- Provider - Health Plan - Clearing House - Other Types How is a Provider defined ✔✔- "a provider of services (as defined in section 1395x (u) of title XIX) - a provider of medical or other health services (as defined in section 1395x (s) of title XIX) - any other person furnishing health care services or supplies. Does a provider need a standing facility to be considered a CE ✔✔NO What does "Health Plan" mean? ✔✔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. • A Medicare supplemental policy • 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 . What is a Clearinghouse ✔✔may be a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements. What are other HIPAA Entities ✔✔Hybrid, Business Associate Organized Health Care Arrangement Affiliated Covered Entity What is a Hybrid Entity? ✔✔single legal enti [Show More]

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