How Does HIPAA Define a Health Care Provider?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted to establish guidelines for health care providers that transmit health information in an electronic form. All covered health care providers are required to obtain a 10-digit National Provider Identifier (NPI) number.

Background on HIPAA

• The enactment of HIPAA was an attempt to establish rules governing patient privacy in the electronic medical billing process. The Act also set standards for sharing electronic medical billing information between health care providers. Covered providers must share their NPI number with other providers. There are two major categories of health organizations defined by HIPAA--institutional-type providers and professional-type providers.

Institutional-Type Providers

• HIPAA defines a health care provider as "any provider of medical or other health services, and any other person or organization that furnishes, bills, or is paid for health care in the normal course of business."

  Examples of institutional-type providers include hospitals, nursing homes, ambulatory care facilities and pharmacies, among others.

Professional-Type Providers

• According to the Centers for Medicare & Medicaid Services (CMS), the term "health care provider" includes additional providers of health care such as physicians, dentists, psychologists and health care organizations (HMOs).