HIPAA review questions

32 terms by dororo4510

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Compliance is the process of

Meeting regulation, recommendations, and expectations of federal and states agencies that pay for health care services and regulate the industry.

Transactions in which health care information is accessed, processed, stored, and transferrred using electronic technologies are known as 1.______________ and its acronym is 2._________.

1. e-Health information Management
2. eHIM

Baby Nelson was born January 20, 2005, at 7:15 am. When using the required Health Level Seven (HL7) format for transmission, how would this appear?

YYYYMMDDHHMM 200501200715

A code system used for managing patinet electronic health records, informatics, indexing,and billing laboratory procedures is called 1._________________ and its acronym is 2.______________

1. Systematized nomenclature of human and Veterinacy medicine
2. SNOMED

What is the primary purpose of HIPAA title 1: Insurance Reform?

Is to provide continues insurance coverage for workers and their insured dependents when they charge or lose jobs.

The focus on the health care practice setting and reduction of administrative costs and burdens are the goals of which part of HIPAA ?

Tittle 2 : Administrative Simplifiration

An independent organization that receives insurance claims from the physician's office performs edits, and transmits claims to insurance carriers is known as a/an:

Clearinghouse

Under HIPAA guidelines, a health care coverage carrier, such as Blue Cross/ Blue Shield, that transmits health information in elctronic form in connection with a transaction is called a/an:

Covered Entity

Dr. John Doe contracts with an outside billing company to manage claims and accounts receivable. Under HIPAA guidelines, the billing company is considered a/an:

Business Associate

An individual designated to assist the provider by putting compliance policies and procedures in place and training office staff is known as a/an 1.___________________ under HIPAA guidelines.

1. Privacy officer or privacy official (PO)

If you give, release, or transfer information to another entity, this is known as:

Disclosure

Define protected health information -PHI

Is any information that identifies an individual and describes his or her health status, age, sex, ethnicity, or other demographic characteristics, whether or not that information is stored or transmitted electronically.

Unauthorized release of a patient's health information is called:

Breach of confidential communication

A confidential communication related to the patient's treatment and progress that may be disclosed only with the patient's permission is known as:

Privilidged information-communication

Under HIPAA, exections to the right of privacy are those record involving:

1.Patients who are members of a MCO and the physician has signed contract
2. When a patient has a certain communicable disease
3.Medical device that breaks or malfunctions, food and drug administration provides to report
4. If patient is a suspect for a criminal investigation
5.When patient records are subpoened
6. Patient that is suing someone and wants to protect
7. Suspious death or suspected crime victim, providers must report cases
8. Workers' compensation-indutrial accident cases
9. Child abuse, elder abuse, domestic violence

At a patient's first visit under HIPAA guidelines, the document that must be given so the patient acknowledges the provider's confidentiality of their protected health information is the:

Notice of Privacy Practices - NPP

Name the tree main sections of the HIPAA Security Rule for protecting electronic health information.

1. Administrative Safeguards
2. Technical Safeguards
3. Physical Safeguards

Fraud or Abuse:

Under the False Claims Act, billing a claim for services not medically necessary.

Fraud

Fraud or Abuse:

Changing a figure on an insurance claim form to get increased payment.

Fraud

Fraud or Abuse:

Dismissing the copayment owed by a Medicare patient.

Fraud

Fraud or Abuse:

Neglecting to refund an overpayment to the patient.

Abuse

Fraud or Abuse:

Billing for a complax fracture when the patient suffered a simple break.

Fraud

A standards developing organization whose mission is to provide standards for the exchange, management, and intergration of data that support clinical patient care and management, delivery, and evaluation of health care services is called:

Health Level Seven - HL7

HIPAA transaction standards apply to the following, which are called covered entities. They are:

1. health care third-party payers
2. health care providers
3. health care clearinghouse
(all of the above)

Enforcement of the privacy standards of HIPAA is the responsibility of:

Office for Civil Rights - OCR

Verbal or written agreement that gives approval to some action, situation, or some action, situation, or statement is called:

Consent

An individual's formal written permission to use or disclose his or her personally identifiable health information for purposes other than treatment, payment, or health care operations is called:

Authorization

True or False

Individually identifable health information-IHHI is any part of person's health data (e.g., demographic information, adress, date of birth) obtained from the patient that is created or received by a covered entity.

True

True or False

HIPAA requirements protect disclosure of protected health information outside of the organization but not for internal use of health information.

False

True or False

Under HIPAA, patients may request confidential communications and may restrict certain disclosures of protected health information.

True

True or False

A national provider identifier-NPI number is issued for 5 years and must be renewed.

False

True or False

To submit an insurance claim for medical services that were not medically necessary is violation of the False Claims Act-FCA.

True

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