Medical Insurance Concepts

·        Define the following terms:  referral, deductible, pre-certification, capitation fee, and Medicare Part A.

·        Identify the provisions of HIPAA that makes it illegal for group health plans to knowingly discriminate against individuals based on health-related factors

·        Determine which types of insurance require pre-authorization

·        Determine which groups are excluded from Medicaid cost sharing

·        Identify the procedures for predetermination of benefits for dental plans

·        Determine which type of medical plans are designed to make the greatest use of managed care

·        Determine what groups are Medicaid eligible

·        Identify the advantages of HMO and PPO plans

·        Identify what group of doctors are typically primary care physicians

General Knowledge

·        Determine individual identifiers

·        Determine reasonable safeguards to protect privacy of individual’s medical information in either electronic or paper form

·        Identify the actions a covered entity must take to de-identify a dataset that contains protected health information

Impacted Areas

·        Define covered entities including software companies

·        Identify items contained in a covered entity’s notice of privacy practices

·        Define policy and procedures for hybrid entities

·        Determine the transition period for existing written business associate agreements

·        Define business associates agreements

·        Define minimum necessary guidelines in the HIPAA Privacy Regulations

·        Identify the safeguards necessary for protected health information

·        Determine the appropriate disclosure of patient information when contacting patients regarding lab results

·        Determine which information is exempt from inclusion in a patient authorization or consent form

·        Identify the Protected Health Information guidelines, timeframes, and restrictions in marketing and in research

Implementation

·        Identify which agency is responsible for enforcement of HIPAA Privacy Regulations

·        Determine which members of the workforce are required to participate in HIPAA training

·        Determine which type of legal organizations are exempt from HIPAA regulations

·        Identify the procedures and timeline for documenting HIPAA compliance

·        Identify the compliance date for HIPAA Privacy Rules for various the types of organizations

·        Determine how the Office of Civil Rights is notified of HIPAA violations

·        Determine the resources available for implementing compliance

·        Determine which training approaches meet HIPAA compliance

·        Identify health care organizations as defined by HIPAA

·        Determine when incidental disclosures of protected health information are permissible

·        Identify a hybrid organization

·        Determine which position must be created in the HIPAA privacy regulations

Regulatory Environment

·        Identify how often the Department of Health and Human Services is permitted to change or update the regulations once the effective date of HIPAA privacy regulations have passed

·        Determine which privacy rules prevail based on which state provides more patient protection and what state prevails when multiple states are involved

·        Identify which federal organization the Office of Civil Rights falls under

·        Determine what qualifies a provider as a covered entity

·        Identify egregious violations of the HIPAA statue that have criminal penalties

Workplace Privacy

·        Define the Final Privacy Rule

·        Determine organizations that are exempt from developing notice of privacy practices or having to track disclosures of patient information

·        Define non-routine disclosure of personal health information

·        Identify the primary purpose of the disclosure accounting provisions

·        Determine the procedures for developing a notice of privacy practices to include emergency treatment situations

·        Determine the minimum necessary HIPAA privacy regulations for medical professionals to access patient records

·        Determine if utilizing fund raising databases for previous fundraising history falls under the HIPAA rules

·        Define incidental release

·        Determine which situations are covered under release of information for public health purposes

·        Identify how to make sign-in sheets HIPPA complaint