Health Insurance Portability and Accountability Act (HIPPA) Practice Exam

Are any covered entities exempted from submitting claims electronically under HIPAA?

1. Yes, some are exempted

2. No, none are exempted

3. Only large providers are exempted

4. Only non-profit organizations are exempted

The correct answer is: Yes, some are exempted

Covered entities under HIPAA include healthcare providers, health plans, and healthcare clearinghouses that transmit any health information in electronic form. While HIPAA mandates the electronic submission of claims for efficiency and standardization, there are exceptions based on certain criteria. Specifically, small health care providers who do not conduct electronic transactions may be exempt from the requirements to submit claims electronically. The determination of whether a provider qualifies for this exemption typically depends on the size, scope of operations, and the volume of claims they handle. Consequently, some covered entities may be exempted from the mandate to submit claims electronically, especially if they primarily engage in paper transaction methods. In contrast, large providers and non-profit organizations do not have blanket exemptions regarding electronic claims submission, as their operations often involve conducting electronic transactions. Therefore, the correct answer recognizes that some covered entities, particularly small providers, are indeed exempted from electronic claims submission under HIPAA regulations.