ABA Section of Business Law
ABA Section of Business Law
Business Law Today
September/October 2000
The K.I.S.S. glossary
• Protected health information: Individually identifiable health information that is or has been electronically maintained or electronically transmitted by a covered entity, as well as such information when it takes any other form. 64 Fed. Reg. 59937.
• Health plan: An individual or group plan that provides, or pays the cost of, medical care. The term would include, when applied to public-benefit programs, the component of the government agency administering the program. Health plan also includes health-insurance issuers, HMOs, long-term care policies, employee welfare-benefit plans, CHAMPUS, Federal Employees Health Benefits Programs and others. 64 Fed. Reg. 59931.
• Health-care clearinghouse: A public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements. 64 Fed. Reg. 59930.
• Health-care provider: Any person who furnishes health-care services or supplies in the normal course of business, including a researcher who provides health care to the subjects of research, free clinics and a health clinic or licensed health-care professional located at a school or business. 64 Fed. Reg. 59930.
• Payment: Activities undertaken by a health plan (or by a business partner on behalf of a health plan) to determine its responsibilities for coverage under the health plan policy or contract including the actual payment under the policy or contract, or by a health-care provider (or by a business partner on behalf of a provider) to obtain reimbursement for the provision of health care. 64 Fed. Reg. 59937.
• Treatment: The provision of health care by, or the coordination of health care (including health-care management of the individual through risk assessment, case management and disease management) among, health-care providers or the referral of an individual from one provider to another or the coordination of health care or other services among health-care providers and third parties authorized by the health plan or the individual. 64 Fed. Reg. 59939.
• Health-care operations: Activities undertaken by or on behalf of a covered health plan or health-care provider for the purposes of carrying out the management functions of such entity needed for the support of treatment or payment. 64 Fed. Reg. 59933-59934.
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