What is HIPAA Compliance and Why You Must Not Ignore It?

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, is a set of rules that specify how protected health information (PHI) may be used and disclosed legally.

Healthcare businesses must instill a HIPAA-compliant culture throughout their operations in order to safeguard the confidentiality, integrity, and availability of protected health information.

To achieve HIPAA Compliance, organizations that deal with protected health information (PHI) must put in place and adhere to physical, network, and process security measures.

HIPAA compliance is required of all covered entities (those who provide healthcare treatment, payment, and operations) and business associates (those who have access to patient information and assist with those activities).

To make sure your company complies with HIPAA rules for the privacy and security of protected health information, it is advised that you examine our HIPAA compliance checklist 2022 if it is subject to the Healthcare Insurance Portability and Accountability Act (HIPAA).

Even if there is no PHI breach, failure to comply with HIPAA standards can result in significant fines, while breaches can lead to criminal charges and civil litigation.

There are processes to follow for reporting violations of the HIPAA Privacy and Security Rules and notifying affected individuals of breaches.

The Office for Civil Rights (OCR) of the Department of Health and Human Services does not regard ignorance of the HIPAA compliance standards to be a valid defense against penalty for HIPAA violations.

Whether infractions are due to careless negligence or deliberate error, the OCR will impose fines for non-compliance with HIPAA laws.

Why Do You Need to be HIPAA Compliant?

HHS notes that HIPAA compliance is more crucial than ever as healthcare providers and other organizations that deal with PHI transition to computerized operations, including computerized physician order entry (CPOE) systems, electronic health records (EHR), and radiology, pharmacy, and laboratory systems.

In a similar vein, health insurance offers access to applications for care management and self-service. All of these technological techniques boost productivity and mobility, but they also significantly raise security threats for healthcare data.

The Security Rule enables covered entities to embrace innovative technology to enhance the effectiveness and quality of patient care while still safeguarding the privacy of individuals’ health information.

By design, the Security Rule is adaptable enough to let a covered business use policies, practices, and technology that are appropriate for its size, organizational structure, and e-PHI security threats.

Who Needs to be HIPAA-Compliant?

There are two categories of enterprises that must adhere to HIPAA regulations.

1 – Covered Entities

According to HIPAA regulations, a covered entity is any business that acquires, produces, or transmits PHI electronically. Healthcare providers, clearinghouses, and insurance companies are examples of healthcare organizations that fall under the definition of covered entities.

Healthcare Providers: Any healthcare professional who electronically communicates patient information in conjunction with specific transactions, regardless of the size of their business. These transactions include those for which HHS has established standards under the HIPAA Transactions Rule, such as claims, benefit eligibility questions, referral authorization requests, and others.
Health Plans: Health maintenance organizations (HMOs), Medicare, Medicaid, Medicare+Choice, Medicare supplement insurers, long-term care insurers (with the exception of nursing home fixed-indemnity policies), employer-sponsored group health plans, government- and church-sponsored health plans, and multi-employer health plans are all examples of health plans.
Healthcare Clearinghouses: Organizations that convert nonstandard data or format received from another organization into a standard format, or vice versa. Healthcare clearinghouses will often only get individually identifiable health information when they’re acting as a business associate for a health plan or healthcare provider and offering these processing services.

2 – Business Associates

According to HIPAA regulations, a business associate is any organization that comes into contact with PHI while working for a covered entity under a contract. Because there are so many different service providers that can handle, transmit, or process PHI, there are a ton of examples of business associates.

HIPAA Compliance in the Post-COVID World

To say that the pandemic has changed the world is an understatement. The greatest significant change over the next few years will almost certainly be in healthcare. Additionally, maintaining privacy compliance is more challenging. Private health information is in danger because of the following factors:

Telehealth Visits: The number of online visits to medical professionals has grown. Unless an in-person visit is absolutely necessary, patients who generally make brief journeys to the clinic or office choose to stay at home and see their doctor electronically. If necessary safeguards are disregarded, protecting data over the Internet can be challenging.
Increased Patient Count (Post-Lockdown): There have been a ton of appointments since most treatments and visits are now permitted in several states. When schedules are fully booked, offices frequently run low on workers due to physical separation rules. This circumstance gives room for HIPAA compliance errors.
Multiple Healthcare Providers: Patients frequently visit several doctors. However, the situation is murky due to more testing and inconsistent outcome timeframes. Data is flowing in and out more quickly because primary care physicians are receiving updates from numerous testing labs, patients, or hospitals (if dealing with potential virus cases).

HIPAA Rules You Must be Aware of

Several HIPAA rules make up the larger HIPAA Rule. These rules have been passed over more than 20 years that have elapsed since HIPAA was initially implemented in 1996.

These are some of the HIPAA Rules that you should be aware of:

HIPAA Privacy Rule: The HIPAA Privacy Rule establishes federal guidelines for patients’ PHI rights. Business associates have not covered entities and are not subject to the HIPAA Privacy Rule.
The HIPAA Privacy Rule includes a number of requirements, such as those relating to patients’ access rights to PHI, health care providers’ access rights to PHI, and the information that Use and Disclosure HIPAA release forms and Notices of Privacy Practices must contain, among others.
HIPAA Security Rule: The HIPAA Security Rule establishes federal requirements for the safe storage, processing, and transmission of ePHI. Due to the potential sharing of ePHI, both covered entities and business partners are subject to the HIPAA Security Rule.
HIPAA Omnibus Rule: The HIPAA Omnibus Rule was created as an extension to the HIPAA regulation in order to extend its coverage to business associates as well as covered companies. The HIPAA Omnibus Rule specifies the requirements for Business Associate Agreements (BAAs) and mandates that Business Associates comply with HIPAA.
HIPAA Breach Notification Rule: In the case of a data breach involving PHI or ePHI, covered entities and business partners are required to comply with a set of rules known as the HIPAA Breach Notification Rule. Depending on the scale and severity of the breach, the Rule specifies various breach reporting obligations.

What is Required for HIPAA Compliance?

All covered companies and business associates are required to adhere to a set of federal requirements outlined in the HIPAA regulation.

Plans for correcting compliance violations must be put in place once covered businesses and business partners have discovered their compliance gaps through these self-audits.

Self-Audits: In order to determine if their organization complies with HIPAA Privacy and Security standards on an administrative, technical, and physical level, covered entities and business partners must undertake annual audits of their business.
Policies, Procedures, and Employee Training: Employee training and policies must be developed in accordance with HIPAA regulatory standards as defined in the HIPAA Rules by covered businesses and business associates. To take into account changes to the company, these policies and procedures must be revised on a regular basis.
Incident Management: If a covered company or business associate has a data breach, they must have a procedure in place to record the incident and notify patients in line with the HIPAA Breach Notification Rule that their personal information has been compromised.
Documentation: HIPAA-responsible enterprises are required to keep track of EVERY step they take to comply with the law. To pass stringent HIPAA audits, this documentation is essential during a HIPAA investigation with HHS OCR.
Business Associate Management: To ensure PHI is handled securely and to reduce liability, covered organizations and business associates alike must document all vendors with whom they exchange PHI in any capacity and sign business associate agreements.

How to Become HIPAA compliant

It takes a combination of internal procedures, the appropriate technology, and deliberate external collaborations to meet all HIPAA regulations. Here are some strategic steps you may take to become HIPAA compliant before delving into the specifics of the legislation.