Understanding What Hipaa Requires Me to Comply with in Healthcare

Understanding what HIPAA requires you to comply with in healthcare can be a daunting task, but it's essential to protect patient data. HIPAA (Health Insurance Portability and Accountability Act) is a federal law that sets standards for safeguarding sensitive health information.

To start, HIPAA requires you to ensure that all electronic protected health information (ePHI) is encrypted. This means that any digital data, including emails, text messages, and medical records, must be encrypted to prevent unauthorized access.

Compliance with HIPAA also involves implementing administrative safeguards, such as conducting regular risk analyses and implementing policies and procedures for handling protected health information.

A fresh viewpoint: Hipaa Data Storage Requirements

HIPAA compliance is a must for any organization that handles protected health information (PHI). You must designate a privacy official who is responsible for developing and implementing HIPAA policies and procedures.

As a covered entity, you must also designate a contact person to receive complaints and provide further information about your privacy practices. For solo practitioners, that person is themselves.

Expand your knowledge: Which of the following Are Considered Hipaa Privacy Administrative Requirements

To ensure compliance, you must permit access by HHS during regular business hours to facilities, books, records, accounts, and other sources of information, as well as PHI. If HHS determines that you're hiding or destroying information, they can access your records at any time without notice.

You must also be prepared to cooperate with investigations and reviews of your policies and procedures. Failure to comply can result in fines up to $250,000 and/or five years in jail for willfully and maliciously violating HIPAA regulations.

Here are some specific types of medical records that must be shredded:

You must also shred any records relating to an individual's past, present, or future health or condition, including the provision of healthcare to the individual, past, present, or future payment for healthcare, and information that can be used to identify the individual.

Protected Health Information (PHI) is defined as health information that can be used to individually identify a patient, whether provided in oral or written format. This includes names, phone numbers, email addresses, physical addresses, medical record numbers, social security numbers, dates of birth, and descriptions of the individual.

To work with or share PHI, providers, healthcare payers, and industry vendors must only use HIPAA-compliant software. Covered entities under HIPAA law must also train staff for HIPAA compliance and ensure that all third-party work is completed HIPAA-compliant.

Here are the 18 identifiers for PHI, as defined by HIPAA:

Protected Health Information (PHI) is a critical concept in healthcare, and understanding its identifiers is essential for compliance with HIPAA regulations. HIPAA defines PHI as health information that can be used to individually identify a patient.

Names, dates of birth, and social security numbers are all examples of PHI identifiers. These pieces of information can be used to uniquely identify an individual, making them protected under HIPAA.

Phone numbers, email addresses, and physical addresses are also considered PHI identifiers. These contact details can be used to reach out to an individual, making them identifiable.

Medical record numbers, account numbers, and health plan beneficiary numbers are all PHI identifiers. These numbers are used to track an individual's medical history and insurance information.

For another approach, see: Under Hipaa Law What Is the Best Description of Phi

Some PHI identifiers may seem less obvious, but they are still protected under HIPAA. Examples include fax numbers, vehicle identifiers, and device identifiers.

Here is a list of the 18 PHI identifiers, as defined by HIPAA:

HIPAA standards require that an authorization only be signed for the disclosure of psychotherapy notes.

A covered entity under HIPAA must allow clients to request that it restrict the use and disclosure of PHI.

Under HIPAA, clients cannot restrict disclosure for treatment, payment and health care operations (TPO).

Disclosures are permitted for involvement in the individual's care and notification purposes.

Generally, it is best to only release information without a written authorization if the client represents a danger to him/herself or others.

Suggestion: Under Hipaa a Disclosure Accounting Is Required

Psychotherapy notes are protected in the HIPAA rule and belong to the clinician. This means that a clinician may not use or disclose them for most purposes, including treatment, payment, and healthcare operations, unless the client's authorization is obtained.

There are some exceptions where an authorization isn't required, such as when the clinician uses the notes for supervision and training purposes, or for defense in a legal action. The clinician is not required to show the patient their psychotherapy notes, but they can do so if they choose to.

To qualify for protection, psychotherapy notes must be kept physically separate from the rest of the client's record. However, the HIPAA rules don't define what "physically separate" means, so it's best to keep the information in a separate file folder.

Consider reading: Which of the following Is Required by Hipaa Standards

As a covered entity, you may be surprised at how far-reaching HIPAA compliance is. Any organization that comes into contact with patient data must comply with HIPAA.

Covered entities include health plans, health care clearinghouses, and health care providers, which can be quite broad. Health plans are organizations that provide medical care or pay the cost of providing medical care, such as HMOs, PPOs, and company health plans.

Suggestion: Hipaa Requires That All Covered Entities Designate

Health care clearinghouses are organizations that receive data from one healthcare entity, convert it to another format, and provide it to another entity. Examples include billing services and community health information systems.

Even outside of a provider's office, HIPAA comes into play. Anyone working for a covered entity must comply with HIPAA, including software vendors, medical device companies, and even cleaning services that contract with medical providers.

Covered entities are organizations that come into contact with patient data, including software vendors, medical device companies, social work firms, insurance payers, and even cleaning services that contract with medical providers.

Any organization that provides medical care or pays the cost of providing medical care is considered a health plan, which includes Health Maintenance Organizations (HMOs) and Medicare.

Health care clearinghouses convert data from one format to another and provide it to another entity, including billing services and community health information systems.

Health care providers, such as doctors and hospitals, are also covered entities.

These organizations must comply with the HIPAA Privacy Rule and ensure that anyone working for them complies with HIPAA as well.

As a healthcare provider, if you submit bills electronically to insurers, you are considered a covered entity. This is because electronic billing is a covered transaction.

A covered transaction is any computer-to-computer transmission of healthcare claims, payment and remittance, benefit information, or health plan eligibility information. This can include submitting bills electronically to insurers, or checking eligibility information online.

There are eight electronic transactions that can initiate covered entity status, but most of them are not common to individual practitioners. These transactions include submitting claims, payment and remittance, and checking eligibility information online.

If you electronically submit bills or check eligibility information online, you must comply with HIPAA regulations. This means you must protect patient data and ensure it is not disclosed without authorization.

Related reading: Hipaa Edi Transactions Must Comply with

As a health services professional, understanding HIPAA is essential for success in the field. HIPAA is critical for anyone entering the health and human services field.

No job exists within or parallel to the healthcare industry that doesn't require some knowledge of HIPAA. This includes managing a healthcare office, working in healthcare human resources, or dealing with patients in any capacity.

Having more than a basic understanding of the law is necessary for success in these roles. This is because HIPAA is a crucial aspect of the healthcare industry.