What's Hip with HIPAA? Covered Entities

Dec. 14, 2017

It goes without saying that if you have ever dealt with or thought about HIPAA, you have figured out there is a lot of jargon that goes along with it.  The following article will discuss some HIPAA basics.

 

Both covered entities and their business associates (we discussed this term here What's Hip with HIPAA? Business Associate Agreements) must comply with Health Insurance Portability and Accountability Act (HIPAA). Covered entities include:

 

  • Health care providers – specifically those conducting certain administrative and financial transactions electronically.

  • Health plans – individual or group plans that pay for the cost of medical care, such as health insurance companies, HMOs, or Medicare.

  • Health care clearinghouses – intermediaries that converts health information from another entity from a nonstandard format into a standard format, checking for errors and compatibility.

 

Covered entities often hire other people or entities to perform certain services involving the use or disclosure of protected health information (PHI) (we covered this term here What's Hip with HIPAA? Protected Health Information).   These are people or entities engaged by covered entities are called business associates (we covered this term here What's Hip with HIPAA? Business Associate Agreements), and they often provide services relating to:

 What's Hip with HIPAA? Covered Entities

  • Billing.

  • Benefits management.

  • Practice management.

  • Re-pricing.

  • Claims processing and administration.

  • Data analysis and processing.

  • Quality assurance.

  • Legal advice.

  • Accounting.

 

Employees of a covered entities, researchers for a covered entity, or financial institutions such as a bank are not considered business associates. Before a covered entity may disclose protected health information (PHI) to a business associate, they should have entered into a business associate agreement (we covered Business Associate Agreements here What's Hip with HIPAA? Business Associate Agreements).

 


Written By:
Kimberly Lowe

For almost 20 years Kim Lowe has lawyered from the trenches. Kim lawyers from experience, using her knowledge of the law and understanding of how both for-profit and nonprofit business enterprises operate.

Emilee Walters is a second year law student at St. Thomas School of Law. Emilee is an Avisen Fellow exploring a legal career in business law.

E-mail Kimberly

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