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An Ultimate Guide to HIPAA Compliance

Are you ready to delve into the world of HIPAA Compliance? In this ultimate guide, we are going to explore how HIPAA is more than just a strict set of healthcare regulations and a key component for building trust and improving patient care. We will see how the goal of this compliance isn’t just to point out the mistakes, but to promote an advanced healthcare system. No matter whether you are a healthcare provider, patient, or just anyone who is interested in the topic, you will get every detail on HIPAA Compliance that you need to know.

Before we move forward to the actual guide of HIPAA Compliance, one basic thing that you must know is that it is HIPAA, not HIPPA or HIPPO. Even though you might have to face the same wrath for not being HIPAA compliant, as for not respecting a hippo.

These days, data privacy is the topmost concern in every field. And the concern is even deeper when it comes to protecting sensitive information such as – healthcare data. Whether you are a business associate or any other entity transmitting healthcare data, it becomes critical for you to be HIPAA Complaint.

The aim of this guide is to give you complete information on HIPAA and ensure that you are fully HIPAA-compliant so that data breaches are avoided.

What is HIPAA?

The Health Insurance Portability and Accountability Act (HIPAA) is basically a U.S. law that is designed to place safeguards on protected health information (PHI) and aims to streamline the healthcare industry. The PHI includes any personally identifiable information, such as name, address, phone number, and other medical records. It is important for all healthcare providers to be HIPAA Compliant. Even if the single record is compromised, it can result in a fine up to $2500.

The provision in HIPAA not only prevents healthcare fraud and abuse but also mandates standards for healthcare information on electronic billing. The privacy and security rules of HIPAA work together. They require healthcare providers and associated entities to follow the procedures to ensure the confidentiality and security of PHI, whenever it is received or shared. The requirements of HIPAA apply to all forms of PHI, whether it is paper, oral, or electronic.

The History of HIPAA Compliance: A Nutshell View

It was in 1996 when Congress enacted the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, to recognize that technological advances might result in the erosion of health information privacy.

When the law was initially written it contained an administrative simplification rule that required HHS to adopt national standards for health care transactions and security. It also mandated federal privacy protections for health information and data of patients.

HIPAA has undergone various changes and evolved over the years and various amendments took place in the original act. The major changes are listed hereunder:

  • The HIPAA Privacy Rule, got published in December 2000 & was again modified in August 2002, with compliance required in 2003
  • The HIPAA Security Rule, with compliance required in 2005
  • The Enforcement Rule
  • The Omnibus Rule
  • The Breach Notification Rule

A proposed modification of the HIPAA privacy rule published by the Office of civil rights at the U.S. Department of Health and Human Services (HHS) facilitates the transition to value-based health care.

The fundamental changes in this modification are:

  • Changes to the requirements for the notices of privacy practices (NPP)
  • Disclosure of PHI to health-related coordination services
  • Broaden the guidelines for the disclosure of PHI
  • Strengthens rights for individuals to access their PHI
  • Added definitions

Understanding the Importance of HIPAA

HIPAA was designed to specifically address flaws in the US Health Insurance system. When it comes to protecting the data of patients, it looks after the portability of insurance coverage and the accountability of healthcare organizations.

Few Reasons why HIPAA is so important are:

Introduces higher level of standardization:

It was a time of transition between paper and electronic health records when HIPAA was introduced. It created a way for healthcare professionals by streamlining administrative tasks, improving efficiency, and ensuring PHI is stored securely. Since all the organizations under HIPAA must use the same set of codes and identifiers, these changes standardized processes. It became simpler and more secure to transfer information between healthcare providers, insurance companies, and other entities.

Established safeguards to protect healthcare information:

There are all kinds of personal information in PHI. It is not just the names and addresses. It includes credit card information and details of medical conditions and procedures. PHI has significant value because of its potential for identity theft.

If it wasn’t for HIPAA, there would be no legal requirement for healthcare organizations to protect private data as there would be no penalties if they didn’t protect it. It is because of HIPAA that to protect personal health information organizations are legally required to put a series of strict security controls in place. They must ensure to train their staff to protect patient data and also prove to an auditor that they are HIPAA compliant.

Greater control over patient information:

Before HIPAA rule was introduced, healthcare organizations were not bound to release copies of patient health information. Now, it is a rule that patient’s request to access their health records must be honored within 30 days. If in any case, a patient changes the healthcare provider, they can easily get complete records from their old healthcare providers. The new doctor can have access to the previous healthcare history which will enhance patient care.

It is also clearly stated the covered entities can’t use patient’s data for marketing or even for research purposes without written permission of the patients.

Anyone violating standards is held accountable.

If, in any case, covered entities fail to protect PHI, they are subject to strict fines & criminal penalties. There is a Department of Health and Human Services Office for Civil Rights that enforces HIPAA and investigates any HIPAA violations being reported. It also conducts periodic audits of covered entities and their business associates.

Who Must Comply with HIPAA?

HIPAA (Health Insurance Portability and Accountability Act of 1996) is a federal law that is established to maintain the security and privacy of protected health information by certain individuals and organizations.

Covered Entities include:

All individuals, businesses, or organizations that work directly with protected health information

Organizations and individuals who are defined as covered entities (CEs) fall into three main categories:
  • Healthcare providers
  • Healthcare plan provider
  • Healthcare clearinghouse
Business Associates:

Business Associates include any third party that provides services to a covered entity and has access to protected health information of patients.

Examples are billing services, transcription services, and data storage companies.

Overall, HIPAA compliance is of absolute importance for organizations that are responsible for handling protected health information. If organizations fail to comply with HIPAA regulations it can result in hefty fines and penalties.

Benefits of HIPAA Compliance

Increased patient’s well-being awareness

Being healthcare workers, you may prioritize patients’ well-being, but it is not possible to focus on sensitive data about their health in the same manner. While healthcare providers are deeply caring about their patients, they must also focus on the significance of protecting their PHI. HIPAA compliance offers an opportunity for staff members to receive proper training on handling patient information properly. This leads to a deeper understanding of every interaction's repercussion.

Protection against PHI loss

The most important benefit of HIPAA Compliance is that it serves as a protection against PHI loss, which is a serious offence.

When your organization experiences PHI loss, you put your patients' sensitive data at risk. Your organization regularly deals with personal, protected health information, and each interaction presents an opportunity to either expose or protect patients' data. HIPAA provides a clear methodology for ensuring that all members of your organization understand how to keep patients' PHI safe, secure, and private.

Enhanced Patient Satisfaction

The focus of every healthcare organization is to ensure patient care. However, it is equally important to ensure whether the patient is satisfied with the services provided or not. Unsatisfaction with patients can lead to loss of satisfaction for your healthcare organization in the long run.

When an organization comprehensively understands and is being trained in HIPAA compliance, the likelihood of investigations decreases in a significant manner. To protect both your company and your patients' PHI, it becomes crucial to implement a robust HIPAA compliance program and strictly adhere to it.

Seven Fundamental Elements of an Effective Compliance

  • Implementing written policies, procedures, & standards of a conduct
  • Properly Designating a compliance officer and compliance committee
  • Conducting effective training and education on a timely basis
  • Developing effective and clear lines of communication
  • Conducting detailed internal monitoring and auditing
  • Enforcing standards with well-publicized disciplinary guidelines
  • Responding quickly to detected offenses and undertake corrective actions accordingly

Common HIPAA Violations to Avoid

Snooping on Records in Healthcare

Snooping in healthcare records of family, friends, neighbors, co-workers, and celebrities is one of the most prominent HIPAA violations committed by employees. As soon as the violations are discovered, they not only lead to termination of employment but can also result in criminal charges for the employee concerned. Financial penalties for healthcare organizations that have failed to prevent snooping are relatively uncommon, but they are still possible – as the University of California Los Angeles Health System discovered.

Lack of Risk Management

It is essential to perform risk analysis, but it is still not a checkbox item for compliance. As soon as the risks are identified, they should at once be subjected to the risk management process and should be addressed in a reasonable time frame. Failing to address the risks in PHI is one of the most common HIPAA violations that is penalized by the office of civil rights.

Exceeding Timescale for Providing Access

As per the HIPAA privacy rules, patients have the right to access their medical records and obtain copies as per the request. This allows patients to check their records for errors and share them with other entities and individuals accordingly. Denying patients access to health records, overcharging for copies, or failing to provide records within 30 days is considered a violation of HIPAA.

HIPAA Compliance Checklist

An interactive checklist to help you judge your HIPAA compliance readiness:

Step 1: Appoint a HIPAA compliance officer

Step 2: Develop security management policies and standards

Step 3: Manage business associates with access to PHI

Step 4: Implement the necessary safeguards to comply with the Security Rule

Step 5: Perform HIPAA risk assessments

Step 6: Train employees on HIPAA procedures

Step 7: Investigate violations and learn from these instances

Step 8: Continually monitor and update compliance policies as your organization matures

How Cyber Cops Can Help with HIPAA Compliance

This detailed guide on HIPAA Compliance is enough for a deep understanding of the concept. Cyber Cops have already done all the hard work and are ready to ensure fast and easy HIPAA training and compliance for every healthcare provider, irrespective of the size of the organization. Now, all you need to do is get in touch with a cyber security expert like – Cyber Cops and get your organization enrolled for our exclusive weekly training & compliance programs. It will definitely help you operate your business faster and better.

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