I-H-01 Protected Health Information 01/05/2021

Questions and Answers

What is the role of an authorized representative?

To provide legal advice regarding health care.

To conduct medical research on patients.

To manage health care facilities.

To make health care decisions on behalf of a customer/patient. (correct)

Which of the following accurately describes a business associate?

A legal representative in health care disputes.

A health care provider that transmits electronic health information.

An individual who provides direct medical care to patients.

A person or entity assisting a covered entity with health information functions. (correct)

What is one of the primary responsibilities of a Chief Privacy Officer?

To enforce departmental privacy policies and procedures. (correct)

To conduct patient satisfaction surveys.

To manage the billing process for health care services.

To provide medical treatment to patients.

What does confidentiality primarily safeguard?

Identifiable and personal information of customers/patients. Signup and view all the answers

Which of the following is considered a covered entity?

A healthcare clearinghouse that processes health information electronically. Signup and view all the answers

Which service might NOT be provided by a business associate?

Direct patient care. Signup and view all the answers

What types of functions might involve a business associate?

Claims processing for insurance reimbursement. Signup and view all the answers

Who can an authorized representative act for?

Deceased patients and their estates. Signup and view all the answers

For how many years will MDFR maintain a customer's/patient's PHI?

7 years Signup and view all the answers

What is the civil penalty imposed by HHS for a failure to comply with the Privacy Rule?

$100 per failure Signup and view all the answers

Under which condition will HHS not impose a civil penalty for a violation?

When the violation is due to reasonable cause and corrected within 30 business days Signup and view all the answers

What action may result for MDFR personnel who do not comply with the established policy?

They will receive informal and formal counseling Signup and view all the answers

What is the maximum amount a person can be fined for knowingly disclosing IIHI under HIPAA?

$50,000 Signup and view all the answers

What could increase the criminal penalties for disclosing IIHI to $100,000?

The intent to sell or transfer identifiable health information for commercial advantage Signup and view all the answers

Which department is responsible for enforcing criminal sanctions for HIPAA violations?

Department of Justice Signup and view all the answers

What disciplinary actions might MDFR personnel face for non-compliance?

Disciplinary action as per Administrative Order 7-3 Signup and view all the answers

What is the role of the Departmental Privacy Liaison?

To develop and implement privacy policies and procedures Signup and view all the answers

Which of the following is included in a Designated Record Set under HIPAA Privacy Rule?

Medical records created by MDFR Signup and view all the answers

What is the purpose of the Health Insurance Portability and Accountability Act (HIPAA)?

To improve healthcare efficiency and protect identifiable health information Signup and view all the answers

What defines a customer's Health Plan?

Any combination of plans that pays for medical care costs Signup and view all the answers

Which of the following is excluded from the definition of a Health Plan?

Government-funded programs without healthcare goals Signup and view all the answers

Identify the role of a Healthcare Clearinghouse in health information processing.

To process health information into standard formats Signup and view all the answers

What does Protected Health Information (PHI) encompass?

Any information related to an individual's health care or payment that identifies them. Signup and view all the answers

What type of information is included in Identifiable, Personal, Confidential Information?

Social security numbers and personal addresses Signup and view all the answers

Which of the following is NOT a circumstance under which PHI can be disclosed?

For marketing purposes without consent. Signup and view all the answers

What is meant by 'Designated Record Set' in relation to PHI access?

The specific records maintained by a covered entity that contain PHI. Signup and view all the answers

What does the Notice of Privacy Practices (NOPP) outline?

Ways in which PHI may be used and disclosed Signup and view all the answers

What does preemption refer to in context with state law and HIPAA?

State law can impose stricter regulations than HIPAA Signup and view all the answers

Which organization is primarily responsible for the enforcement of the Privacy Rule?

The Department of Health and Human Services. Signup and view all the answers

What type of information is NOT considered PHI under HIPAA?

Sick leave information obtained directly from an employee. Signup and view all the answers

Which of the following is NOT a type of record included in MDFR’s Designated Record Set?

Quality assurance data Signup and view all the answers

Under the Privacy Rule, which of the following entities is NOT classified as a covered entity?

Public libraries. Signup and view all the answers

Who is considered a Healthcare Provider under the described policy?

Any entity that provides medical services, including individuals and organizations Signup and view all the answers

Which of the following best describes a Trading Partner in the context of health information?

A person or organization exchanging health information with a covered entity. Signup and view all the answers

Which aspect of patient information is protected under HIPAA Privacy Rule?

Confidentiality and integrity of identifiable health information Signup and view all the answers

Which of the following is TRUE regarding disclosures of PHI?

PHI must be kept private and can only be disclosed under certain exceptions. Signup and view all the answers

What is the term used for a customer served indirectly by an organization?

Patient Signup and view all the answers

In the context of PHI, what does the term 'confidentiality' refer to?

The requirement to keep health information secret from unauthorized individuals. Signup and view all the answers

What protects the integrity and confidentiality of PHI?

Access restrictions and employee training on data protection. Signup and view all the answers

Which of the following types of records related to employment is considered exempt from HIPAA compliance?

Health assessments for employee hiring evaluations. Signup and view all the answers

When should a healthcare provider furnish a copy of the Notice of Privacy Practices (NOPP) to a patient?

At the time of or before treatment in a non-emergency situation. Signup and view all the answers

What is one of the required uses of PHI as stated in the Privacy Rule?

For billing and payment purposes related to healthcare. Signup and view all the answers

What hours are requests for access to PHI accepted?

0800 to 1630 hours Signup and view all the answers

Who can request access to PHI according to the policy?

Customers/patients or authorized representatives Signup and view all the answers

What must a customer complete to request access to PHI?

A Request for Access to Protected Health Information Form Signup and view all the answers

What is required if a customer wants to retain copies of PHI?

They will be charged a reproduction fee Signup and view all the answers

What happens if access to PHI is denied?

The customer can request a review of the denial Signup and view all the answers

Who reviews the denial of access to PHI?

A licensed health professional not involved in the denial Signup and view all the answers

How long does MDFR have to act on a request for amendment to PHI?

30 business days Signup and view all the answers

What must be documented if MDFR agrees to restrict the use of PHI?

The Approval of Request to Restrict Protected Health Information Signup and view all the answers

For how many years can a customer request a disclosure accounting of PHI?

Seven years Signup and view all the answers

When should complaints regarding privacy issues be submitted?

Within 180 days Signup and view all the answers

What does MDFR provide if a request for amendment is denied?

A Denial of Request for Amendment form Signup and view all the answers

What must be submitted for a complaint regarding PHI?

A written or email complaint naming the subject entity Signup and view all the answers

What is the purpose of the 'Request for Disclosure Accounting' form?

To account for uses and disclosures of PHI Signup and view all the answers

What is explicitly prohibited regarding the original PHI documents?

Allowing originals to leave the premises Signup and view all the answers

Study Notes

Authorized Representative

Legally designated person to make health care decisions for a customer/patient or their estate.
Treated equally as the customer/patient concerning uses and disclosures of Protected Health Information (PHI).

Business Associate

Entity or person assisting a Covered Entity with tasks involving use/disclosure of Individually Identifiable Health Information (IIHI).
Functions include claims processing, data analysis, quality assurance, billing, and management services.

Chief Privacy Officer

Key individual responsible for enforcing departmental privacy policies, resolving complaints, and providing privacy information.

Confidentiality

Mechanism to protect identifiable and personal customer information from unauthorized disclosure.

Covered Entity

Categories include Health Plans, Healthcare Clearinghouses, or Healthcare Providers transmitting health information electronically.

Customer/Patient

Refers to individuals or groups served or employed by MDFR, interchangeable with the term patient in policy context.

Departmental Privacy Liaison

Department-level individual responsible for developing privacy policies and handling complaints related to PHI.

Designated Record Set (DRS)

Under HIPAA, includes covered PHI relevant for decision-making, excluding operational data like quality assurance reports.
Components may consist of ePCR, Florida EMS Report, amendments to PHI, and statements of disagreement.

Health Insurance Portability and Accountability Act (HIPAA)

Aims to enhance healthcare efficiency by implementing security standards, data standardization, and unique health identifiers.

Health Plan

Customer’s plan providing medical or social service care, encompassing individual/group plans, HMOs, and more.

Healthcare Clearinghouse

Entity that processes health information for standard electronic transactions.

Healthcare Provider

Entity offering medical and health services, including hospitals, clinics, and licensed practitioners.

Identifiable, Personal, Confidential Information

Includes the individual’s name, social security number, address, phone number, and medical information.

Notice of Privacy Practices (NOPP)

Details the ways a Covered Entity can use and disclose PHI and outlines patient rights regarding privacy.

Preemption

Whenever state law divides from HIPAA to offer more stringent privacy rights, state law prevails.

Privacy Rule

Established under HIPAA to govern the use and disclosure of PHI by Covered Entities and safeguard individuals' privacy rights.

Protected Health Information (PHI) / Individually Identifiable Health Information (IIHI)

Encompasses any health-related information that identifies the individual, regardless of its form or medium.

Exceptions to Disclosure of PHI

Specific legal requirements, public health activities, law enforcement activities, and serious threats to safety may permit disclosures.

Security Measures

Encompasses physical, technical, and administrative safeguards protecting the confidentiality and integrity of health information.

Trading Partner

An organization exchanging health information electronically with a Covered Entity.

Authorized Uses and Disclosures

Prohibition against releasing customer/patient information outside MDFR unless for treatment, payment, or operations.
Internal discussions on PHI limited to necessary exchanges for patient care and organizational functions.

Individual Rights

Patients receive a copy of NOPP upon treatment and are encouraged to sign for confirmation.

Access to PHI

Requests limited to information in DRS; requires submission of a request form to the Records Bureau, operational during business hours.

Amendment of PHI

Customers/patients may request amendments, which must be acted upon by the MDFR Privacy Liaison within a specified timeframe.

Documentation and Record Retention

All procedural steps for actually handling patient data must be documented, including access requests, amendments, and complaints received.### Designated Record Set Maintenance
Effective April 14, 2003, MDFR is responsible for maintaining the Designated Record Set (DRS) of patients' Protected Health Information (PHI).
The retention period for PHI is seven years from its creation, encompassing amendments and restrictions made by MDFR or business associates.

Enforcement and Penalties for Non-Compliance

Non-compliance with the policy results in informal and formal counseling for MDFR personnel, along with potential disciplinary actions as per Miami-Dade County Administrative Order 7-3.
Civil penalties by the U.S. Department of Health and Human Services (HHS) can reach 100perviolationofthePrivacyRule,cappedat100 per violation of the Privacy Rule, capped at 100perviolationofthePrivacyRule,cappedat50,000 per year for multiple violations.
Penalties may be waived if the violation was due to reasonable cause, not willful neglect, and the issue is corrected within 30 business days after awareness.

Criminal Penalties

Individuals knowingly disclosing or obtaining Individually Identifiable Health Information (IIHI) in violation of HIPAA can face fines of $50,000 and up to one year in prison.
Penalties escalate to 100,000to100,000 to 100,000to250,000 and up to ten years of imprisonment for violations intended for commercial advantage, personal gain, or malicious harm.
Criminal enforcement is conducted by the Department of Justice.

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Test your knowledge on health care privacy regulations and the roles of authorized representatives and business associates. This quiz covers important definitions and responsibilities as outlined under the Privacy Rule. Perfect for professionals in the health care sector.