HCCA - CHPC Study Guide-with 2026-2027 23pages

What is the purpose of HIPAA? • Protect PHI from unauthorized disclosure/use; • Prevent fraud, waste and abuse (via Administrative Simplification); • Make health insurance portable under ERISA; • Move health care onto a nationally standardized electronic billing platform Ref. https://quizlet.com/6202653/hcca-chpc-overview-flash-cards/ More on HIPAA: https://www.hhs.gov/hipaa/index.html HIPAA resides in which CFR section? 45 CFR sections 164.102 through 164.534 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164 What are the subparts of HIPAA part 164? HIPAA - 45 CFR 164, subparts: Subpart A - General rules Subpart C - Security Subpart D - Breach notification Subpart E - Privacy https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164 How do you determine if an organization is a "Covered Entity"? 1. compare if the organization meets one of the 3 types of CE (provider, health plan, clearinghouse) and 2. determine if the organization electronically transmits one of the 9 defined transactions: • Health claims or equivalent encounter information • Health claims attachments • Enrollment and disenrollment in a health plan • Eligibility for a health plan • Health care payment and remittance advice • Health plan premium payments • First report of injury • Health claim status • Referral certification and authorization In addition, business associates of covered entities must follow parts of the HIPAA regulations. https://www.hhs.gov/hipaa/for-individuals/guidance-materials-forconsumers/index.html This Act established in 1974 was created for government agencies placing restrictions on how the government can share the information maintained in Federal systems of records that might infringe on an individual's privacy rights with other individuals and agencies.