What is HIPAA Compliance?
One of the most commonly asked questions we discover is “What is HIPAA compliance?” so it’s important to explain compliance.
“HIPAA” stands for the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, defines the security and privacy regulations required to protect sensitive patient health information. It is a series of regulatory standards that outline the lawful use and disclosure of protected health information (PHI).?
HIPAA compliance is regulated by the Department of Health and Human Services (HHS) and enforced by the Office for Civil Rights (OCR).
What is Protected Health Information?
Protected health information (PHI) is any numerical information that can be used to identify a patient or client of a HIPAA-compliance system.?
Basically, any data in your medical records that could be used to identify you is considered PHI. This applies to information held by doctors, hospitals, insurers, and any other organization involved in your healthcare.?
Systems that process PHI should establish physical networks and process security measures ensuring HIPAA and protecting patient data privacy. Covered entities, business associates and individuals with access to PHI are also bound to follow these requirements to pertain to the HIPAA compliance regulations.
The Data Protected Under HIPAA
HIPAA is designed to protect PHI provided by patients to covered entities and their business associates. HHS defines eighteen types of PHI identifiers, including:
Why is HIPAA Compliance Important?
The aim of HIPAA compliance is to ensure the confidentiality of private patient information in all its forms (paper, oral, and electronic), complying with HIPAA protects organizations from costly security breaches, lawsuits, and penalties for violations. This is especially required as cybersecurity threats continue to rise in an increasingly digital-first world where electronic record keeping, digital data transfer, and cloud services are the primary mode of communication and data storage.
Ultimately, HIPAA compliance protects your privacy and secures your valuable health information.
HIPAA Compliance Requirements
HIPAA compliance has become more important than ever because healthcare providers and associated entities are moving to electronic data collection, processing, and storage, increasing the risk of data breaches.
Bodies that are required to be HIPAA compliant include:
Covered Entities
Any company that provides treatment, operations, and payment in healthcare and consequently creates, collects, or transmits PHI electronically is called a covered entity. Examples are hospitals, nursing homes, health IT consulting firms, medical care entities, health insurance providers, and health care clearinghouses.
Business Associates
Business partners (referred to as Business Associates in HIPAA) are generally subject to some – but not all – of the Administrative Simplification provisions depending on the type of service they perform for, or on behalf of, a Covered Entity.?
Not every business partner is a Business Associate. A business partner is only a Business Associate if it creates, receives, maintains, or transmits Protected Health Information (PHI) for a function or activity regulated by HIPAA.?
Examples include cloud storage providers, third-party service providers, billing firms, IT providers, practice management companies, email hosting services, managed service providers, and EHR/EMR platforms.
HIPAA rules you need to follow
HIPAA rules are a set of guidelines and regulations established to protect the confidentiality, integrity, and availability of electronically protected health information (ePHI). Moreover, HIPAA rules give patients certain rights regarding their healthcare information.?
HIPAA is broken up into two major rules: the Privacy Rule and the Security Rule.
Privacy Rule
The Standards for Privacy of Individually Identifiable Health Information (Privacy Rule) mandates how healthcare organizations should protect certain types of health information entrusted to them. The Privacy Rule defines cases in which PHI can be accessed and disclosed. It also defines safeguards that covered entities should have in place to protect PHI and gives patients certain rights regarding their PHI.
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Security Rule
The Security Standards for the Protection of Electronic Protected Health Information (Security Rule) describes the IT security controls that companies should have in place for protected health information (PHI) that is stored or transferred electronically. It provides concrete IT security controls, processes, and procedures that organizations must have in place to fulfill the data protection requirements outlined within the Privacy Rule.
HIPAA Compliance Checklist
Achieving HIPAA compliance is a multi-step process. Here are some of the key steps -
Determine your compliance obligations: As mentioned earlier, HIPAA applies to covered entities and – through them – their business associates. Under HIPAA, covered entities are defined as healthcare providers, health plans, and healthcare clearinghouses. Their business associates are any organization with whom they share PHI.?
Know the HIPAA Rules: The HIPAA Privacy and Security Rules define a covered entity or business associate’s responsibilities under HIPAA. It's important to know the necessary controls, policies, and procedures to stay compliant.??
Identify Scope of Compliance: HHS defines eighteen types of data that qualify as PHI and must be protected under HIPAA. Identifying where this data is stored, processed, and transmitted within an organization's IT setup is crucial for identifying which systems and staff fall under HIPAA regulations.
Fulfill a Gap Assessment: An organization might have some HIPAA controls set up, but others may be missing. Conducting a gap assessment against HIPAA standards is essential to identify areas where the company lacks compliance.
Deploy Missing Controls: A gap assessment may identify places where the organization is currently non-compliant. After identifying these gaps, it's essential to develop and execute a strategy to address and rectify these deficiencies.
Create needful documentation: HIPAA requires that covered entities have specific documented policies and processes. If any processes are missing or are undocumented, generate the required documents.?
Prepare for Compliance Audits: Passing a compliance audit requires the ability to demonstrate to an auditor that an organization’s security controls, processes, and procedures meet the regulation’s requirements. Develop an audit plan and collect necessary data and reports before the audit.
Conclusion
HIPAA was developed to ensure the privacy of patient PHI, and its safeguards are planned to help healthcare organizations take necessary measures to secure patient data.?
HIPAA Compliant Software Development may seem like a challenging task, but adopting a step-by-step approach with a compliance checklist will help you achieve it quickly.?
You can become HIPAA-compliant quickly and effortlessly with Ailoitte’s assistance in crafting HIPAA policies, establishing controls, and collecting evidence.?
FAQs
Question - Who controls and regulates HIPAA guidelines??
Answer - In 1996, the Health Insurance Portability and Accountability Act (HIPAA) mandated the U.S. Department of Health and Human Services (HHS) Secretary to create rules safeguarding the privacy and security of specific health information.?
Question - What is not covered under HIPAA?
Answer - Though HIPAA requires covered entities to increase the effectiveness of healthcare delivery procedures through standards for electronic transactions and security precautions, it makes no particular mention of requirements for quality of care in its regulations.
Question - Is it mandatory to follow all HIPAA rules?
Answer - HIPAA is a regulatory requirement. This makes it mandatory for all healthcare organizations and entities to follow HIPAA rules without exception. Violation of any rule can lead to severe fines and penalties.
Question - Why do healthcare organizations need HIPAA compliance??
Answer - HIPAA compliance is necessary to protect patients’ private health information and maintain trust. Following the HIPAA rules helps you avoid legal penalties for mishandling sensitive data.?
Question - What are the most common HIPAA violations?
Answer - The following are some of the most common HIPAA violations