2.1 Regulatory Requirements

Question 1

Healthcare clearinghouse

Answer 1

Receives health info and translates into standard format to be sent to a health plan provider. Sometimes a billing service.

Question 2

HHS operating divisions

Answer 2

CMS- Medicare and Medicaid services
ONC- office national coordinator for HIT
OCR- office for civil rights

Question 3

Version 5010

Answer 3

Standard for electronic clamor transaction

Question 4

ICD 9

Answer 4

Standard for electronic provider and diagnostic codes

Question 5

ICD 10

Answer 5

Updated to ICD 9. Allows for more info to be entered into EMR systems.

Question 6

ONC

Answer 6

Tests and certifies EMR and EHR solutions. Provides must use certified solutions to quality for incentives.

Question 7

NIST

Answer 7

National institute of standard and tech.

Promote innovation and competition, accelerates research, improve usefulness, and develops security for HIT.

Question 8

Medicare

Answer 8

Insurance program for elderly for hospital and medical care.

Question 9

Medicaid

Answer 9

Welfare program for low income families that provides health and medical services. State participation to use funding is voluntary. States control scope, eligibility standards and rate of payment.

Question 10

Privacy rule

Answer 10

National standard to protect patient health info when a covered entity uses info.

Question 11

Security rule

Answer 11

National standard to protect PHI.

Question 12

ARRA

Answer 12

Funds to HHS to preserve and improve affordable care.

Question 13

HITECH Act

Answer 13

Advancement of HIT through ONC. aim to make EMR EHR useful to all Americans. Involves money incentives.

Question 14

Three types of health record

Answer 14

Public, private, legal

Question 15

How long must health records be kept for?

Answer 15

At lest 6 years

Question 16

MOU

Answer 16

Memorandum of understanding. Used within covered entity to ensure safeguard of phi for those not normally exposed to phi.

Question 17

Which HHS division is responsible for enforcing HIPAA rules?

Answer 17

Office of civil rights.

Question 18

What does the enforcement rule determine?

Answer 18

Impose penalties for violating HIPAA rules and investigation.

Question 19

SLA

Answer 19

Service level agreement- expected service provided and establish how phi is used and shared among parties.

Question 20

HIPAA

Answer 20

Standard rules that covered entities must follow to protect patient health info.