Nowadays, technology has become a part of the entire economy and everyone’s lives. As a result, industries across varying sectors began implementing methods to promote efficiency and productivity within the workplace. And one of the industries that have experienced significant growth in the healthcare sector, thanks to modern advances in technology.

By going paperless, most hospital employees such as doctors, nurses, pharmacists, and more have been able to speed up their workflow. They rely on accessible records in the form of questionnaires and payment systems to push forward with their jobs. This information is then stored on electronic devices for easy access.

And because of this, the Health Insurance Portability and Accountability Act (HIPAA) was curated. It was developed by the Department of Health and Human Services (HSS) together with the Office of Civil Rights (OCR) to have universally accepted rules and cybersecurity standards for protecting patient data.

So, what is HIPAA, and how do you stay compliant?

Explaining HIPAA Compliance

In a nutshell, HIPAA is a security initiative that provides a standardized protocol for governing, handling, and storing sensitive patient data. As such, organizations that deal with Protected Health Information (PHI) must follow the stringent set of rules and regulations stated by the HIPAA to avoid penalties. HIPAA compliance is the act of abiding by the standard rules.

The amendment states that PHI refers to any data maintained by an organization such as a healthcare center that can be used to identify a patient. It also covers their specific health status, billing history, and healthcare provisions. The following demographics are under PHI:

  • Names
  • Phone numbers
  • Social security numbers
  • Addresses
  • Medical records
  • Full facial photos
  • Financial records

This definition was made to provide autonomy over private information related to the linked individual. In this context, healthcare providers and associated companies with access to PHI records need to ask permission from the patient before utilizing the data for research, fundraising, or marketing. And thanks to this extra layer of protection, patients could easily withhold their personal information from health insurance providers, primarily if they used private funding for their treatment.

With this in mind, it’s essential to know and understand who has to follow HIPAA rules and the consequences they must face upon violating it.

Covered Entities

Covered entities are:

Healthcare Providers

Some of the most common examples are clinics, hospitals, doctors, psychologists, dentists, nurses, pharmacists, etc.

Healthcare Clearinghouses

These are groups that process health-focused information into standard formats. They act as the middleman between healthcare providers and various insurance companies.

Health Plans

These include health insurance organizations, company health plans, Medicare, Medicaid, and HMOs.

Business Associates

Business associates are organizations with firsthand access to PHI. Some examples are:

  • Lawyers
  • Accountants
  • IT staff
  • Third-party administrators

They typically offer support in delivering payment, treatment, or operations. So if a private company, public institution, or subcontractor directly manages PHI, they must meet HIPAA compliance requirements. Failure to comply also results in violation fees.

How To Stay HIPAA Compliant

For your reference, here are specific examples of how you can stay compliant with the HIPAA privacy standards:

  • Track all available PHI disclosures to ensure that they don’t fall into the wrong hands;
  • As much as possible, you should document all privacy procedures and policies;
  • Inform patients regarding how your organization will utilize their PHI
  • Obtain written consent from the individual/patient prior to sharing or using their sensitive data
  • Provide the patient’s PHI within 30 days while presenting a written request
  • Identify the proper instances where you may or may not disclose PHI without the patient’s consent. For example, you may do so if it’s regarding patient treatment, payment collection, or to assist law enforcement.
  • If you ever find yourself in a situation where you must disclose a patient’s PHI, only provide the necessary information.

What Happens If You Violate HIPAA?

HIPAA violations are ranked in four different categories. If you find yourself in a pickle, you’ll face financial penalties governed by the HHS and OCR.

Tier 1

The violator is unaware of the HIPAA rules; the fine ranges from $100 to $50,000 per individual violation. However, it may increase up to $25,000 per year.

Tier 2

There’s a reasonable cause for authorities to believe that the covered entity has prior knowledge of HIPAA compliance. The penalty is $1,000 to $50,000 per violation and a maximum of $100,000 each year.

Tier 3

For this level, the covered entity willfully neglected HIPAA rules. However, the violation was fixed within 30 days. The penalty is $10,000 to $50,000 for each violation, while a yearly fine of $250,000 is also plausible.

Tier 4

The individual willfully neglected HIPAA rules without fixing the problem within the allotted time (30 days). The fine is $50,000 per violation and up to $1.5 million per year.

The Takeaway

As you can tell, HIPAA rules can be extensive and complicated. And it’s not exactly easy to identify which context HIPAA applies to or how to implement all existing regulations into practice, especially with dozens or hundreds of employees. However, the specific fines for not knowing and following all the provided rules can be costly.

So, in this case, it’s always better to abide by the rules and regulations provided by HIPAA. And by following this guide to the heart, you’ll be lightyears closer to being HIPAA compliant.

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