HIPAA Healthcare Provider Obligations and Covered Entities

Question 1

Under HIPAA, which of the following is a 'covered entity'?

Accepted Answer

A healthcare clearinghouse that processes health insurance claims electronically

Answer

Healthcare clearinghouses that process health information from non-standard to standard formats are one of the three categories of HIPAA covered entities.

Question 2

A small cash-only family physician practice that has never transmitted any health information electronically is subject to HIPAA under which condition?

Accepted Answer

The practice becomes covered if it submits even a single electronic claim or electronic transaction covered by HIPAA standards

Answer

Healthcare providers become HIPAA covered entities only when they conduct electronic transactions using HIPAA standard transactions — a single electronic submission triggers covered entity status.

Question 3

Which of the following healthcare entities is NOT typically a covered entity under HIPAA?

Accepted Answer

A workers' compensation insurer

Answer

Workers' compensation insurers are specifically excluded from HIPAA's definition of health plans because they provide coverage for work-related injuries, not health coverage per se.

Question 4

Under HIPAA, what is a 'hybrid entity'?

Accepted Answer

An organization that performs both covered and non-covered healthcare functions within the same legal entity

Answer

A hybrid entity is a single legal entity that performs both HIPAA-covered healthcare functions and non-healthcare functions within the same organization.

Question 5

What is the primary HIPAA obligation when a healthcare provider refers a patient to a specialist?

Accepted Answer

The provider may share the minimum necessary PHI for treatment purposes without patient authorization

Answer

Treatment disclosures between healthcare providers are explicitly permitted under HIPAA's Privacy Rule without individual authorization, subject to the minimum necessary standard.

HIPAA - Health Insurance Portability and Accountability Act Practice Test

HIPAA - Health Insurance Portability and Accountability Act Practice Test

HIPAA Healthcare Provider Obligations and Covered Entities