In which of the following circumstances must an individual be given the opportunity to agree or object to the use and disclosure of their PHI?
A and C (answer)
a). Before their information is included in a facility directory
b). Before PHI directly relevant to a person’s involvement with the individual’s care or payment of health care is shared with that person
Which of the following statements about the HIPAA Security Rule are true?
All of the above (answer)
a). Established a national set of standards for the protection of PHI that is created, received, maintained, or transmitted in electronic media by a HIPAA covered entity (CE) or business associate (BA)
b). Protects electronic PHI (ePHI)
c). Addresses three types of safeguards – administrative, technical and physical – that must be in place to secure individuals’ ePHI
A covered entity (CE) must have an established complaint process.
True
The e-Government Act promotes the use of electronic government services by the public and improves the use of information technology in the government.
True
(CORECT)
When must a breach be reported to the U.S. Computer Emergency Readiness Team?
Within 1 hour of discovery
Which of the following statements about the Privacy Act are true?
All of the above (answer)
a). Balances the privacy rights of individuals with the Government’s need to collect and maintain information
b). Regulates how federal agencies solicit and collect personally identifiable information (PII)
c). Sets forth requirements for the maintenance, use, and disclosure of PII
What of the following are categories for punishing violations of federal health care laws?
All of the above (answer)
Criminal penalties
Civil money penalties
Sanctions
Which of the following are common causes of breaches?
All of the above (answer)
Theft and intentional unauthorized access to PHI and personally identifiable information (PII)
Human error (e.g. misdirected communication containing PHI or PII)
Lost or stolen electronic media devices or paper records containing PHI or PII
Which of the following are fundamental objectives of information security?
All of the above (answer)
Confidentiality
Integrity
Availability
If an individual believes that a DoD covered entity (CE) is not complying with HIPAA, he or she may file a complaint with the:
All of the above (answer)
DHA Privacy Office
HHS Secretary
MTF HIPAA Privacy Officer
Technical safeguards are:
Information technology and the associated policies and procedures that are used to protect and control access to ePHI
A Privacy Impact Assessment (PIA) is an analysis of how information is handled:
Physical measures, including policies and procedures that are used to protect electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion
(correct)
A Privacy Impact Assessment (PIA) is an analysis of how information is handled:
All of the above
To ensure handling conforms to applicable legal, regulatory, and policy requirements regarding privacy
To determine the risks and effects of collecting, maintaining and disseminating information in identifiable form in an electronic information system
To examine and evaluate protections and alternative processes for handling information to mitigate potential privacy risks
A breach as defined by the DoD is broader than a HIPAA breach (or breach defined by HHS).
True
Which of the following are breach prevention best practices?
All of this above (answer)
Access only the minimum amount of PHI/personally identifiable information (PII) necessary
Logoff or lock your workstation when it is unattended
Promptly retrieve documents containing PHI/PHI from the printer
An incidental use or disclosure is not a violation of the HIPAA Privacy Rule if the covered entity (CE) has:
All of the above (answer)
Implemented the minimum necessary standard
Established appropriate administrative safeguards
Established appropriate physical and technical safeguards
Under the Privacy Act, individuals have the right to request amendments of their records contained in a system of records.
True
Which HHS Office is charged with protecting an individual patient’s health information privacy and security through the enforcement of HIPAA?
-Office of Medicare Hearings and Appeals (OMHA)
(CORRECT)
Challenge exam:
-Office for Civil Rights (OCR)
Physical safeguards are:
-Administrative actions, and policies and procedures that are used to manage the selection, development, implementation and maintenance of security measures to protect electronic PHI (ePHI). These safeguards also outline how to manage the conduct of the workforce in relation to the protection of ePHI
Challenge exam:
-Physical measures, including policies and procedures that are used to protect electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion
Which of the following would be considered PHI?
An individual’s first and last name and the medical diagnosis in a physician’s progress report
The minimum necessary standard:
All of the above (ANSWER)
Limits uses, disclosures, and requests for PHI to the minimum necessary amount of PHI needed to carry out the intended purposes of the use or disclosure
Does not apply to exchanges between providers treating a patient
Does not apply to uses or disclosures made to the individual or pursuant to the individual’s authorization
ePHI
ePHI is PHI that is created, received, maintained, or transmitted in electronic media by a HIPAA CE or BA.
Information security:
the process of protecting data from unauthorized access, destruction, modification, or disruption
Fundamental objectives of information security:
Confidentiality
Integrity
Availability
Privacy Overlay
The Privacy Overlay is the authoritative source of HIPAA Security Rule-specific security controls for DoD and includes supporting guidance to complement overall system security. It is intended to help information systems security engineers, authorizing officials, and privacy officials select reasonable and appropriate protections for ePHI that satisfy current policy requirements.
Elements of a risk analysis include:
Defining the scope of the analysis to include all ePHI the CE creates, receives, maintains and transmits, and documenting where the ePHI is located
Identifying and documenting reasonably anticipated and potential threats specific to the CE’s operating environment and vulnerabilities which, if exploited by a threat, would create a risk of an inappropriate use or disclosure of ePHI
Assessing existing security measures
Determining and documenting the potential impact and risk to the confidentiality, integrity and availability of ePHI
Periodically reviewing and updating the risk analysis
physical safeguard in the form of an access control to a secure area of the Valley Forge MTF.
Pursuant to the HIPAA Security Rule, covered entities must maintain secure access (for example, facility door locks) in areas where PHI is located. Allowing an unidentified individual to bypass a security entrance in this scenario violates the HIPAA Security Rule and exposes the MTF and its patients to a potential breach situation.
The HIPAA Security Rule applies to which of the following:
C. PHI transmitted electronically
Administrative safeguards are:
A. Administrative actions, and policies and procedures that are used to manage the selection, development, implementation and maintenance of security measures to protect electronic PHI (ePHI). These safeguards also outline how to manage the conduct of the workforce in relation to the protection of ePHI
Select the best answer. Which of the following are fundamental objectives of information security?
Confidentiality
B. Integrity
C. Availability
D. All of the above
In which of the following circumstances must an individual be given the opportunity to agree or object to the use and disclosure of their PHI?
A) Before their information is included in a facility directory
B) Prior to disclosure to a business associate
C) Before PHI directly relevant to a person’s involvement with the individual’s care or payment of health care is shared with that person
D) A and C
A and C
Which of the following statements about the HIPAA Security Rule are true?
A) Established a national set of standards for the protection of PHI that is created, received, maintained, or transmitted in electronic media by a HIPAA covered entity (CE) or business associate (BA)
B) Protects electronic PHI (ePHI)
C) Addresses three types of safeguards – administrative, technical and physical – that must be in place to secure individuals’ ePHI
D) All of the above
All of the above
A covered entity (CE) must have an established complaint process.
True
The e-Government Act promotes the use of electronic government services by the public and improves the use of information technology in the government.
True
When must a breach be reported to the U.S. Computer Emergency Readiness Team?
A) Within 1 hour of discovery
B) Within 24 hours of discovery
C) Within 48 hours of discovery
D) Within 72 hours of discovery
Within 1 hour of discovery
Which of the following statements about the Privacy Act are true?
A) Balances the privacy rights of individuals with the Government’s need to collect and maintain information
B) Regulates how federal agencies solicit and collect personally identifiable information (PII)
C) Sets forth requirements for the maintenance, use, and disclosure of PII
D) All of the above
All of the above
What of the following are categories for punishing violations of federal health care laws?
A) Criminal penalties
B) Civil money penalties
C) Sanctions
D) All of the above
All of the above
Which of the following are common causes of breaches?
A) Theft and intentional unauthorized access to PHI and personally identifiable information (PII)
B) Human error (e.g. misdirected communication containing PHI or PII)
C) Lost or stolen electronic media devices or paper records containing PHI or PII
D) All of the above
All of the above
Which of the following are fundamental objectives of information security?
A) Confidentiality
B) Integrity
C) Availability
D) All of the above
Confidentiality
Integrity
Availability
All of the above (correct)
If an individual believes that a DoD covered entity (CE) is not complying with HIPAA, he or she may file a complaint with the:
A) DHA Privacy Office
B) HHS Secretary MTF
C) HIPAA Privacy Officer
D) All of the above
All of the above
Technical safeguards are:
A) Administrative actions, and policies and procedures that are used to manage the selection, development, implementation and maintenance of security measures to protect electronic PHI (ePHI). These safeguards also outline how to manage the conduct of the workforce in relation to the protection of ePHI
B) Physical measures, including policies and procedures that are used to protect electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion
C) Information technology and the associated policies and procedures that are used to protect and control access to ePHI
D) None of the above
Information technology and the associated policies and procedures that are used to protect and control access to ePHI
A Privacy Impact Assessment (PIA) is an analysis of how information is handled:
A) To ensure handling conforms to applicable legal, regulatory, and policy requirements regarding privacy
B) To determine the risks and effects of collecting, maintaining and disseminating information in identifiable form in an electronic information system
C) To examine and evaluate protections and alternative processes for handling information to mitigate potential privacy risks
D) All of the above
All of the above
A breach as defined by the DoD is broader than a HIPAA breach (or breach defined by HHS).
True
Which of the following are breach prevention best practices?
A) Access only the minimum amount of PHI/personally identifiable information (PII) necessary
B) Logoff or lock your workstation when it is unattended
C) Promptly retrieve documents containing PHI/PHI from the printer
D) All of this above
Access only the minimum amount of PHI/personally identifiable information (PII) necessary
Logoff or lock your workstation when it is unattended
Promptly retrieve documents containing PHI/PHI from the printer
All of this above (correct)
An incidental use or disclosure is not a violation of the HIPAA Privacy Rule if the covered entity (CE) has:
A) Implemented the minimum necessary standard
B) Established appropriate administrative safeguards
C) Established appropriate physical and technical safeguards
D) All of the above
All of the above
Under the Privacy Act, individuals have the right to request amendments of their records contained in a system of records.
True
Which HHS Office is charged with protecting an individual patient’s health information privacy and security through the enforcement of HIPAA?
A) Office of Medicare Hearings and Appeals (OMHA)
B) Office for Civil Rights (OCR)
C) Office of the National Coordinator for Health Information Technology (ONC)
D) None of the above
Office for Civil Rights (OCR)
Physical safeguards are:
A) Administrative actions, and policies and procedures that are used to manage the selection, development, implementation and maintenance of security measures to protect electronic PHI (ePHI). These safeguards also outline how to manage the conduct of the workforce in relation to the protection of ePHI
B) Physical measures, including policies and procedures that are used to protect electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion
C) Information technology and the associated policies and procedures that are used to protect and control access to ePHI
D) None of the above
Physical measures, including policies and procedures that are used to protect electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion
Which of the following would be considered PHI?
A) IIHI of persons deceased more than 50 years
B) Individually identifiable health information (IIHI) in employment records held by a covered entity (CE) in its role as an employer
C) An individual’s first and last name and the medical diagnosis in a physician’s progress report
D) Results of an eye exam taken at the DMV as part of a driving test
An individual’s first and last name and the medical diagnosis in a physician’s progress report
The minimum necessary standard:
A) Limits uses, disclosures, and requests for PHI to the minimum necessary amount of PHI needed to carry out the intended purposes of the use or disclosure
B) Does not apply to exchanges between providers treating a patient
C) Does not apply to uses or disclosures made to the individual or pursuant to the individual’s authorization
C) All of the above
All of the above
The HIPAA Privacy Rule applies to which of the following?
A) PHI transmitted orally
B) PHI in paper form
C) PHI transmitted electronically
D) All of the above
All of the above
Select all that apply: The HIPAA Privacy Rule permits use or disclosure of a patient’s PHI in accordance with an individual’s authorization that:
A) Includes core elements and required statements set forth in the HIPAA Privacy Rule and DoD’s implementing issuance
B) Is written and signed by the patient
C) Is orally provided to a health care provider
Includes core elements and required statements set forth in the HIPAA Privacy Rule and DoD’s implementing issuance
Is written and signed by the patient
Which of the following are examples of personally identifiable information (PII)?
A) Social Security number
B) Home address
C) Telephone
D) All of the above
All of the above
A Systems of Records Notice (SORN) serves as a notice to the public about a system of records and must:
A) Specify routine uses (how the information will be used)
B) Be republished if a new routine use is created
C) Be provided to Office of Management and Budget (OMB) and Congress and published in the Federal Register before the system is operational
D) All of the above
All of the above
In which of the following circumstances must an individual be given the opportunity to agree or object to the use and disclosure of their PHI?
-Before their information is included in a facility directory
-Before PHI directly relevant to a person’s involvement with the individual’s care or payment of health care is shared with that person
Which of the following statements about the HIPAA Security Rule are true?
All of the above
-a national set of standards for the protection of PHI that is created, received, maintained, or transmitted in electronic media by a HIPAA covered entity (CE) or business associate (BA)
-Protects electronic PHI (ePHI)
- Addresses three types of safeguards – administrative, technical and physical – that must be in place to secure individuals’ ePHI
A covered entity (CE) must have an established complaint process.
true
The e-Government Act promotes the use of electronic government services by the public and improves the use of information technology in the government.
true
When must a breach be reported to the U.S. Computer Emergency Readiness Team?
1 hour
Which of the following statements about the Privacy Act are true?
All of the above
What of the following are categories for punishing violations of federal health care laws?
All of the above
Which of the following are common causes of breaches?
All of the above
Which of the following are fundamental objectives of information security?
All of the above
If an individual believes that a DoD covered entity (CE) is not complying with HIPAA, he or she may file a complaint with the:
All of the above
Technical safeguards are:
Information technology and the associated policies and procedures that are used to protect and control access to ePHI (correct)
A Privacy Impact Assessment (PIA) is an analysisof how information is handled
All of the above
A breach as defined by the DoD is broader than a HIPAA breach (or breach defined by HHS).
true
Which of the following are breach prevention best practices?
All of the above
An incidental use or disclosure is not a violation of the HIPAA Privacy Rule if the covered entity (CE) has:
All of the above
Under the Privacy Act, individuals have the right to request amendments of their records contained in a system of records.
true
Which HHS Office is charged with protecting an individual patient’s health information privacy and security through the enforcement of HIPAA?
Office for Civil Rights (OCR) (correct)
Physical safeguards are:
Physical measures, including policies and procedures that are used to protect electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion (correct)
Which of the following would be considered PHI?
An individual’s first and last name and the medical diagnosis in a physician’s progress report (correct)
The minimum necessary standard:
All of the above