HIPAA – Health Insurance Portability and Accountability Act of 1996

IIHI – Individually Identifiable Health Information: Information that is a subset of health information, including demographic information collected from an individual, and:

• Is created or received by a health care provider, health plan, employer or health care clearinghouse.
• 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.; and
• That identifies the individual with respect to which there is a reasonable basis to believe the information can be used to identify the individual.

PHI – Protected Health Information: PHI means IIHI that is held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, on paper or oral.

DRS – Designated Record Set: Rapid City Medical Center facilities maintain a Designated Record Set. The DRS includes medical and billing records to which patients and/or his or her personal representatives have the right to access, inspect and copy. Records include any item, collection or grouping of information that includes PHI and is maintained, collected, used or disseminated by or for a provider. Patient health care records are the property of Rapid City Medical Center but the information maintained within the record belongs to the patient.

Individual (for purposes of HIPAA) – The patient and his/her legal Personal Representative.

A Personal Representative is one who under law has the authority to act on behalf of a patient in making decisions related to health care (i.e., a parent, guardian or legal custodian under WI stat. 48.02(8) and (11)). Personal Representatives may have access to and/or request amendment of PHI relevant to their representative capacity unless there is a reasonable belief that the patient has been or may be subjected to domestic violence, abuse or neglect by such person, the release could endanger the patient, or in the exercise of professional judgment it is decided that it is not in the best interest of the patient to treat the person as the patient’s personal representative.

Treatment – The provision, coordination or management of health care and related services, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another.

Payment – Activities undertaken by Rapid City Medical Center to obtain or provide reimbursement for the provision of health care. Activities for payment include eligibility of coverage determination, billing, claims management, collection activities, utilization review including precertification, preauthorization, concurrent and retrospective review of services, and specified disclosures to consumer reporting agencies.

Health Care Operations – Quality assessment and improvement activities; reviewing the competence, qualifications, performance of health care professionals, conducting training programs, accreditation, certification, licensing, credentialing, underwriting, premium rating and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits; conducting or arranging for medical review, legal services and audition functions; business planning and development; business management.

Workforce – Under Section 160.103 of HIPAA, workforce means employees, volunteers, trainees and other persons whose conduct, in the performance of work for Rapid City Medical Center, is under the direct control of Rapid City Medical Center, whether or not they are paid by Rapid City Medical Center.

Provider – Under Section 160.103 of HIPAA, a provider of medical or health services and any other person or organization who furnishes, bills or is paid for health care in the normal course of business. Providers at Rapid City Medical Center are those contracted, subcontracted or employed and provides services on behalf of Rapid City Medical Center.