AHIP AHM-250 Q&A: Privacy standards to control the use and disclosure of health information.

Question

A. all health plans, healthcare providers, and healthcare clearinghouses from using any protected health information for purposes of treatment, payment, or healthcare operations without an individual’s written consent
B. patients from requesting that restrictions be placed on the accessibility and use of protected health information
C. transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization
D. patients from accessing their medical records and requesting the amendment of incorrect or incomplete information

Answer

D. patients from accessing their medical records and requesting the amendment of incorrect or incomplete information

Explanation 1

The correct answer is C. The privacy standards described under Title II of HIPAA prohibit the transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization.

Explanation:
The privacy standards established under Title II of HIPAA, known as the Administrative Simplification provisions, aim to protect the privacy and security of individuals’ health information. These standards apply to covered entities such as health plans, healthcare providers, and healthcare clearinghouses.

One of the key aspects of the privacy standards is the control over the use and disclosure of protected health information (PHI). PHI refers to individually identifiable health information that is created, received, or maintained by covered entities.

According to HIPAA’s privacy standards, covered entities are allowed to use and disclose PHI without an individual’s written consent or authorization for the purposes of treatment, payment, and healthcare operations. Treatment refers to the provision, coordination, or management of healthcare, while payment involves activities such as billing and insurance claims. Healthcare operations encompass various administrative and support functions within a healthcare organization.

However, the privacy standards impose strict limitations on the use and disclosure of PHI for other purposes not related to treatment, payment, or healthcare operations. In such cases, covered entities are required to obtain the individual’s written authorization. This written authorization must be specific and clearly state the purpose for which the PHI will be used or disclosed.

Option A is incorrect because the privacy standards do not require written consent for the use of protected health information for treatment, payment, or healthcare operations. In these cases, covered entities are allowed to use and disclose PHI without obtaining explicit consent, as long as it is done within the permitted boundaries.

Option B is incorrect because HIPAA grants individuals the right to request restrictions on the accessibility and use of their protected health information. However, this does not imply a prohibition on such requests. The covered entity has the discretion to accept or deny the requested restrictions, but patients have the right to make the request.

Option D is incorrect because HIPAA grants individuals the right to access their medical records and request the amendment of incorrect or incomplete information. The privacy standards emphasize the importance of individuals having control and access to their health information, enabling them to ensure its accuracy and completeness.

Explanation 2

The correct answer is C. “Transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization.”

Here’s a detailed explanation:

The Health Insurance Portability and Accountability Act (HIPAA) was enacted to protect the privacy and security of patient health information. Title II of HIPAA, known as the Administrative Simplification provisions, includes privacy standards that control the use and disclosure of protected health information (PHI).

Option A is incorrect because HIPAA does not prohibit health plans, healthcare providers, and healthcare clearinghouses (collectively known as covered entities) from using PHI for purposes of treatment, payment, or healthcare operations. These are considered standard uses and disclosures for which individual authorization is not required.

Option B is incorrect because HIPAA actually gives patients the right to request restrictions on the use and disclosure of their PHI. Covered entities are not required to agree to these restrictions, but if they do, they must abide by them.

Option C is correct. HIPAA generally prohibits the transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization. There are some exceptions to this rule, such as when the disclosure is required by law.

Option D is incorrect because HIPAA gives patients the right to access their medical records and request the amendment of incorrect or incomplete information. Covered entities are required to provide patients with access to their PHI and to consider their requests for amendment.

In summary, HIPAA’s privacy standards are designed to protect the privacy of individuals’ health information while allowing for the necessary flow of health information to provide and promote high-quality health care.

Explanation 3

The answer to your question is C. transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization. The reason is that the HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other individually identifiable health information (collectively defined as “protected health information” or PHI) and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Privacy Rule requires appropriate safeguards to protect the privacy of PHI and sets limits and conditions on the uses and disclosures that may be made of such information without an individual’s authorization. The Privacy Rule also gives individuals rights over their PHI, including rights to examine and obtain a copy of their health records, to direct a covered entity to transmit to a third party an electronic copy of their PHI in an electronic health record, and to request corrections.

The Privacy Rule generally prohibits covered entities from using or disclosing PHI for purposes other than treatment, payment, or healthcare operations without an individual’s written authorization. Treatment means the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another. Payment means the activities undertaken by a health plan to obtain premiums or to determine or fulfill its responsibility for coverage and provision of benefits under the plan; or activities undertaken by a health care provider or health plan to obtain or provide reimbursement for the provision of health care. Health care operations means any of the following activities of the covered entity to the extent that the activities are related to covered functions: conducting quality assessment and improvement activities; reviewing the competence or qualifications of health care professionals; evaluating practitioner and provider performance; conducting training programs; accreditation, certification, licensing, or credentialing activities; conducting or arranging for medical review, legal services, and auditing functions; business planning and development; business management and general administrative activities.

The Privacy Rule allows covered entities to use or disclose PHI for purposes other than treatment, payment, or healthcare operations only with an individual’s written authorization that meets certain requirements. An authorization is a detailed document that gives covered entities permission to use PHI for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose PHI to a third party specified by the individual. An authorization must specify a number of elements, including a description of the PHI to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization.

Explanation 4

The administrative simplification standards described under Title II of HIPAA include privacy standards to control the use and disclosure of health information. In general, these privacy standards prohibit the transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization. Therefore, option C is the correct answer.

Explanation 5

The correct answer is C. transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization.

The HIPAA Privacy Rule generally prohibits the use or disclosure of protected health information (PHI) without the individual’s written authorization, except for certain limited circumstances.

The three permissible uses and disclosures of PHI are:

Treatment: PHI can be used by healthcare providers to provide treatment to the individual.
Payment: PHI can be used by healthcare providers to bill for treatment.
Healthcare operations: PHI can be used by healthcare providers for activities related to their core business operations, such as quality improvement, training, and marketing.

In addition to the three permissible uses and disclosures, there are a number of other circumstances in which HIPAA permits the use or disclosure of PHI without the individual’s authorization. These circumstances include:

Public health activities: PHI can be disclosed to public health authorities for the purpose of preventing or controlling disease, injury, or disability.
Law enforcement: PHI can be disclosed to law enforcement officials in response to a court order or subpoena.
Research: PHI can be disclosed to researchers for the purpose of conducting research that has been approved by an Institutional Review Board (IRB).
Organ and tissue donation: PHI can be disclosed to organ procurement organizations and tissue banks for the purpose of facilitating organ and tissue donation.
Disaster relief: PHI can be disclosed to disaster relief organizations for the purpose of providing assistance to individuals affected by a disaster.

If a healthcare provider or other covered entity wants to use or disclose PHI for any other purpose, they must obtain the individual’s written authorization.

The HIPAA Privacy Rule also gives individuals the right to access their medical records and request the amendment of incorrect or incomplete information.

Here are some additional tips for understanding the HIPAA Privacy Rule:

The HIPAA Privacy Rule is complex and there are a number of exceptions to the general prohibitions on the use and disclosure of PHI.
If you have any questions about the HIPAA Privacy Rule, you should consult with an attorney who is experienced in HIPAA compliance.

Explanation 6

The correct answer is C. The HIPAA Privacy Rule prohibits transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization. The other options are incorrect because:

Option A is too broad. The Privacy Rule does not prohibit all health plans, healthcare providers, and healthcare clearinghouses from using any protected health information for purposes of treatment, payment, or healthcare operations without an individual’s written consent. The Privacy Rule only requires consent for certain types of disclosures, such as psychotherapy notes or marketing.
Option B is false. The Privacy Rule gives patients the right to request that restrictions be placed on the accessibility and use of protected health information. However, covered entities are not obligated to agree to these requests unless they pertain to disclosures to a health plan for payment or health care operations purposes and the information pertains solely to a health care item or service for which the individual has paid out of pocket in full.
Option D is false. The Privacy Rule gives patients the right to access their medical records and request the amendment of incorrect or incomplete information. Covered entities must provide individuals with access to their protected health information in a designated record set, and must make reasonable efforts to accommodate requests for amendments.

Explanation 7

The HIPAA Privacy Rule prohibits the transmission of individually identifiable health information (PHI) for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization. There are a few exceptions to this rule, such as when the disclosure is required by law or when the individual has given consent for the disclosure.

Here is a more detailed explanation of the HIPAA Privacy Rule:

Treatment: This includes the provision of health care, coordinating or referring patients to health care providers, and billing for health care services.
Payment: This includes the processing of health insurance claims and collecting payments for health care services.
Healthcare operations: This includes activities that are necessary to run a health care organization, such as quality improvement, training, and marketing.

The HIPAA Privacy Rule also gives individuals the right to:

Inspect and copy their medical records
Request that their medical records be amended if they believe the information is incorrect or incomplete
Request that restrictions be placed on the accessibility and use of their medical records
Revoke their authorization for the disclosure of their medical records

Explanation 8

These standards prohibit transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization. Therefore, the correct answer is C.

The other options are incorrect because:

Option A is too broad. The privacy standards do not prohibit all uses and disclosures of protected health information for treatment, payment, or healthcare operations without an individual’s written consent. Rather, they allow covered entities to use and disclose such information without consent in most cases, unless they have agreed to a more restrictive policy.
Option B is false. The privacy standards give individuals the right to request that restrictions be placed on the use and disclosure of their protected health information by covered entities.
Option D is false. The privacy standards give individuals the right to access their own medical records and request amendments of incorrect or incomplete information.

Explanation 9

HIPAA privacy standards prohibit the transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization. This means that health plans, healthcare providers, and healthcare clearinghouses cannot share a patient’s health information with anyone else without the patient’s permission, unless one of the exceptions to the HIPAA privacy rule applies.

Here are some examples of when HIPAA privacy standards allow the transmission of individually identifiable health information without the individual’s written authorization:

To a business associate of the covered entity, if the business associate has signed a HIPAA Business Associate Agreement
To the patient’s family or friends, if the patient has given permission
To the government, if the government is required by law to have the information
To a public health authority, if the information is necessary to prevent or control a disease

HIPAA privacy standards also allow patients to request that restrictions be placed on the accessibility and use of their protected health information. For example, a patient may request that their health information not be shared with their employer. Health plans, healthcare providers, and healthcare clearinghouses must comply with these requests, unless they believe that the request would interfere with the provider’s ability to provide care to the patient.

Patients also have the right to access their medical records and request the amendment of incorrect or incomplete information. Health plans, healthcare providers, and healthcare clearinghouses must provide patients with access to their records within 30 days of receiving a request. If the patient believes that their records are incorrect or incomplete, they can request that the information be amended. Health plans, healthcare providers, and healthcare clearinghouses must review the request and make a determination about whether to amend the records. If the records are amended, the patient must be notified of the amendment.

HIPAA privacy standards are designed to protect the privacy of patients’ health information. These standards are important because they help to ensure that patients’ health information is kept confidential and is only used for authorized purposes.

Explanation 10

In general, the administrative simplification standards described under Title II of HIPAA include privacy standards to control the use and disclosure of health information. These privacy standards prohibit:

C. transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization

HIPAA privacy standards aim to protect sensitive patient health information from unauthorized disclosure. The standards stipulate that covered entities, such as health plans, healthcare providers, and healthcare clearinghouses, may use or disclose protected health information for treatment, payment, or healthcare operations. For any other purposes, they must obtain the individual’s written authorization.

Option A is incorrect because HIPAA does allow the use of protected health information for treatment, payment, and healthcare operations without an individual’s written consent. Option B is also incorrect because patients can request restrictions on the accessibility and use of their protected health information. Finally, option D is incorrect because HIPAA grants patients the right to access their medical records and request amendments of incorrect or incomplete information.

In summary, HIPAA privacy standards generally prohibit the transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization.

Explanation 11

C. transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual’s written authorization

This is the correct answer because it reflects the main purpose of the HIPAA privacy standards, which is to protect the privacy of individuals’ health information while allowing for its appropriate use and disclosure by health plans, healthcare providers, and healthcare clearinghouses. The other options are incorrect because they either overstate or understate the scope of the privacy standards.

Option A is incorrect because it implies that all health plans, healthcare providers, and healthcare clearinghouses need an individual’s written consent for any use or disclosure of protected health information for treatment, payment, or healthcare operations. However, the privacy standards do not require such consent in most cases, as these are considered routine and necessary uses and disclosures.

Option B is incorrect because it contradicts the privacy standards, which give patients the right to request that restrictions be placed on the accessibility and use of protected health information. However, health plans, healthcare providers, and healthcare clearinghouses are not obligated to agree to such requests.

Option D is incorrect because it also contradicts the privacy standards, which give patients the right to access their medical records and request the amendment of incorrect or incomplete information. Health plans, healthcare providers, and healthcare clearinghouses must comply with such requests unless they have a valid reason to deny them.

As an expert in AHIP Healthcare Management: An Introduction AHM-250 certification exam, you should be familiar with the basic concepts and principles of health care management, including the legislative and regulatory issues affecting the health insurance industry. This question tests your knowledge of one of the most important laws that governs health information privacy and security: the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Reference

AHIP Healthcare Management: An Introduction AHM-250 certification exam practice question and answer (Q&A) dump with detail explanation and reference available free, helpful to pass the AHIP Healthcare Management: An Introduction AHM-250 exam and earn AHIP Healthcare Management: An Introduction AHM-250 certification.