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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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HIPAA Business Associates 

What is a Business Associate?

No Business Associate Agreement?  $31K Mistake

A “business associate” is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity.  A member of the covered entity’s workforce is not a business associate.  A covered health care provider, health plan, or health care clearinghouse can be a business associate of another covered entity.  The Privacy Rule lists some of the functions or activities, as well as the particular services, that make a person or entity a business associate, if the activity or service involves the use or disclosure of protected health information. The types of functions or activities that may make a person or entity a business associate include payment or health care operations activities, as well as other functions or activities regulated by the Administrative Simplification Rules.

Functions and Activities

Business associate functions and activities include:

    • Claims processing or administration;
    • Data analysis,
    • Processing or administration;
    • Utilization review;
    • Quality assurance;
    • Billing;
    • Benefit management;
    • Email services
    • Cloud storage
    • Practice management; and 
    • Repricing.  

Business associate services are:

    • Legal;
    • Actuarial;
    • Accounting;
    • Consulting;
    • Data aggregation;
    • Management;
    • Administrative;
    • Accreditation; and
    • Financial. 

Examples of Business Associates

    • A third party administrator that assists a health plan with claims processing. 
    • An email service provider.
    • A CPA firm whose accounting services to a health care provider involve access to protected health information. 
    • An attorney whose legal services to a health plan involve access to protected health information. 
    • A consultant that performs utilization reviews for a hospital. 
    • A health care clearinghouse that translates a claim from a non-standard format into a standard transaction on behalf of a health care provider and forwards the processed transaction to a payer. 
    • An independent medical transcriptionist that provides transcription services to a physician. 
    • A pharmacy benefits manager that manages a health plan’s pharmacist network.  

Sample Agreements and Policy

Sample Business Associate Agreements: Sample 1 and Sample 2

Sample Policy and Procedures on Business Associates

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Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

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