Health HIPAA Expert

The Health Insurance Portability and Accountability Act, or HIPAA, is designed to help protect individual’s health information and privacy. The Privacy Rule exists under HIPAA and applies to health care providers who typically transmit health information electronically. The Privacy Rule helps establish protective standards on a wide-scale level. This helps protect the medical records or other types of personal health information for individuals. It is applicable to records and information which is handled through electronic transactions. The Privacy Rule sets certain requirements for how health information is handled and gives patients their rights over their own health information.

What entities does the Privacy Rule apply to?

The Privacy rule applies to those in the health field such as:

  • Health Plans
  • Health Care Providers
  • Health Care Clearinghouses

The Privacy Rule and Health Plans

Health plans can include any group or individual plans that pay the cost of medical care. It can include health, vision, dental, HMOs, Medicare, Medicaid, dental and any supplemental type “insurance.” Health plans can also refer to plans that are sponsored by the government, a religious organization or an employer, all aimed at providing and paying for health care.

The Privacy Rule and Health Care Providers

Any provider of health care that transmits health information electronically is covered by HIPAA’s Privacy Rule. Health providers frequently submit health information such as claims, referrals, authorization requests, eligibility inquiries and such requests through electronic means. Health care providers are a covered entity even if they use a third party to actually submit information. Any physicians, dentists or other types of medical practitioners who provide paid health care are covered.

The Privacy Rule and Health Care Clearinghouses

A health care clearing house is an entity that processes information. They typically receive information in a nonstandard form and transfer it to a standard format or vice versa. Usually the health care clearinghouse receives identifiable information if they are providing services to a health plan or health care provider in a business type setting. The types of services typical of a health care clearinghouse includes actions such as:

  • Billing services
  • Re-pricing companies
  • Community health management information systems
  • Networks