Chapter 3: Regulatory Requirements

Question 1

BAA

Answer 1

business associate agreement

Question 2

e-PHI

Answer 2

electronic protected health information

Question 3

HIPAA

Answer 3

Health Insurance Portability and Accountability Act

Question 4

MOU

Answer 4

memorandum of understanding

Question 5

SLA

Answer 5

service-level agreement

Question 6

breach notification rule

Answer 6

Requires covered entities to notify affected individuals, the HHS secretary, and possibly the media when protected health information (PHI) has been breached

Question 7

business associate agreement (BAA)

Answer 7

A contract used between healthcare entities and third parties to establish a mutual understanding of safeguards of e-PHI.

Question 8

covered entity

Answer 8

Health Insurance Portability and Accountability Act (HIPAA) is designed to protect health information used by health insurance plan providers, healthcare clearinghouses, and healthcare providers. These three entities are classified as covered entities. Basically, a covered entity is anyone or any organization required to submit to HIPAA rules.

Question 9

electronic protected health information (e-PHI)

Answer 9

HIPAA protects the electronic information that can be used to identify an individual. e-PHI is information created, used, or disclosed about a patient while providing healthcare.

Question 10

eligible provider

Answer 10

Hospitals or professionals participating in incentive programs must meet meaningful use criteria to be eligible to receive incentive money.

Question 11

enforcement rule

Answer 11

Establishes penalties for violations to HIPAA rules and procedures following a violation, such as investigations and hearings.

Question 12

Health Insurance Portability and Accountability Act (HIPAA)

Answer 12

A law created in 1996 to provide a standard set of rules that all covered entities must follow to protect patient health information and to help healthcare providers transition from paper to electronic health records.

Question 13

healthcare clearinghouse

Answer 13

A business that receives healthcare information and translates that information into a standardized format to be sent to a health plan provider. A healthcare clearinghouse is sometimes called a billing service. Basically, a healthcare clearinghouse is a middle person that processes healthcare information.

Question 14

ICD 9

Answer 14

HIPAA mandated a standard format for electronic provider and diagnostic codes. The current standard has limitations that restrict the full use of EMR/EHR software.

Question 15

ICD 10

Answer 15

HIPAA mandated a standard electronic format for provider and diagnostic codes. The new standard is intended to grow with the functional needs of the healthcare industry. The http://www.cms.gov website offers more details about ICD-10.

Question 16

legal health record

Answer 16

Health organizations must retain a health record of patients for use by the patient or legal services.

Question 17

meaningful use

Answer 17

The goals of meaningful use are to help healthcare providers know more about their patients, make better decisions, and save money by using HIT in a meaningful way.

Question 18

memorandum of understanding (MOU)

Answer 18

Contracts are sometimes necessary within an organization between departments or personnel for mutual understanding of the safeguards of e-PHI.

Question 19

privacy rule

Answer 19

Establishes national standards to protect individuals’ health information whenever a covered entity accesses this information. This rule establishes safeguards to regulate who can access e-PHI (electronic protected health information) and the reasons why someone needs to access e-PHI.

Question 20

private health record

Answer 20

A health record created and maintained by an individual. Sometimes called a personal health record (PHR).

Question 21

public health record

Answer 21

Researchers need access to health records to analyze data. For this reason a public health record is made available for the collection of public health data in an anonymous manner.

Question 22

service-level agreement (SLA)

Answer 22

Contracts used between healthcare entities and third parties to establish how e-PHI is shared and used. An SLA also establishes expectations of service provided.

Question 23

Version 5010

Answer 23

HIPAA mandated a standard format for electronic claims transactions. This standard was updated to grow with the functional needs of the healthcare industry. The http://www.cms.gov website offers more details about Version 5010.

Question 24

waiver of liability

Answer 24

A contract used to protect healthcare entities from being inappropriately responsible or sued for harm or debt.