Background

Question 1

What are the covered entities as it relates to HIPAA?

Answer 1

Healthcare providers, health plans, and health care clearinghouses

Question 2

What is HITECH?

Answer 2

Health Information Technology for Economic and Clinical Health - made certain provisions of the HIPAA Privacy and Security Rules applicable to business associates as well as covered entities.

Question 3

Transactions and Code Set Standards

Answer 3

Created rules to be followed by CEs when electronically exchanging certain health information: claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, coordination of benefits and premium payment (Covered Transactions).

Question 4

Employer Identifier Standard

Answer 4

Requires that employers use their Employer Identification Numbers (EIN) as issued by the Internal Revenue Service (IRS) for identification on standard transactions

Question 5

NPI Standard

Answer 5

Requires each health care provider, health plan and health care clearinghouse to use a unique 10-position, intelligence-free numeric identifier for all administrative and financial transactions under HIPAA. A CE May apply for a NPI through CMS.

Question 6

Office of Civil Rights (OCR)

Answer 6

Administers and enforces the HIPAA Privacy and Security Rules

Question 7

ANSI

Answer 7

American National Standards Institute - develops electronic data interchange standards for national and global markets

Question 8

Code Sets

HCPCS

Answer 8

HCPCS - Health Care Common Procedure Coding System - This code set is established by CMS and primarily represents items and supplies and ancillary non-physician services not covered by the CPT-4 codes.

Question 9

Current Procedure Terminology (CPT)

Code Set

Answer 9

The CPT-4 codes, maintained and distributed by the American Medical Association, are used to describe medical procedures and physician services.

Question 10

ICD-10 codes

Code Set

Answer 10

Maintained by CMS that are used to report hospital services.

Question 11

National Drug Codes (NDC)

Code Sets

Answer 11

The NDC is a code set maintained by HHS in collaboration with drug manufacturers that identifies the manufacturer, product, and package size of all drugs and biological recognized by the FDA.

Question 12

CDT

Code Sets

Answer 12

Code on Dental Procedures and Nomenclature - maintained and distributed by the American Dental Association. The CDT is the code set for dental services.

Question 13

HIPAA applies to…

Answer 13

Covered entities - health plans, health care clearinghouses, and health care providers

Question 14

What is PHI?

Answer 14

Protected Health Information - this information is individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral communication.

Question 15

What is individually identifiable health information?

Answer 15

Information that relates to:

• the individual’s past, present, or future physical or mental health or condition;
• the provision of health care to the individual;
• the past, present, or future payment for the provision of health care to the individual