American Academy of Professional Coders (AAPC) Practice Exam

Which of the following is a requirement for a covered entity to disclose PHI?

1. Patient must be informed prior to disclosure

2. Disclosures must be for treatment, payment, or health care operations

3. Disclosure must occur within 24 hours

4. Information must be sent via registered mail

The correct answer is: Disclosures must be for treatment, payment, or health care operations

The requirement for a covered entity to disclose Protected Health Information (PHI) primarily revolves around the necessity of the disclosure for treatment, payment, or healthcare operations. This guideline is established under the Health Insurance Portability and Accountability Act (HIPAA), which allows for the sharing of PHI without patient consent as long as the disclosure is pertinent to these specified uses. When it comes to treatment, this refers to coordinating care among providers, while payment relates to billing and reimbursement activities. Healthcare operations include a broad range of activities necessary for the operation of the health care business, such as quality assessment, training programs, and management activities. The emphasis on these three categories signifies that disclosures made for these purposes are considered routine and are integral to providing quality health care. The other options outline scenarios that aren't requisite under HIPAA rules. For instance, while it is important to keep patients informed about their PHI, prior patient notification isn't mandated for disclosures made under treatment, payment, or healthcare operations. Additionally, there is no specific time frame like 24 hours dictated by HIPAA for when disclosures must occur, nor is there any stipulation for sending information via registered mail as a general requirement for disclosures. These are more about best practices or specific company policies rather than legal