Who and What is a Covered Entity? A New Tool Makes it Easy

Did you know that CMS has an entire area called the National Standards Group (NSG) within the Office of Burden Reduction & Health Informatics (OBRHI) that is responsible for administering HIPAA Administrative Simplification requirements related to transactions like electronic claims and payment?  Provisions related to privacy and security, however, are under the domain of the Office for Civil Rights (OCR).

Included on the HIPAA Administrative Simplification website is a new tool to make it easier to understand the concept of HIPAA covered entities. The decision tree asks a number of questions that allow you to click and go to find out what is and what is not fits the covered entity definition. This has always been important for the secure transmittal of health care information, but is even more timely now, with the need to properly steward social care data. In the long term, it’s possible and even probable that federal guidance will be issued to guide and guard social care/health care data exchange. Until then, many states, including our own, are working on methods and protections for securely exchanging social care data. It is important work in Michigan and aims to be helpful for the growth of Community Information Exchange (CIE) efforts aimed at addressing social determinants of health.