HIPAA: Acronym that stands for the Health Insurance Portability and Accountability Act, a US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers. 1320d-1320d-4, 1320d-7, 1320d-8, and 1320d-9; (3) Sections 13400-13424 of Public Law 111-5; or. Use means, with respect to individually identifiable health information, the sharing, employment, application, utilization, examination, or analysis of such information within an entity that maintains such information. Individually identifiable health information, Electronic Code of Federal Regulations (e-CFR), Chapter A. chapter 17. (2) Any reference in this subchapter to genetic information concerning an individual or family member of an individual shall include the genetic information of: (i) A fetus carried by the individual or family member who is a pregnant woman; and. 300gg-91(a)(2)). The following types of individuals and organizations are subject to the Privacy Rule and considered covered entities: 1. (C) Payment activities, if the financial risk for delivering health care is shared, in part or in whole, by participating covered entities through the joint arrangement and if protected health information created or received by a covered entity is reviewed by other participating covered entities or by a third party on their behalf for the purpose of administering the sharing of financial risk. 300gg-91(b)(3) and used in the definition of health plan in this section) means a federally qualified HMO, an organization recognized as an HMO under State law, or a similar organization regulated for solvency under State law in the same manner and to the same extent as such an HMO. (viii) An issuer of a long-term care policy, excluding a nursing home fixed indemnity policy. Health maintenance organization (HMO) (as defined in section 2791(b)(3) of the PHS Act, 42 U.S.C. A Health Care Provider A Health Plan A Health Care Clearinghouse; This includes providers such as: Doctors; Clinics; Psychologists; Dentists; Chiropractors; Nursing Homes; Pharmacies...but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard. 1395ss(g)(1)). 1232g; (ii) In records described at 20 U.S.C. Using electronic technology, such as email, does not mean a health care provider is a covered entity; the transmission must be in connection with a standard transaction. 2. (3) A health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter. (2) The making of grants to fund the direct provision of health care to persons. A health plan may use protected health information to provide customer service to its enrollees. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business. A health care provider may disclose protected health information about an individual as part of a claim for payment to a health plan. (5) Enrollment and disenrollment in a health plan. (2) 26 U.S.C. (xiv) An approved State child health plan under title XXI of the Act, providing benefits for child health assistance that meet the requirements of section 2103 of the Act, 42 U.S.C. Subcontractor means a person to whom a business associate delegates a function, activity, or service, other than in the capacity of a member of the workforce of such business associate. ANSI stands for the American National Standards Institute. (2) Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. Transaction means the transmission of information between two parties to carry out financial or administrative activities related to health care. 300gg-91(a)(2)), including items and services paid for as medical care, to employees or their dependents directly or through insurance, reimbursement, or otherwise, that: (1) Has 50 or more participants (as defined in section 3(7) of ERISA, 29 U.S.C. (a) The Act defines health care provider as: (1) A doctor of medicine or osteopathy who is authorized to practice medicine or surgery (as appropriate) by the State in which the doctor practices; or (2) Any other person determined by the Secretary to be capable of providing health care services. (ii) A person that offers a personal health record to one or more individuals on behalf of a covered entity. 6109, which is the portion of the Internal Revenue Code dealing with identifying numbers in tax returns, statements, and other required documents. Protected health information means individually identifiable health information: (1) Except as provided in paragraph (2) of this definition, that is: (iii) Transmitted or maintained in any other form or medium. CMS stands for Centers for Medicare & Medicaid Services within the Department of Health and Human Services. The Privacy Rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf.Â, Health care providers include all “providers of services” (e.g., institutional providers such as hospitals) and “providers of medical or health services” (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for health care.Â. (i) Any policy, plan, or program to the extent that it provides, or pays for the cost of, excepted benefits that are listed in section 2791(c)(1) of the PHS Act, 42 U.S.C. Healthcare providers: Every healthcare provider, regardless of size of practice, who electronically transmits health information in connection with certain transactions. (v) The Medicaid program under title XIX of the Act, 42 U.S.C. (vi) The Voluntary Prescription Drug Benefit Program under Part D of title XVIII of the Act, 42 U.S.C. Genetic test does not include an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition. (2) Sale or dispensing of a drug, device, equipment, or other item in accordance with a prescription. Disclosure means the release, transfer, provision of access to, or divulging in any manner of information outside the entity holding the information. (iii) A government agency, with respect to determining eligibility for, or enrollment in, a government health plan that provides public benefits and is administered by another government agency, or collecting protected health information for such purposes, to the extent such activities are authorized by law. (xiii) The Federal Employees Health Benefits Program under 5 U.S.C. (i) A health care provider, with respect to disclosures by a covered entity to the health care provider concerning the treatment of the individual. [45 CFR 160.103] Clarification as issued by the Office of Discrimination:Every health care provider, … (2) Health care payment and remittance advice. (iii) An HMO, as defined in this section. A provider of services (as defined in section 1861 (u) of the Act, 42 U.S.C. Standard means a rule, condition, or requirement: (1) Describing the following information for products, systems, services, or practices: (ii) Specification of materials, performance, or operations; or. (ii) A plan sponsor, with respect to disclosures by a group health plan (or by a health insurance issuer or HMO with respect to a group health plan) to the plan sponsor, to the extent that the requirements of § 164.504(f) of this subchapter apply and are met. These transactions include claims, benefit eligibility inquiries, referral authorization requests, or other transactions for which HHS has established standards under the HIPAA Transactions Rule.Â. (x) The health care program for uniformed services under title 10 of the United States Code. (xi) The veterans health care program under 38 U.S.C. 1232g(a)(4)(B)(iv); (iii) In employment records held by a covered entity in its role as employer; and. (i) First-degree relatives include parents, spouses, siblings, and children. Transmission media include, for example, the Internet, extranet or intranet, leased lines, dial-up lines, private networks, and the physical movement of removable/transportable electronic storage media. 6011(b), which is the portion of the Internal Revenue Code dealing with identifying the taxpayer in tax returns and statements, or corresponding provisions of prior law. (ii) A health insurance issuer, as defined in this section. (xii) The Indian Health Service program under the Indian Health Care Improvement Act, 25 U.S.C. Relatives by affinity (such as by marriage or adoption) are treated the same as relatives by consanguinity (that is, relatives who share a common biological ancestor). HHS stands for the Department of Health and Human Services. Family member means, with respect to an individual: (1) A dependent (as such term is defined in 45 CFR 144.103), of the individual; or. (8) Referral certification and authorization. Health Insurance Portability and Accountability Act, A provider of services (as defined in section 1861(u) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business. EIN stands for the employer identification number assigned by the Internal Revenue Service, U.S. Department of the Treasury. HIPAA Regulations: General Provisions - Definitions - Health Care Provider - § 160.103. 1396, et seq. (iv) Part A or Part B of the Medicare program under title XVIII of the Act. [45 CFR 160.103]Clarification as issued by the Office of Discrimination:Every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity. 8902, et seq. Standard setting organization (SSO) means an organization accredited by the American National Standards Institute that develops and maintains standards for information transactions or data elements, or any other standard that is necessary for, or will facilitate the implementation of, this part. Certain transmissions, including of paper, via facsimile, and of voice, via telephone, are not considered to be transmissions via electronic media if the information being exchanged did not exist in electronic form immediately before the transmission. (vii) An issuer of a Medicare supplemental policy (as defined in section 1882(g)(1) of the Act, 42 U.S.C. Implementation specification means specific requirements or instructions for implementing a standard. (2) A covered entity may be a business associate of another covered entity. Individual means the person who is the subject of protected health information. These transactions include claims, benefit eligibility inquiries, referral authorization requests, or other transactions for which HHS has established standards under the HIPAA Transactions Rule. Using electronic technology, such as email, does not mean a health care provider is a covered entity; the transmission must be in connection with a standard transaction.The Privacy Rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf. Health care providers include all “providers of services” (e.g., institutional providers such as hospitals) and “providers of medical or health services” (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for health care.Â, All Rights Reserved © HIPPA.com   Site Design by, A provider of services (as defined in section 1861(u) of the Act, 42 U.S.C. 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