Health Insurance Portability and Accountability Act (HIPPA) Practice Exam

Under what circumstance is PHI disclosure allowed without patient authorization?

1. For research purposes

2. For payment purposes

3. For marketing purposes

4. For employee training

The correct answer is: For payment purposes

PHI, or Protected Health Information, can be disclosed without patient authorization primarily in situations that are essential for the health care operations. Payment purposes fall under these exceptions because they involve healthcare providers obtaining necessary funds for care provided. This disclosure is in alignment with the provisions of HIPAA that allow for healthcare transactions essential to carry out payment activities for the services rendered. For payment purposes includes activities such as billing and collection, verifying coverage, and determining eligibility for benefits. These actions are considered necessary for the provision of healthcare services and are therefore allowed without the need for explicit patient consent. Other options, such as research and marketing purposes, generally require patient authorization since they do not fall under the typical operational activities necessary for treatment or payment. Employee training may involve PHI but typically will require identifiable information to be handled with additional precautions or consent to protect patient privacy. Therefore, the context of payment purposes is essential for operations in the medical field and allows for certain disclosures of PHI without prior patient consent under HIPAA regulations.