INSIGHT
Every day, medical facilities handle thousands of sensitive patient records while trying to deliver quality care. HIPAA compliance is at the center of these efforts, providing the framework that safeguards protected health information (PHI).
This article explores what HIPAA compliance means for your organization, its key components and how proper implementation protects both patients and providers.
Defining HIPAA compliance
HIPAA compliance refers to adhering to the requirements outlined in the Health Insurance Portability and Accountability Act of 1996. This federal law establishes national standards for protecting patient health information, ensuring that PHI is kept private and secure while still enabling efficient healthcare administration.
The Department of Health and Human Services (HHS) regulates HIPAA compliance, with enforcement handled by the Office for Civil Rights (OCR). Through routine guidance and investigations of violations, these agencies maintain the integrity of healthcare data protection nationwide.
HIPAA compliance isn’t just a one-time achievement but an ongoing culture that organizations must integrate into their operations.
Who must maintain HIPAA compliance?
HIPAA regulations identify two primary categories of organizations required to maintain compliance:
- Covered Entities: These include healthcare providers, health insurance companies and healthcare clearinghouses that collect, create or transmit PHI electronically.
- Business Associates: Any organization that encounters PHI while performing contracted services for a covered entity falls into this category. Examples include billing companies, practice management firms, IT providers, cloud storage services and many others.
The three core rules of HIPAA compliance
HIPAA compliance centers around three fundamental rules that organizations must follow:
- The HIPAA Privacy Rule: Sets national standards for patients’ rights regarding their PHI. This rule primarily applies to covered entities and addresses patients’ rights to access their information, providers’ rights to deny access in certain circumstances and requirements for disclosure forms and privacy notices.
- The HIPAA Security Rule: Establishes standards for the secure maintenance, transmission and handling of electronic PHI (ePHI). Unlike the Privacy Rule, this applies to both covered entities and business associates. It outlines necessary physical, administrative and technical safeguards for protecting ePHI.
- The Breach Notification Rule: Requires covered entities and business associates to follow specific protocols when reporting data breaches involving PHI. The reporting requirements vary based on the scope and size of the breach.
Essential HIPAA compliance requirements
Achieving and maintaining HIPAA compliance requires organizations to implement several key measures:
- Self-audits: Conduct annual audits to assess administrative, technical and physical gaps in your HIPAA compliance. A Security Risk Assessment alone is insufficient—it’s just one component of the required auditing process.
- Remediation plans: Develop and document plans to address compliance gaps identified during self-audits. Include specific timelines for resolving each issue.
- Policies and procedures: Create comprehensive documentation that aligns with HIPAA standards and reflects your organization’s operations. Update these regularly and conduct annual training for all staff.
- Documentation: Maintain thorough records of all compliance efforts, which become crucial during OCR investigations or audits.
- Business associate management: Document all vendors with whom you share PHI and execute Business Associate Agreements before any data sharing occurs.
- Incident management: Establish clear processes for documenting breaches and notifying affected patients as required by the Breach Notification Rule.
” Self assessments are tricky. They should be documented by an individual with subject matter expertise. You want to know your gaps before further audits reveal such.” – Sarah A. Lynn – BPM Advisory Partner, IT Security & Compliance Subject Matter Expert
Understanding HIPAA violations and consequences
A HIPAA violation occurs when there’s a breach in an organization’s compliance program that compromises PHI or ePHI. Violations differ from data breaches—not all breaches constitute violations, but breaches resulting from incomplete or outdated compliance programs do. Many individuals are not clear on what constitutes PHI and ePHI. This is key to the underlying foundation of HIPAA.
Penalties for non-compliance fall into two categories: civil and criminal. Civil fines can reach up to $1,919,173 per violation, while criminal penalties can include fines up to $250,000 and/or imprisonment for up to ten years. These penalties compound, meaning organizations can face multiple fines for different violations.
Working with BPM for your HIPAA compliance needs
Navigating the complex landscape of HIPAA compliance requires specialized knowledge and dedicated resources that many organizations struggle to maintain internally. BPM provides comprehensive HIPAA compliance services tailored to your organization’s specific needs, helping you develop robust policies, implement effective safeguards and maintain ongoing compliance through regular assessments and training.
Our team will work with you to identify potential vulnerabilities in your current program and develop pragmatic solutions that protect both your patients’ information and your organization’s reputation.
“Our team has assisted many companies in their HIPAA and Privacy related assessments, to further protect the customer or employee data.” – Sarah A. Lynn
To schedule a confidential HIPAA compliance evaluation, contact us.
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