HIPAA

Question 1

CMS stands for…

Answer 1

Centers for Medicare & Medicaid Services

Question 2

it is the main federal government agency responsible for Medicare & Medicaid

Answer 2

CMS

Question 3

HIPAA stands for…

Answer 3

Health Insurance Portability & Accountability Act of 1996

Question 4

What does HIPAA do?

Answer 4

— protect health info
— ensures coverage for PT
— created industry standards

Question 5

3 parts of HIPAA

Answer 5

— Privacy Rule
— Security Rule
— Electric Healthcare Transactions & Code Sets (TCS) Rule

Question 6

What does privacy rule do?

Answer 6

— regulates use & disclosure of PT’s protected health info

Question 7

What does PHI stands for & what is it?

Answer 7

it stands for Protected Health Info, it is anything that can identify the PT
— identifier + health info = PHI

Question 8

What are the 3 Covered Entities (CE) that must follow HIPAA?

Answer 8

Payers, Clearinghouse, Provider

Question 9

What are payers?

Answer 9

they are the insurance companies or health plan

Question 10

What is a clearinghouse?

Answer 10

it’s the organizations that checks for error on the claim before submitting to the payer

Question 11

What are examples of Providers?

Answer 11

Nurse Practitioner, Physician Assistant, Medical Dr., Laboratory, Pharmacy

Question 12

What are business associates?

Answer 12

it is anyone that are personally employed for the CEs
— ex : Biller, Coder, Insurance Specialist, Office Staff, Receptionist, etc.

Question 13

TPO stands for…

Answer 13

Treatment, Payment, & Healthcare Operations

Question 14

What is a TPO?

Answer 14

it is an exception to releasing PT’s info w/o a release form

Question 15

What are other situations where release form is not needed?

Answer 15

— Subpoena (court orders) - Duces Tecum
— Emergency
— Workman Compensation
— Communicable diseases (HIV, COVID)

Question 16

What does security rule do?

Answer 16

— requires CEs to establish physical & technical safeguards to protect PHI

Question 17

What does TCS Rule do?

Answer 17

— releasing PT’s data where the “Laymen person” can’t understand

Question 18

What is a code set?

Answer 18

any group of codes used for encoding data elemets

Question 19

What does NPI stands for and what is it?

Answer 19

National Provider Identifier — a unique 10-digit identifier given to provider

Question 20

What does NPP stands for and what is it for?

Answer 20

Notice of Privacy Practices — a form letting PT know how we protect their PHI

Question 21

What is a Breach?

Answer 21

it is when PHI is leaked w/o permission

Question 22

HITECH stands for…
and, what does it do?

Answer 22

Health Info Technology for Economic & Clinical Health Act — requires CEs to notify affected individuals ff the discovery of a breach of unsecured HI

Question 23

What is a breach notification?

Answer 23

it’s a document notifying an individual of a breach (only 60 days)

Question 24

What is the difference between fraud and abuse?

Answer 24

Fraud is intentional, it’s to gain access and abuse is unintentional due to lack of training or a mistake.

Question 25

What is an OIG?

Answer 25

Office of Inspector General — DHHS calls to investigate payer’s & provider’s suspected fraud & abuse

Question 26

DHHS stands for…

Answer 26

Department of Health & Human Services — who you call first to report fraud & abuse

Question 27

When was the Medicare program established?

Answer 27

1965

Question 28

What do Medical Part A & B pay for?

Answer 28

Part A — hospital/facility care
Part B — physician services and durable medical equipment

Question 29

Who is eligible for Medicare?

Answer 29

— those w permanent kidney failure
— 65 & over
— w disability benefits

Question 30

Who administers funds for Medicare?

Answer 30

Social Security Administration

Question 31

What is the fastest growing population today?

Answer 31

Elderly