| A | B |
|---|
| Preemption | The rule that HIPAA rules supersede state laws except when HIPAA deems a state law necessary to prevent fraud and abuse or when the state law is more restrictive than the HIPAA rule. |
| Consolidated Omnibus Budget Reconciliation Act (COBRA) | An amendment to Title I of HIPAA that gives employees the right to continue health coverage as a private payer for a limited period of time once they leave a job. |
| covered entity (CE) | A health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in connection with a HIPAA transaction. |
| business associate (BA) | A person or organization that performs a function or activity on behalf of a covered entity, but is not part of the covered entity itself. Business associates, such as law firms and accountants must adhere to HIPAA standards in order to do business with a covered entity. |
| health plan | Any individual or group plan that provides or pays for medical care. |
| provider | People or businesses that furnish, bill, or are paid for health care in the normal course of business. Under HIPAA, a covered provider is one who submits electronic administrative and financial transactions. |
| clearinghouse | (also called Health Care Clearinghouse) A company that handles electronic transactions for providers, such as submitting claims using HIPAA formats and may also manage electronic medical records. |
| Administrative Simplification (A/S) | The part of HIPAA that gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the standards to protect the security and privacy of ePHI. This is Title II. |
| direct provider | A health care provider who has a direct treatment relationship with a patient, such as a physician or therapist. See also indirect provider. |
| Health Insurance Portability and Accountability Act (HIPAA) of 1996 | The federal legislation covering rules regarding the health care industry, specifically how it is administered and the rights of patients in regard to health care coverage and privacy. |
| Centers for Medicare and Medicaid Services (CMS) | (formerly known as HCFA) The division of Health and Human Services responsible for health care. CMS is responsible for Medicare and parts of Medicaid. CMS maintains specifications for various certifications and authorizations used by the Medicare and Medicaid programs. CMS also maintains various code sets. |
| creditable coverage | Insurance coverage under a group health plan, a health plan, or the Medicaid program know as SCHIP. This coverage is taken into account when an employee joins a new health plan. |
| Department of Health and Human Services (HHS) | The federal department that administers federal programs covering public health and welfare. |
| Federal Employees Health Benefits (FEHB) program | The program that provides medical insurance coverage to the more than 8 million federal employees, retirees, and their families. Administered by the federal government's Office of Personnel Management (OPM). |
| Federal Register | A publication of the Office of the Federal Register (OFR), which is responsible for publishing federal laws, presidential documents, admistrative regulations and notices, and descriptions of federal organizations, programs, and activities. |
| group health plan | Medical insurance offered to employees and payed for in part or in full by an employer. |
| indirect provider | A health care provider is a person or business that has an indirect treatment relationship with the patient, such as a laboratory. See also direct provider. |
| Notice of Proposed Rule-Making (NPRM) | A document that describes and explains rules that the Federal Government proposes to adopt at some future date. Interested parties are invited to submit comments, which may then be used in developing a final regulation. |
| Office for Civil Rights (OCR) | The division of Health and Human Services responsible for enforcing the HIPAA privacy rules. Privacy is considered a civil right. |
| small health plan | Under HIPAA, a health plan with annual revenue of 5 million dollars or less. It is in Part II. |
| Title I | The portion of the HIPAA law concerned with health insurance reform. The main purpose of Title I is to ensure the continuation of health coverage when employees change jobs. It also entitles people who leave a job to continue their health insurance coverage as a private payer for a limited period of time under COBRA. |
| Title II | The portion of the HIPAA law known as administrative simplification. The rules in this section cover administrative, financial, and case management policies and procedures. It contains strict requirements for the uniform transfer of electronic health data and covers rules of patient confidentiality. |
| transaction | One electronic exchange in EDI, specifically under HIPAA, the exchange of information between two parties involved in financial or administrative activities related to health care. It is in Part II. |
