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MBIC- module 1 > HIPAA > Flashcards

HIPAA Flashcards

1
Q

A court order that prohibits the use or disclosure of PHI for any purpose other than the litigation or proceeding for which the PHI was requested.

A

Qualified protective order

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2
Q

A document that advises the individual of how his or her PHI may be used or disclosed.

A

Notice of Privacy

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3
Q

A fine imposed by the Secretary of the DHHS (Department of Health and Human Services) on a CE (Covered entity) if it is determined that the CE has violated any provision of the Privacy Rule.

A

Civil monetary penalty

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4
Q

A legal agreement between two parties that lays out the method and timetable for solving a complaint

A

Resolution agreement

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5
Q

A person or agency to which the rules apply

A

Covered entity (CE)

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6
Q

A summary of payment or denial of health insurance claim issued by the insurance carrier to the patient or the patient’s representative

A

Explanation of benefits

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7
Q

An individual or group plan that provides or pays the cost of medical care: group health plans, health insurance issuers, health maintenance organizations (HMOs), issuers of long-term care policies, employee welfare benefit plans, and government health plans.

A

Healthcare plans

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8
Q

An organization that processes healthcare transactions on behalf of providers and insurers: billing services, medical reviewers, and repricing companies.

A

Healthcare Clearinghouses

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9
Q

Another person or organization to whom a CE discloses PHI so that person or organization may carry out, assist with the performance of, or perform on behalf of the CE a function or activity.

A

Business associate

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10
Q

Any health information created or received by a medical practice or healthcare organization that identifies a specific individual.

A

Protected health information (PHI)

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11
Q

Any person or entity trained and licensed to render health care: physicians, hospitals, dentist, clinics pharmacies, and nursing homes.

A

Healthcare providers

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12
Q

Employees, volunteers, student, and trainees. Training requirements extend to people working in clinical, administrative, clerical, and related positions in the healthcare environment.

A

Workforce members

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13
Q

HIPAA

A

Health Insurance Portability and Accountability Act

aka the Kennedy-Kassebaum BIll

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14
Q

HITECH

A

Health Information Technology for Economic and Clinical heath Act

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15
Q

Provision under HIPAA that limits denial of coverage on the basis of previous poor health and the exclusion of preexisting conditions by health plans

A

Portability

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16
Q

refers to PHI handled by a healthcare organization’s workforce members.

A

Used

17
Q

The broad variety of activities relating to the typical functions of a medical practice: case management, peer review, legal services, auditing services, and other administrative and management functions.

A

Operations

18
Q

The computer-to-computer exchange of business information

A

Electronic data interchange (EDI)

19
Q

The person who is seeking or has received medical care, the person whose health information we are protecting

A

Individuals

20
Q

The provision, coordination, and management of health care and related services by one or more healthcare providers, as well as consultations between healthcare providers and referrals of patients for health care

A

Treatment

21
Q

these are an example of what?
Billing, claims management, collection activities, determinations of eligibility or coverage, coordination of benefits, adjudication of health claims, and utilization review

A

Payment

22
Q

Uses and disclosures of PHI are permitted under HIPAA for activities related to treatment, payment, or healthcare operations.

A

Treatment, payment or Healthcare operations (TPO)

23
Q

When a workforce member within a healthcare organization releases, transfers, or provides access to PHI (Protected health Information) to another organization or individual outside the entity holding the information

A

Disclosed/Disclosure

24
Q

Which title of HIPAA:

  • Helps find and root out healthcare fraud
  • files claims for payment
  • Checks patient eligibility benefits
  • requests authorization for services
  • Notify providers of payments
  • Transfers medical records
A

TItle II

25
Q

Which title of HIPAA:

  • Makes it easier for workers to get health coverage when they start new jobs
  • Reduces the likelihood that existing healthcare coverage will be lost
  • Helps workers maintain continuous health coverage when they change jobs
  • Helps workers purchase health insurance coverage on their own if they lose coverage under an employer’s group health plan and have no other coverage available
  • Limits the use of exclusions for preexisting conditions
  • Prohibits group health plans from discriminating by denying coverage or charging extra for coverage on the basis of past or current poor health
A

Title I

MBIC- module 1 (12 decks)

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