What’s Hip with HIPAA? Covered Entities

What’s Hip with HIPAA? Covered Entities

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).

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Kimberly Lowe

Kimberly Lowe

For over 20 years I have lawyered from the trenches with experience based on a comprehensive knowledge and understanding of how both for-profit and nonprofit enterprises operate. I guide entrepreneurs, executive management teams, boards of directors, multigenerational families, shareholders and investors through all aspects of the business life cycle from formation to operation to exit. Read Kim's Bio.

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