Health Information Management

HIPAA Q&A: You've got questions. We've got answers!

HIM-HIPAA Insider, August 24, 2015

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Q: Our non-employed radiology group is being evaluated by its insurer from a risk and safety standpoint. This requires the insurer to come into the hospital and review patient records. Does the hospital need to have a business associate agreement (BAA) with this insurer?

A: No. If the insurer is a health plan and the patient record review is conducted as part of the insurer's payment and healthcare operations activity, the health plan is acting as a covered entity (CE). On the other hand, if the risk and safety evaluation is ¬conducted for purposes other than the insurer's payment and healthcare operations activity, a BAA is necessary. If, as an example, the insurer was assessing risk as it relates to a malpractice on the radiology group's behalf, the BAA would be with the radiology group and not the hospital. Ultimately, it amounts to which type of insurer it is and whom the insurer is conducting activities on behalf of.

Editor’s note: Chris Apgar, CISSP, president of Apgar & Associates, LLC, in Portland, Oregon, answered this question for HCPro’s Briefings on HIPAA newsletter. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions.

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