Medical Management Privacy Practices

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| By Treid1

Treid1

Community Contributor

Quizzes Created: 2 | Total Attempts: 763

Questions: 9 | Attempts: 84 | Updated: Nov 20, 2023

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Medical Management Privacy Practices - Quiz

This is a brief quiz to test your knowlegde of privacy practices as they relate to Medicare Advantage and Medical Management.

Questions and Answers

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?
- A.
  
  Full name, children's name, pet's name, favorite color
- B.
  
  Name and date of birth
- C.
  
  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.
- D.
  
  None of these options
Correct Answer
C. 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.

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.

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2.

By law, ADVANTAGE Medicare Solutions must have our members' verbal or written authorization to release their protected health information (PHI).
- A.
  
  True
- B.
  
  False
Correct Answer
A. 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.

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3.

You initiate a call to a member's provider to discuss a case. Do you need to go through the caller authentication procedures?
- A.
  
  Yes
- B.
  
  No
Correct Answer
B. No

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.

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4.

Which screen in Facets would you view to see if a member has a POA on file?
- A.
  
  Members/Responsible Person
- B.
  
  Members/Medicare Verification
- C.
  
  Subscriber/Memo Field
- D.
  
  None of the above
Correct Answer
A. Members/Responsible Person

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.

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5.

A member provides verbal authorization for you to speak with his/her sibling. How long does this authorization last?
- A.
  
  45 days
- B.
  
  30 days
- C.
  
  20 days
- D.
  
  14 days
- E.
  
  None of the above
Correct Answer
D. 14 days

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.

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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?
- A.
  
  No such form exists.
- B.
  
  Yes, it is called the PHI Authorization form.
- C.
  
  Yes, it is called the HIPAA Authorization form.
- D.
  
  There is no form, they just need to call and have it permantly documented.
Correct Answer
C. Yes, it is called the HIPAA Authorization form.

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.

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7.

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?
- A.
  
  Facets
- B.
  
  Google
- C.
  
  NPPES
- D.
  
  All of the above
- E.
  
  None of the above
Correct Answer
C. NPPES

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.

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8.

How can a member obtain a HIPAA Authorization form?
- A.
  
  Call Member Services
- B.
  
  Call the Grievance Line
- C.
  
  Look in their EOC
- D.
  
  All of the above
- E.
  
  None of the above
Correct Answer
A. Call Member Services

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

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9.

A member's diagnosis or condition is considered PHI.
- A.
  
  True
- B.
  
  False
Correct Answer
A. 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.

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Medical Management Privacy Practices

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?

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

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

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

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

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?

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?

How can a member obtain a HIPAA Authorization form?

A member's diagnosis or condition is considered PHI.