Business Procedures Manual

Essential business procedural components for University System of Georgia institutions.

26.1 Definitions

(Last Modified on November 14, 2019)

Definitions relevant to the HCC as defined by the HIPAA regulations:

Business Associate (BA) means a person, contractor, vendor, institution, or other entity that, on behalf of the HCC, but other than in the capacity of a member of the HCC workforce, performs, or assists in the performance of:

  • A function or activity involving the use or disclosure of individually identifiable health information, including claims processing or administration, data analysis, processing or administration, utilization review, quality assurance, billing, benefit management, practice management, and re-pricing; or
  • Legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services to or for the HCC, or to or for an organized health care arrangement in which the HCC participates, where the provision of the service involves the disclosure of individually identifiable health information from the HCC or arrangement, or from another business associate of the HCC or arrangement, to the person.

Covered Entity (CE) means a health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in connection with furnishing, billing, or receiving payment for health care.

Covered Functions means those functions of a covered entity the performance of which makes the entity a health plan, health care provider or a health care clearinghouse.

Disclosure means the release, transfer, provision of access to, or divulging in any manner of information outside the entity holding the information.

Health Care means care, services, or supplies related to the health of an individual. Health care includes, but is not limited to, the following:

  • Preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care, and counseling, service, assessment, or procedure with respect to the physical or mental condition, or functional status, of an individual, or that affects the structure or function of the body; and
  • The sale or dispensing of a drug, device, equipment, or other item in accordance with a prescription.

Health Information means any information, including genetic information, whether oral or recorded in any form or medium, that:

  • Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and
  • Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.

Hybrid Entity means a single legal entity that is a covered entity, whose business activities include both covered and non-covered functions; and that designates health care components. USG is a Hybrid Entity.

Individually Identifiable Health Information (IIHI) means health information, including demographic information collected from an individual, that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.

Protected Health Information (PHI) means individually identifiable health information that is transmitted by or maintained in or by electronic media; or transmitted or maintained in any other form or medium; except for individually identifiable health information in:

  • Education records covered by the Family Educational Rights and Privacy Act (FERPA);
  • Student health records made or maintained by a physician or other health care professional which are used only in connection with the provision of treatment to the student and which are not available to anyone other than persons providing such treatment or other health care professional who has been asked to review such records by the student; and
  • Employment records held by USG in its role as employer.

Use means, with respect to individually identifiable health information, the sharing, employment, application, utilization, examination, or analysis of such information within the entity that maintains such information.

Workforce means employees, including temporary agency or contract employees, health care professionals, including medical students and interns, volunteers, trainees, and other persons whose conduct, in the performance of work for the HCC, or a component of the HCC, is under the direct control of USG, whether or not they are paid by USG.

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