HIPAA compliance is the process of ensuring you are in line with HIPAA’s privacy, security, and breach notification rules. It is important to ensure that you are compliant with HIPAA as it helps protect your patients’ medical records and other personal health information. Having a good understanding of the law can help you avoid being fined or, worse, facing criminal charges because of a breach of patient privacy.
HIPAA compliance is important because it helps protect patients’ privacy. This, in turn, helps you avoid fines and criminal charges. The law also helps ensure that your organization is compliant with the latest technology standards for protecting electronic data and ensuring patient safety. Finally, HIPAA compliance can help improve patient satisfaction as they feel more comfortable knowing their information is being protected. Here are some of the top things on the HIPAA checklist to keep in mind:
HIPAA is a Federal law that protects the privacy of health information. The HIPAA Privacy Rule and the HIPAA Security Rule are only two of the six core components of HIPAA compliance. However, they are among the most important.
The Privacy Rule governs how covered entities (healthcare providers, insurers, or health plans) must handle protected health information (PHI). It states that PHI must be:
In addition to requiring these protections over PHI, it also specifies ways you can use or disclose PHI without having to ask for permission first – such as disclosing it when required by law or court order.
HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses. The HIPAA privacy and security rules also cover the business associates of these covered entities. On the other hand, HIPAA does not apply to all healthcare providers, all health plans, or all healthcare clearinghouses. Some doctors may be exempt from certain provisions of the law if they do not meet certain criteria set forth by the HHS Secretary through regulations. For example, a physician who provides services only to his or her patients in an office setting would not be required to comply with certain requirements under HIPAA because he or she is only a small group practice (likely less than ten employees).
The Health Insurance Portability and Accountability Act is a U.S. law that protects the privacy of patients and the security of their health data. It applies to all medical providers, insurance companies, and clearinghouses who have access to patient medical records in any form—paper or electronic (like email).
The HIPAA regulations also include rules for handling what’s called “protected health information” (PHI). PHI includes your name as well as some other pieces of information about you:
If these kinds of data are contained in an email message or other communication that’s sent via an unencrypted connection instead of using a secure method such as TLS/SSL encryption, then it’s considered PHI under HIPAA rules and must be protected accordingly.
HIPAA’s Privacy Rules are the heart of HIPAA compliance. The Rule requires that protected health information be protected from unauthorized disclosure, and it also requires that protected health information not be used for marketing purposes.
A Brief Primer on HIPAA Protected Health Information (PHI)
First, let’s take a look at what HHS considers to be PHI and how it differs from other types of personal information. Under the HIPAA Privacy Rule, PHI includes:
You must perform a risk analysis to understand the nature of your data, identify potential risks, and assess the likelihood and impact of each risk. Use this information to prioritize risks based on likelihood and impact. You may choose to mitigate certain risks, such as by implementing measures like encryption or limiting network access for users with lower levels of authority. This is a good practice regardless, but it can also help you avoid fines if you’re in violation of HIPAA compliance regulations.
In the context of a HIPAA compliance plan, accountability means determining who is responsible for each task and making sure that they are completed on time. Accountability can be assigned to an individual or group as well as the entire organization.
For example: If you have an employee who needs to access patient records in order to do their job, then it’s important that they know what information they need access to and only use that information when necessary. This person should also know how much time will be required in order for them to complete their task successfully without violating any privacy laws or regulations.
Accountability can also apply when deciding which security measures are necessary based on the size of your organization—a smaller company might not need an extensive upgrade, while larger corporations may require more thorough policies when it comes to protecting sensitive data from hackers who want access because there’s more money involved (and thus more incentive).
Now that you understand what gaps exist in your company’s compliance, it’s time to address them.
In order to be proactive about avoiding HIPAA violations, you should make sure that your organization has a detailed process for communicating any gaps or compliance issues to both management and the appropriate parties. You will also need a documented process for addressing these issues once they have been identified.
Make sure that there is an individual or group of individuals who are responsible for monitoring compliance status at regular intervals and keeping track of any changes or updates regarding the regulations. The best way to do this is by creating a checklist that provides guidance on how often these checks should be performed as well as what types of things should be checked during them (e.g., employee training records).
Documentation is the key to HIPAA compliance. It’s important for legal reasons, quality assurance, training, and security purposes, as well as risk analysis.
Documentation includes a complete record of all policies and procedures along with your privacy notice. The documentation should include information about how you protect the confidentiality of protected health information (PHI), such as:
A breach of unsecured protected health information is a violation that exposes the PHI of one or more individuals. Breach reporting is a key part of HIPAA compliance, and covered entities must report any breaches to the HHS Office for Civil Rights within 60 days from when they learned of them.
HIPAA requires covered entities to notify affected individuals about any breaches that involve their PHI, as well as take steps to mitigate further damage from unauthorized access or disclosure. For example, if an employee loses their laptop containing patient information in a taxi cab on their way home from work, then you will need to inform all affected patients so they can take steps to protect themselves and monitor their credit reports (which are often used by identity thieves).
We hope that you now have a better understanding of HIPAA and its compliance requirements. There are many steps you can take to ensure your organization remains compliant, but it’s important to remember that there are no shortcuts when it comes to protecting your patients’ personal information. As long as you keep up with these basic guidelines – like keeping track of all the data in your organization, performing regular risk assessments, and documenting everything – then you’ll be well on your way toward compliance.