HIPAA

Health Insurance Portability and Accountability Act (HIPAA)

Definitions

Protected Health Information

  • Protected health information is any information (whether oral or recorded) in any form or medium created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse which 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.
  • The information either specifically identifies the individual or the contents of the information can be used to make a reasonable assumption as to the identity of the individual.

Treatment

  • Treatment generally means the provision, coordination or management of health care and related services among health care providers or by a health care provider with a third party, consultation between health care providers regarding an individual, or the referral of the individual from one health care provider to another.

Payment

  • Payment encompasses the various activities of health care providers to obtain payment or be reimbursed for their services and of a health plan to obtain premiums to fulfill their coverage responsibilities and provide benefits under the plan, and to obtain or provide reimbursement for the provision of health care.

Health Care Operations

  • Health care operations are certain administrative, financial, legal and quality improvement activities of a covered entity necessary to run its business and to support the core functions of treatment and payment.