The constantly changing ICD codes, enrollment period ambiguity, increase in premiums etc. have sent tremors down the healthcare practices.
On top of that, with the ever-evolving technology, it has become tedious and almost frustrating for practitioners to protect patient data. However, clinicians that go through these worries, swear by HIPAA compliance!
HIPAA was established in 1996, with the main aim to curb fraud in the healthcare industry and protect a patient’s health information to avoid its misuse.
It is important that anyone related to the health industry understands what the basics of HIPAA compliance are. HIPAA Compliance is a living entity that health care organizations must implement into their own businesses in order to protect their Protected Health Information (PHI).
Some acronyms to note are as follows:
PHI : Protected Health Information
HHS: Department of Health and Human Services
OCR: Office for Civil Rights
HIPAA was established to determine the legal use and disclosure of Protected Health Information (PHI). The Department of Health and Human Services (HHS) regulates compliance. The Office for Civil Rights (OCR) enforces compliance and investigates HIPAA violations.
Protected Health Information (PHI) comprises of Personally Identifiable Information (PII) that is one’s identifying information. It includes the patient’s name and address. The PHI also includes the Health information. The health-related data includes medical records and insurance information.
EPHI (Electronic Protected Health Information) is when PHI is transmitted, stored or accessed electronically. EPHI falls under the HIPAA security rule.
As mentioned earlier, the Health Insurance Portability and Accountability Act (HIPAA) is a set of rules that protects patient information. Anyone who is dealing with patient information has to comply with HIPAA. That would include covered entities and business associates. Covered entities include anyone providing treatment, payment and operations. Business associates includes anyone who has access to patient information and provides support in the treatment, payment or operations.
As healthcare becomes more computerized HIPAA compliance is more important than ever. Electronic methods also increase the security risks facing patient data. HIPAA says companies in America have to follow a guideline on how to secure patient information. This includes the HIPAA privacy rule and the HIPAA security rule. The privacy rule sets the standard for the protection of health information. The security rule establishes a set of security standards for protecting health information in electronic form. It allows covered entities to adopt new technology and enhance the quality of patient care. It is also flexible enough to allow it to implement strategies and technologies suitable to that entity.
HIPAA uses certain physical factors and technological factors to secure Electronic Patient Health Information (EPHI). The physical factors include:
• Restricted facility access and control
• Guidelines about use and access to electronic media
• Limits to be observed for transferring EPHI
The technical factors require access control. Access control includes:
• Using unique user IDs, encryption and decryption
• Audit reports or tracking logs that record activity on hardware and software
• IT disaster recovery and offsite backup ensure that electronic errors are fixed quickly
• PHI is recovered accurately and intact
• Network or transmission security protects against unauthorized access to EPHI.
The importance of HIPAA is great. It ensures privacy and confidentiality. It allows patients access to their health care data. It also reduces fraud and improves data systems.
The advantage of complying with HIPAA is that providers can save millions of dollars annually by managing security risks. HIPAA is the bare minimum standard which must be adhered to in the USA.
A HIPAA violation occurs when there is a breach in the firm’s compliance program in which ePHI is compromised. All data breaches are not HIPAA violations. A data breach is a HIPAA violation only when it is caused by a breakdown in the HIPAA compliance program. For example, a data breach would occur when a doctor’s laptop is stolen and it contains unencrypted access to medical records. This breach would be a HIPAA violation as well if the organization did not have a rule stating that the laptops cannot be taken off campus in the first place.
A data breach is when PHI is handed over to a third party without the patient’s consent for reasons other than treatment, payment and healthcare. Staff should be trained and tested and systems should be established. It is also critical to note that when your information has been breached, to report it timely. Failure to do so, can result in huge fines.
HIPAA violations include:
• Stolen smart phones, laptops, USBs
• Cyber hacks
• Business associate breach
• Electronic health record breach
• Office break in
• PHI being sent to the wrong patient
• Discussing PHI outside the office
• Social media posts
HIPAA compliance requirements include:
• Self audits
• Remediation plans
• Policies, procedures, employee training
• Business associate management
• Incident management
With healthcare going almost completely digital these days, the concerns regarding their data safety have flexed amongst patients. Abiding by the HIPAA standards enables the patient to have more confidence in his healthcare provider.
Therefore, complying with HIPAA regulations may seem monotonous, but failure to do so expose a great deal of risks to not only the practices but the patients too. The continuous review and improvement of systems, procedures, training and implementation is necessary for improved data security. As healthcare becomes more computerized, HIPPA compliance is more important than ever.