American Academy of Professional Coders (AAPC) Practice Exam

Under what conditions can a covered entity disclose health information for treatment activities?

1. If the provider requests it

2. If the patient consents

3. For its own treatment, payment, or health care operations

4. Under any circumstances

The correct answer is: For its own treatment, payment, or health care operations

The ability for a covered entity to disclose health information for treatment activities is guided by the Health Insurance Portability and Accountability Act (HIPAA) regulations. A covered entity, which includes healthcare providers, health plans, and healthcare clearinghouses, can share protected health information (PHI) if it is necessary for their own treatment, payment, or healthcare operations. Disclosing health information for treatment activities is essential for maintaining continuity of care and facilitating the healthcare process. This means that, for example, a physician can share a patient's information with another healthcare provider to ensure that the patient receives comprehensive care. The focus on treatment, payment, or healthcare operations supports the effective delivery of healthcare services while ensuring that patient privacy is safeguarded. Though patient consent and provider requests are important aspects of healthcare privacy, they do not provide the same level of assurance under HIPAA regulations for disclosing PHI as the operational needs of treatment, payment, or healthcare activities do. Therefore, the correct understanding is that covered entities are authorized to disclose health information primarily when it directly relates to their own operational function in providing care.