Insurance Coding Chapter 2

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HIPAA

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Health Insurance Portability and Accountability Act created to improve continuity of health insurance coverage and the administration of health care services

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Covered entities

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Organizations that access the personal health information of patients. They include health care providers, health plans, and health care clearinghouses

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Health care providers

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Any professional who provides health care services

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Health plans

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Companies whose main business focus is providing and/or paying for health care services

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Health care clearinghouses

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Companies that process health claim forms, convert them into proper data format, and submit them to the correct insurance carrier

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IIHI-Individual Identifiable Health Information

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Health care data that can be connected to a specific person

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PHI-Protected Health Information

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Any identifiable patient health information, regardless of the form in which it is stored (for example, paper or computer file)

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Use

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As defined by--HIPAA, the sharing of information between people working in the same health care facility for the purpose of caring for a patient

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Disclosure

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As defined by HIPAA, the sharing of information between health care professionals working in separate entities, or facilities, the course of caring for a patient

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Treatment, payment, and/or operations

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As defined by HIPAA, three situations that permit covered entities to use or disclose PHI, when their best professional judgment deems it necessary

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Incidental use and disclosure

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The accidental release of PHI during the course of proper patient care

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Minimum necessary

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Reveal only the smallest amount of information required to accomplish the task and no more

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Privacy notice

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A covered entity's written policies and procedures for protecting its patients' PHI

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Limited data set

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Stripped-down PHI for approved research and statistics