Medical Management Privacy Practices

1. What are the required elements that must be acquired from a caller identifying themselves as an ADVANTAGE Medicare Solutions member before releasing any information containing PHI or making any changes to their set up in Facets?

Full name, children's name, pet's name, favorite color

Name and date of birth

None of these options

The required elements that must be acquired from a caller identifying themselves as an ADVANTAGE Medicare Solutions member before releasing any information containing PHI or making any changes to their set up in Facets are the full name, date of birth, member ID number, and one additional piece of information such as SSN, address, phone number, effective date(s), if they have Part A and/or B Medicare coverage. This information is necessary to verify the caller's identity and ensure that they are authorized to access the requested information or make changes to their account.

Explanation

The required elements that must be acquired from a caller identifying themselves as an ADVANTAGE Medicare Solutions member before releasing any information containing PHI or making any changes to their set up in Facets are the full name, date of birth, member ID number, and one additional piece of information such as SSN, address, phone number, effective date(s), if they have Part A and/or B Medicare coverage. This information is necessary to verify the caller's identity and ensure that they are authorized to access the requested information or make changes to their account.

2. By law, ADVANTAGE Medicare Solutions must have our members' verbal or written authorization to release their protected health information (PHI).

True

False

According to the law, ADVANTAGE Medicare Solutions is required to obtain authorization from its members, either verbally or in writing, before releasing their protected health information (PHI). This means that the statement "By law, ADVANTAGE Medicare Solutions must have our members' verbal or written authorization to release their protected health information (PHI)" is true.

Explanation

According to the law, ADVANTAGE Medicare Solutions is required to obtain authorization from its members, either verbally or in writing, before releasing their protected health information (PHI). This means that the statement "By law, ADVANTAGE Medicare Solutions must have our members' verbal or written authorization to release their protected health information (PHI)" is true.

3. A member's diagnosis or condition is considered PHI.

True

False

In the context of healthcare, PHI stands for Protected Health Information. It refers to any information about a person's health status, medical history, or healthcare treatment that can be linked to an individual. A member's diagnosis or condition falls under this category as it reveals their health status and is considered private and confidential. Therefore, the statement "A member's diagnosis or condition is considered PHI" is true.

Explanation

In the context of healthcare, PHI stands for Protected Health Information. It refers to any information about a person's health status, medical history, or healthcare treatment that can be linked to an individual. A member's diagnosis or condition falls under this category as it reveals their health status and is considered private and confidential. Therefore, the statement "A member's diagnosis or condition is considered PHI" is true.

4. If a provider calls with specific questions about a member, what system or website do you use to confirm that it's a valid provider you're speaking with?

Facets

Google

NPPES

All of the above

None of the above

NPPES (National Plan and Provider Enumeration System) is the correct answer because it is a system used to confirm the validity of healthcare providers. It is a publicly accessible database that contains information about healthcare providers, including their NPI (National Provider Identifier) numbers. By using NPPES, one can verify the credentials of a healthcare provider and ensure that they are legitimate before providing any sensitive information or discussing member-related matters.

Explanation

NPPES (National Plan and Provider Enumeration System) is the correct answer because it is a system used to confirm the validity of healthcare providers. It is a publicly accessible database that contains information about healthcare providers, including their NPI (National Provider Identifier) numbers. By using NPPES, one can verify the credentials of a healthcare provider and ensure that they are legitimate before providing any sensitive information or discussing member-related matters.

5. A member provides verbal authorization for you to speak with his/her sibling. How long does this authorization last?

45 days

30 days

20 days

14 days

None of the above

Verbal authorization from a member to speak with his/her sibling is valid for 14 days. After this period, the authorization expires and a new authorization would need to be obtained in order to continue communication with the sibling.

Explanation

Verbal authorization from a member to speak with his/her sibling is valid for 14 days. After this period, the authorization expires and a new authorization would need to be obtained in order to continue communication with the sibling.

6. If an ADVANTAGE Medicare Solutions member wants to allow someone to call in and receive information that contains PHI on their behalf for an extended period of time, is there a form they can request? If so, what is it called?

No such form exists.

Yes, it is called the PHI Authorization form.

Yes, it is called the HIPAA Authorization form.

There is no form, they just need to call and have it permantly documented.

The correct answer is "Yes, it is called the HIPAA Authorization form." This form allows an ADVANTAGE Medicare Solutions member to grant permission for someone else to access and receive their protected health information (PHI) on their behalf for an extended period of time. The HIPAA Authorization form ensures that the member's privacy rights are protected and that their PHI is shared only with authorized individuals.

Explanation

The correct answer is "Yes, it is called the HIPAA Authorization form." This form allows an ADVANTAGE Medicare Solutions member to grant permission for someone else to access and receive their protected health information (PHI) on their behalf for an extended period of time. The HIPAA Authorization form ensures that the member's privacy rights are protected and that their PHI is shared only with authorized individuals.

7. You initiate a call to a member's provider to discuss a case. Do you need to go through the caller authentication procedures?

Yes

No

You have already conducted your research and know you're contacting a valid provider as well as the member's correct provider, so there is no need to go through the authentication procedures.

Explanation

You have already conducted your research and know you're contacting a valid provider as well as the member's correct provider, so there is no need to go through the authentication procedures.

8. How can a member obtain a HIPAA Authorization form?

Call Member Services

Call the Grievance Line

Look in their EOC

All of the above

None of the above

A member can obtain a HIPAA Authorization form by calling Member Services.

Explanation

A member can obtain a HIPAA Authorization form by calling Member Services.

9. Which screen in Facets would you view to see if a member has a POA on file?

Members/Responsible Person

Members/Medicare Verification

Subscriber/Memo Field

None of the above

To view if a member has a Power of Attorney (POA) on file, you would need to go to the "Members/Responsible Person" screen in Facets. This screen provides information about the responsible person associated with the member's account, including any POA documentation that may have been filed. The other options mentioned, "Members/Medicare Verification" and "Subscriber/Memo Field," do not specifically display information about a member's POA status.

Explanation

To view if a member has a Power of Attorney (POA) on file, you would need to go to the "Members/Responsible Person" screen in Facets. This screen provides information about the responsible person associated with the member's account, including any POA documentation that may have been filed. The other options mentioned, "Members/Medicare Verification" and "Subscriber/Memo Field," do not specifically display information about a member's POA status.