Correct Answer: C
The transactions addressed by HIPAA are: Health claims or similar encounter information Health care payment and remittance advice Coordination of Benefits Health claim status Enrollment and disenrollment in a health plan Eligibility for a health plan Health plan premium payments Referral certification and authorization The HIPAA EDI transaction standards to address these HIPAA transactions include the following: Health care claims or coordination of benefits Retail drug NCPCP (National Council for Prescription Drug Programs) v. 32 Dental claim ASC X12N 837: dental Professional claim ASC X12N 837: professional Institutional claim ASC X12N 837: institutional Payment and remittance advice ASC X12N 835 Health claim status ASC X12N 276/277 Plan enrollment ASC X12 834 Plan eligibility ASC X12 270/271 Plan premium payments ASC X12 820 Referral certification ASC X12 N 278 The American National Standards Institute was founded in 1917 and is the only source of American Standards. The ANSI Accredited Standards Committee X12 was chartered in 1979 and is responsible for cross-industry standards for electronic documents. The HIPAAprivacy standards, answer a, were finalized in April, 2001, and implementation must be accomplished by April 14, 2003. The privacy rule covers individually identifiable health care information transmitted, stored in electronic or paper form, or communicated orally. Protected health information (PHI) may not be disclosed unless disclosure is approved by the individual, permitted by the legislation, required for treatment, part of health care operations, required by law, or necessary for payment. PHI is defined as individually identifiable health information that is transmitted by electronic media, maintained in any medium described in the definition of electronic media under HIPAA, or is transmitted or maintained in any other form or medium. Answer b, code sets, refers to the codes that are used to fill in the data elements of the HIPAAtransaction standards. Examples of these codes are: ICD-9-CM (vols. 1 and 2) International Classification of Diseases, 9th Ed., Clinical Modification Diseases, injuries, impairments, other health related problems, their manifestations, and causes of injury, disease, impairment, or other health-related problems CPT (Current Procedural Terminology, 4th Ed. [CPT-4]), CDT (Code on Dental Procedures and Nomenclature, 2nd Ed. [CDT-2]) or ICD-9-CM (vol. 3) Procedures or other actions taken to prevent, diagnose, treat, or manage diseases, injuries, and impairments NDC (National Drug Codes) drugs HCPCS (Health Care Financing Administration Common Procedure Coding System) Other health-related services, other substances, equipment, supplies, or other items used in health care services The proposed HIPAA Security Rule, answer d, mandates the protection of the confidentiality, integrity, and availability of protected health information (PHI) through: Administrative procedures Physical safeguards Technical services and mechanisms The rule also addresses electronic signatures, but the final rule will depend on industry progress on reaching a standard. In addition, the proposed security rule requires the appointment of a security officer.
