Regulatory Compliance & Health Privacy Laws Flashcards

A Patient Access Representative is asked to access the records of a high-profile patient out of curiosity. This action would violate which HIPAA principle?

Answer: The minimum necessary standard and permissible use provisions of the Privacy Rule

Accessing PHI without a permissible purpose violates the Privacy Rule's minimum necessary standard and the requirement that PHI only be used for treatment, payment, or operations.

Under the Affordable Care Act, insurance companies are prohibited from doing which of the following?

Answer: Denying coverage or charging higher premiums based on pre-existing conditions

The ACA prohibits insurers from denying coverage or charging higher premiums based on pre-existing health conditions for individual and small group markets.

Which government agency is primarily responsible for enforcing HIPAA Privacy and Security Rules?

Answer: Office for Civil Rights (OCR) within HHS

The Office for Civil Rights (OCR) within the Department of Health and Human Services is the primary enforcer of HIPAA's Privacy and Security Rules.

A patient requests an accounting of disclosures of their PHI. Which type of disclosure is EXCLUDED from this accounting?

Answer: Disclosures for treatment, payment, and healthcare operations

HIPAA excludes disclosures for treatment, payment, and healthcare operations from the required accounting of disclosures, as well as disclosures made with the patient's authorization.

Under HIPAA, a 'covered entity' includes which of the following?

Answer: A health plan, healthcare clearinghouse, or healthcare provider that transmits health information electronically

Covered entities are health plans, healthcare clearinghouses, and healthcare providers that transmit any health information in electronic form in connection with HIPAA transactions.

A patient is leaving the hospital Against Medical Advice (AMA). Which statement best describes the Patient Access Representative's role?

Answer: Ensure the patient signs the AMA form and document the interaction thoroughly

The PAR should ensure the competent patient signs the AMA form acknowledging the risks and document the encounter, while respecting the patient's right to refuse treatment.

The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare and Medicaid patients to entities in which they have a financial relationship for which of the following?

Answer: Designated health services such as lab, imaging, and physical therapy

The Stark Law prohibits physician self-referrals for designated health services (DHS) — including lab, imaging, and PT — to entities where the physician has a financial relationship, unless an exception applies.