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Understanding Covered Entity (Health Care): Key Definitions and Insights
Definition & Meaning
A covered entity in health care refers to an organization or individual that regularly handles protected health information (PHI). Under the Health Insurance Portability and Accountability Act (HIPAA), covered entities include health plans, health care clearinghouses, and health care providers who electronically transmit health information related to billing or payment for services. Examples of covered entities are hospitals, medical clinics, and individual health care providers who send claims electronically to health plans.
Table of content
Legal Use & context
The term "covered entity" is primarily used in the context of health care law, particularly concerning the privacy and security of health information. Covered entities must comply with HIPAA regulations, which govern how they handle, share, and protect PHI. This term is relevant in various legal practices, including health law, privacy law, and compliance. Users can manage related forms and procedures through resources like US Legal Forms, which offers templates for compliance documentation.
Key legal elements
Real-world examples
Here are a couple of examples of abatement:
Example 1: A hospital that processes patient insurance claims electronically is a covered entity, as it handles PHI and transmits it to health plans.
Example 2: A physician's office that submits billing information for services rendered to patients via electronic means is also considered a covered entity.
Relevant laws & statutes
The primary law governing covered entities is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA sets standards for the protection of health information and outlines the responsibilities of covered entities regarding PHI.
Comparison with related terms
Term
Definition
Business Associate
An entity that performs functions on behalf of a covered entity that involves the use or disclosure of PHI.
Health Care Provider
An individual or organization that provides medical services and is considered a covered entity under HIPAA.
Common misunderstandings
What to do if this term applies to you
If you believe you are a covered entity, ensure you understand and comply with HIPAA regulations regarding the handling of PHI. Consider using US Legal Forms to access templates that can help you maintain compliance. If your situation is complex, seeking professional legal advice may be necessary.
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