MPJE Patient Counseling and Confidentiality 4 — Questions and Answers
Question 1: Under HIPAA, which of the following is NOT considered protected health information (PHI)?
- A patient's name linked to their diagnosis in a pharmacy database
- De-identified health information meeting HIPAA's safe harbor standards (Correct answer)
- A prescription label with the patient's name and medication
- A pharmacist's notes about a patient's drug allergies
Correct answer: De-identified health information meeting HIPAA's safe harbor standards
Properly de-identified health information that meets HIPAA's safe harbor or expert determination standards is not considered PHI.
Question 2: A patient who does not speak English fluently requests counseling. The pharmacist's BEST response is to:
- Provide written counseling materials in English and ask the patient to have them translated
- Use a qualified interpreter or translated materials to ensure effective counseling (Correct answer)
- Ask a bilingual family member present to interpret the counseling session
- Document that counseling was offered but declined due to language barriers
Correct answer: Use a qualified interpreter or translated materials to ensure effective counseling
Effective counseling requires that patients understand the information, necessitating qualified interpretation services or translated materials.
Question 3: A patient discovers that their pharmacy shared their medication information with their employer. This would most likely violate:
- OBRA '90 counseling requirements
- HIPAA's Privacy Rule prohibition on unauthorized disclosures (Correct answer)
- The Controlled Substances Act confidentiality provisions
- State pharmacy practice act minimum standards
Correct answer: HIPAA's Privacy Rule prohibition on unauthorized disclosures
HIPAA's Privacy Rule prohibits covered entities from disclosing PHI to employers without the patient's written authorization.
Question 4: For HIPAA purposes, a business associate agreement (BAA) is required when a pharmacy shares PHI with:
- Another pharmacy within the same health system for care coordination
- A billing company hired to process the pharmacy's insurance claims (Correct answer)
- A public health department during a disease outbreak investigation
- A prescriber's office for purposes of treatment
Correct answer: A billing company hired to process the pharmacy's insurance claims
A BAA is required when a covered entity shares PHI with a business associate such as a billing company that performs services on its behalf.
Question 5: A patient asks the pharmacist why they are receiving a generic instead of the brand-name drug they were prescribed. The pharmacist's counseling should include:
- An explanation that generics are lower quality and the patient should request brand-name
- Information that the generic is therapeutically equivalent and state law or the prescriber permit substitution (Correct answer)
- A referral to the prescriber since this is outside the pharmacist's scope
- Documentation of the complaint without providing any additional information
Correct answer: Information that the generic is therapeutically equivalent and state law or the prescriber permit substitution
Counseling on generic substitution should explain therapeutic equivalence and the legal authority permitting substitution under state law or prescriber authorization.
Question 6: A pharmacist is required to document patient counseling refusals because:
- State and federal law requires documentation of all patient interactions
- Documentation provides evidence that the offer to counsel was made, protecting the pharmacy legally (Correct answer)
- Refusals must be reported to state pharmacy boards within 30 days
- Insurance companies require documentation of counseling completion for reimbursement
Correct answer: Documentation provides evidence that the offer to counsel was made, protecting the pharmacy legally
Documenting counseling refusals provides a legal record that the pharmacist fulfilled their duty to offer counseling even when the patient declined.
Question 7: Which of the following scenarios represents an impermissible disclosure under HIPAA without patient authorization?
- Sharing prescription information with another treating provider for care coordination
- Releasing medication records to a patient's attorney without the patient's authorization (Correct answer)
- Disclosing information to public health authorities for disease surveillance
- Providing minimum necessary information for insurance billing purposes
Correct answer: Releasing medication records to a patient's attorney without the patient's authorization
Disclosing PHI to a patient's attorney is not within the treatment, payment, or operations exceptions and requires explicit patient authorization.
MPJE Patient Counseling and Confidentiality 4
Under HIPAA, which of the following is NOT considered protected health information (PHI)?