HIPAA compliance is as crucial to health insurance providers and healthcare providers as to patients. HIPAA rules have serious implications when broken, but your organization should be wary of HIPAA violations for myriad reasons.
HIPAA was set in place to safeguard patient data and sensitive information. That said, much of the onus falls on healthcare organizations to create physical safeguards that protect sensitive patient data.
What Is HIPAA?
The United States established the Health Insurance Portability and Accountability Act primarily to solve a particular issue: covering insurance for people who switch or leave their jobs. HIPAA thereby allows workers to transfer their insurance coverage when between jobs.
HIPAA is widely known today as a set of security measures designed to protect patients’ privacy and health information. HIPAA ensures that all protected health information (PHI) is only available to authorized personnel, preventing healthcare fraud.
Overall, this prevents outside sources from using healthcare data and medical records as grounds for bias toward workers—for example, deciding not to hire someone based on their medical history. This, HIPAA enforces the protection of private health information.
HIPAA Rules
HIPAA Omnibus Rule
This rule acts as an appendix, added to HIPAA to include business associates and not just medical institutions. Setting the standard for Business Associate Agreements (BAAs), this rule enforces that BAAs exist between communicating organizations before any medical data is transferred from one party to another.
HIPAA Security Rule
This rule encompasses covered entities and business associates, mostly when information goes back and forth between the two. This sets a precedent for the security and coherence of PHI, including the handling of medical records in physical or electronic form.
Included are safeguards that work alongside health information technology to make discreetly sharing information easier on healthcare organizations. Some of the formed elements include data encryption, administrative safeguards, and physical safeguards involving controlling facility and staff access to sensitive information.
HIPAA Privacy Rule
The privacy rule applies only to covered entities who work through electronic healthcare transactions. Through this rule, the national standards for access to PHI are set, including how to disclose protected health information to any business associate. Likewise, this gives patients the ability to request their medical information.
HIPAA Breach Notification Rule
Data breaches are frighteningly more common than one would like to think. According to the Office for Civil Rights (OCR), under the US Department of Health and Human Services, more than 300 medical offices are currently under investigation for breaches reported in the last two years. Sometimes, implementing the correct device security, security controls, and technical safeguards is not enough to prevent a data breach.
The HIPAA Breach Notification Rule requires that a HIPAA-covered healthcare provider reach out to an affected customer or patient to inform them that their PHI might have been stolen or put at risk.
HIPAA categorizes a data breach based on size. A minor breach affects fewer than 500 people within the jurisdiction of a single HIPAA-covered entity.
The HIPAA breach notification rule requires you to gather all data on breaches that took place, reporting them to regulators within 60 days of the year’s end. You should notify a patient with a compromised electronic health record (EHR) within 60 days of the data breach.
What Is HIPAA Compliance?
This refers to HIPAA-covered entities following the rules and regulations set by law. Every HIPAA-covered entity, according to law, must follow the policies and procedures set out by HIPAA regulations.
HIPAA-compliant organizations should engage in a continuous process to develop, monitor, and maintain their strategy to meet the HIPAA privacy rule. Likewise, the HIPAA security rule defines what kind of encryption, firewalls, and other security measures should be in place.
HIPAA compliance software is available to any economic and clinical health organization that needs assistance setting up its security protocol, making it easier than ever to avoid committing a HIPAA violation.
Following HIPAA Compliance Checklists
Naturally, there exists a list of HIPAA compliance requirements that make the process of preventing unauthorized access to sensitive medical information relatively straightforward. You should view the HIPAA compliance checklist as a mandatory inclusion in your office’s HIPAA privacy compliance measures.
The checklist includes:
- Performing self-audits
- Setting up a remediation plan
- Developing and implementing policies, procedures, and employee training
- Documentation
- Business associate management
- Incident management
Who Must Comply?
Any covered entity and relevant business associates must comply with these guidelines. If entities do not meet the definition of “covered entities” or “business associates,” HIPAA rules do not apply.
Covered Entities
Any organization that gathers, collects, creates, or transmits PHI is considered a covered entity. Some healthcare organizations considered covered entities include:
- Covered healthcare providers like doctors, clinics, dentists, psychologists, and more
- Health plans such as insurance companies, health maintenance organizations (HMOs), company health directives, and government programs paying for healthcare
- Healthcare clearinghouses like billing services, repricing companies, community health management, information systems, and value-added networks
Business Associates
The concept of business associates encompasses organizations or people who interact with PHI in any way for the work they do. This includes anyone invested in billing, accreditation, consulting, data analysis, or any other task involving the private disclosure of PHI.
What Is HIPAA Training?
HIPAA training is a required part of HIPAA compliance. Anyone who works for or supports the healthcare industry must take an annual HIPAA training course to stay up to date with HIPAA compliance best practices.
As providers and companies continue to find new ways to ease the burden of administrative and clinical tasks, including the use of applications such as computerized physician order entry (CPOE) systems and electronic health records, there is always a need for newer security protocols.
Policies and procedures change rather rapidly in response to how individually identifiable health information can be leaked or mishandled. Remaining HIPAA compliant requires an ongoing engagement with privacy and security rules.
Recognizing Common HIPAA Violations
Familiarizing yourself with what constitutes a HIPAA violation based on national standards will help you shore up your security management process. Some common causes that can lead to a breach include:
- Theft of equipment that stores PHI
- Hacking, malware, or ransomware
- Office break-ins
- Sending PHI to the wrong individual or business associates
- Discussing PHI in public
- Posting PHI to social media
Unfortunately, it is sometimes impossible to avoid every item on this list, even when your organization follows the HIPAA compliance checklist in an attempt to guard electronically protected health information. The best way to ensure HIPAA compliance is to have all your ducks in a row ahead of time. Give us a call if you have any questions.
