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PA Professions > HIPAA > Flashcards

HIPAA Flashcards

0
Q

What is HIPAA?

A

Federally mandated guidelines signed into law in 1996

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1
Q

What does HIPAA stand for?

A

Health Insurance Portability And Accountability Act… of 1996

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2
Q

Pertaining to HIPAA, what is required by all healthcare providers and claims processors?

A

To use the same insurance coding systems

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3
Q

What is universal coding designed to do?

A

Reduce administrative costs for providers and payers.

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4
Q

What are the 3 sections of HIPAA?

A
  • Transaction Code Sets
  • Security
  • Privacy
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5
Q

What are transaction code sets?

A

Mandated requirement of standards that allow for data interchange through one common format. (ie: ICD9 or CPT)

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6
Q

What does the security aspect entail?

A

Protecting access to health information, including computer systems and electronic transmission.

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7
Q

What does privacy affect and how might one ensure it is honored?

A

It affects how physicians practice and function - to be aware of any conversations regarding a patient. You must make every attempt to keep patient information secure.

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8
Q

What is the difference between privacy and confidentiality?

A

PRIVACY - Right of individual to control personal information and not have it used or disclosed without permission.

CONFIDENTIALITY - Obligation of another party to respect privacy by protecting personal information.

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9
Q

What does PHI stand for and what does it mean?

A

Protected Health Information - All health information that can be reasonably identifiable to a specific patient. Including past, present, or future conditions and/or payments of an individual.

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10
Q

What is a covered entity?

A

All healthcare providers and businesses regulated under HIPAA. Including Providers, Health plans (HMO’s), and Healthcare clearinghouses.

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11
Q

(True or False) The Dept. of Health and Human Services recognizes that the hospital and the privileged physicians must be able to share PHI for treatment purposes, payment and for their joint healthcare operations.

A

True

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12
Q

Does every individual have a right to review or receive a copy of their own PHI?

A

NO. An exception would be when it is determined to be in the best interest of the patient to NOT have a copy… An example would be providing medical records to a mental health patient.

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13
Q

When might an individual’s right to access PHI be suspended?

A

When consenting to participate in a clinical research trial provided the participant agreed to the denial of access. The right to access PHI will be reinstated at the conclusion of the clinical trial.

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14
Q

(True or False) Covered entities may use/disclose PHI for research when an individuals authorization is not obtained.

A

True. This is allowed when the covered entity obtains a documented Institutional Review Board (IRB) or Privacy Board approval.

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15
Q

Individuals have the right to request an amendment to their medical record. Who reviews this request?

A

The institution or department involved in the request.

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16
Q

If the request to amend PHI is permitted, what is done next?

A

A notation is made on the file that the record has been amended.

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17
Q

If the request to amend PHI is denied, what happens next?

A

The patient has the right to write up his/her perspective regarding the PHI in controversy. This write up is kept on file and used whenever the PHI in controversy is used/disclosed.

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18
Q

An accounting of PHI disclosure gives an individual the ability to inquire disclosures of their PHI not used for treatment, payment, or operations. What is included in the accounting and how often will they be provided?

A

The accounting will include

  • To whom PHI was disclosed
  • What was disclosed
  • When it was disclosed

Each patient is allowed 1 accounting per 12 month period without charge.

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19
Q

When might PHI disclosure supersede privacy?

A
  • Required by public policy
  • Court orders
  • Workman’s compensation
20
Q

What are some examples of disclosure based on public policy?

A

These include reporting abuse and violence, communicable diseases, infection control, and subpoenas.

21
Q

What does NPP stand for and what does it mean?

A

Notice of Privacy Practice - Document summarizing the “covered entity’s” policy and procedures for disclosing PHI and the patients rights under HIPAA.

22
Q

When is an NPP presented to a patient?

A

Prior to performance of services by a healthcare provider. And in an emergency it must be presented to the patient as soon as the emergency has resolved and is practical.

23
Q

What is the role of the NPP?

A

It allows a covered entity to use/disclose PHI, without a patient’s explicit authorization, solely for Treatment Payment Operations (TPO). This includes…

1) TREATING the patient
2) Obtaining PAYMENTS for services provided to the patient
3) Performing standard OPERATIONS (Quality Assurance)

24
Q

A good faith effort must be made to obtain the patient’s signature acknowledging presentation of the NPP, but what must be done if a patient refuses to sign?

A

The person presenting the NPP must document that it was presented but the patient refused to sign the acknowledgement.

25
Q

(True or False) If an NPP has been presented to a patient but they refuse to sign, PHI can still be used/disclosed for limited purposes.

A

True

26
Q

Besides TPO, what are some other examples of why to obtain patient authorization?

A
  • Requests for transfer of medical records
  • Requests from life insurance companies
  • Requests from lawyers
  • Patients must specifically authorize to release genetic, HIV/AIDS (except as required by public policy) and mental health information.
27
Q

HIPAA requires that only the “minimum necessary” PHI be obtained/used/disclosed except in what 3 incidences?

A

1) Disclosures to/requests by healthcare providers for treatment purposes
2) Disclosure to the individual who is the subject of the PHI
3) Uses or disclosures required by law

28
Q

Who determines the authority of personal representatives?

A

State law

29
Q

What is a personal representative?

A

An individual granted legal authority to make healthcare decisions for adults or emancipated minors, parents and guardians. (Healthcare proxy, Estate executor)

30
Q

Who should not be included as a personal representative?

A

Nannies, babysitters, or anyone that does not meet state requirements, or is not court ordered.

31
Q

Can a physician discuss a patient’s condition with family or the patient’s friends involved in the individual’s care?

A

Yes, unless the patient objects

32
Q

(True or False) Healthcare professionals may not discuss a patient’s condition via phone with the patient, a provider, or a family member.

A

False. They can unless a patient restricts such discussion.

33
Q

(True or False) Healthcare professionals may discuss a patient’s condition during training rounds in an academic or training institution.

A

True

34
Q

What are “reasonable precautions”?

A
  • Speak using lowered voices or talking apart from others when sharing PHI.
  • In an area where frequent patient-staff communication occurs, use cubicles, divider shields, curtains or similar barriers.
35
Q

(True or Flase) Reasonable precautions must be taken to minimize the chance of incidental disclosure to others who may be nearby.

A

True

36
Q

What reasonable safeguards should be used to protect PHI?

A
  • Limit amount of information left on answering machines.
  • Use professional judgment as to whether leaving specific information with a family member, or other person in the household, is in the best interest of the individual and remember to limit the information disclosed.
37
Q

(True or False) If an individual requests communication in a confidential manner, such as by alternative means or alternative location, the Covered Entity does not have to accommodate the request.

A

False. If the request is reasonable, the Covered Entity must accommodate it.

38
Q

(True or False) HIPAA permits hospitals and disaster relief agencies to notify family members when a loved one has been admitted to a hospital or involved in a disaster.

A

True

39
Q

If the patient has not requested that information be withheld, can you release the condition of the patient to someone who asks?

A

Yes, but only using one-word terminology (undetermined, good, fair, serious, or critical).

40
Q

If the patient has not requested that information be withheld, when can you release the location of the patient?

A

When individuals inquire about the patient BY NAME, or to clergy without obtaining prior patient authorization.

41
Q

What should be done with media requests for informaiton?

A

Refer them to a hospital representative or hospital public relations representative.

42
Q

What are the penalties for disclosure of PHI or violation of a provision?

A
  • Single violation of a provision = $100 fine

- Multiple violations of a single provision in a year = up to $25,000 fine

43
Q

What are the penalties for knowingly using a unique identifier, or obtaining/disclosing PHI?

A
  • A fine of not more than $50,000
    AND/OR
  • Imprisonment of not more than 1 year
44
Q

What are the penalties for knowingly using a unique identifier, or obtaining/disclosing PHI under false pretenses?

A
  • A fine of not more than $100,000
    AND/OR
  • Imprisonment of not more than 5 years
45
Q

What are the penalties for intent to sell, transfer, or use PHI for commercial advantage, personal gain, or malicious harm?

A
  • A fine of not more than $250,000
    AND/OR
  • Imprisonment of not more than 10 years
46
Q

What government agencies oversee HIPAA?

A
  • Center for Medicare and Medicaid Services (CMS)

- Office for Civil Rights (OCR)

47
Q

Does HIPAA prohibit faxing of PHI?

A

No, but there should be appropriate administrative, technical, and physical safeguards in place to protect the privacy of PHI.

PA Professions (13 decks)

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