Navigating HIPAA for covered entities

Written by Liyanda Tembani | August 07, 2024

Covered entities can become or remain HIPAA compliant by using robust privacy and security practices to protect patient information, including secure email and text messages, and ensuring businesses sign associate agreements (BAAs). Regular training and assessments can ensure covered entities appropriately navigate HIPAA.

What is a covered entity?

Under HIPAA, a covered entity is defined as any organization or individual that handles protected health information (PHI) in certain capacities. The term specifically refers to three categories:

Healthcare providers: Includes any medical or health service provider who transmits PHI electronically during transactions. Examples are doctors, hospitals, and clinics.
Health plans: Entities that provide or pay the cost of medical care, such as health insurance companies, HMOs, and government programs like Medicare and Medicaid.
Healthcare clearinghouses: Organizations that process or assist in processing health information from nonstandard formats to standard formats, or vice versa. They often act as intermediaries between providers and payers.

What covered entities need to know about the HIPAA Privacy Rule

According to the HHS, "A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual's protected health information may be used or disclosed by covered entities. A covered entity may not use or disclose protected health information, except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual's pe representative) authorizes in writing."

Permitted uses and disclosures: Covered entities can use or disclose PHI for treatment, payment, and healthcare operations without patient authorization. Other uses require explicit consent from the patient or specific legal exceptions.
Patient rights: Patients have the right to access their health information, request amendments, and receive a copy of their health records. Covered entities must have procedures to handle these requests and provide the necessary documentation.
Minimum necessary rule: When using or disclosing PHI, covered entities must try to limit the information to the minimum necessary to accomplish the intended purpose.

How the HIPAA Security Rule safeguards PHI

The HHS states that "The Security Rule requires covered entities to maintain reasonable and appropriate administrative, technical, and physical safeguards for protecting e-PHI.".

Administrative safeguards: These involve policies and procedures to manage the selection, development, and implementation of security measures, including conducting risk assessments and ensuring staff training.
Physical safeguards: Measures to protect physical access to electronic PHI, including facility security and equipment protection.
Technical safeguards: Technologies and systems used to protect electronic PHI, including encryption, secure login procedures, and audit controls.

Compliance measures for covered entities

Develop and implement policies: Create comprehensive policies and procedures to address HIPAA requirements. Regularly update as needed.
Staff training: Regularly train employees on HIPAA regulations, including how to handle PHI securely and recognize potential breaches.
Risk assessments: Conduct periodic inspections to identify vulnerabilities and implement corrective measures.
Business associate agreements (BAAs): Ensure that any third-party service providers who handle PHI on your behalf sign a BAA, which outlines each associate’s responsibilities to protect the information and comply with HIPAA.

Handling electronic transactions

Covered entities often engage in electronic transactions for claims, eligibility inquiries, and payment processes. HIPAA stipulates that:

Standard transactions: Electronic transactions must comply with HIPAA’s standardized formats to ensure consistency and protection of data.
Security measures: Secure systems must be in place to handle these transactions. That includes encryption, secure transmission protocols, and access controls to protect electronic PHI during transmission.

Challenges and considerations

Keeping up with changes: HIPAA regulations can evolve, and healthcare organizations must stay current with changes by regularly updating policies and educating staff.
Balancing compliance and efficiency: Implement comprehensive security measures balanced with operational efficiency to avoid disrupting healthcare delivery.
Managing breach risks: Even with stringent policies, breaches can occur. Have a response plan to manage and mitigate the impact of any violations, including notifying affected individuals and regulatory bodies.

Practical tips for compliance

Here are some practical tips for covered entities to ensure ongoing HIPAA compliance:

Regular audits: Conduct regular internal audits to ensure adherence to HIPAA policies and identify areas for improvement.
Engage experts: Consult with HIPAA compliance experts or legal advisors to ensure your practices are up-to-date and effective.
Patient communication: Maintain transparent communication with patients regarding their rights and how their PHI is protected.
Incident response plan: Develop and test an incident response plan to quickly address breaches or security issues.

Employee training programs

Effective employee training helps maintain HIPAA compliance and programs should include the following:

Key HIPAA concepts: Educate staff on the basics of HIPAA, including definitions of PHI, privacy rules, and security standards.
Role-specific training: Tailor training to different roles within the organization, such as administrative staff, clinical staff, and IT professionals. Ensure that each group understands their specific responsibilities related to HIPAA compliance.
Regular updates: Provide ongoing training and updates to address new regulations, emerging threats, and changes in organizational policies.
Testing and evaluation: Incorporate assessments and evaluations to measure understanding and effectiveness of the training. Use feedback to improve the training program.

Risk management and incident response

Establish a risk management plan: Develop a comprehensive plan to identify, assess, and manage risks related to PHI. That includes regular audits and updates to address new threats.
Implement an incident response plan: Create a response plan for handling security incidents and breaches. It should include steps for containment, investigation, notification, and remediation.
Maintain documentation: Keep detailed records of risk assessments, incidents, and corrective actions to demonstrate compliance and facilitate audits.

Patient rights and engagement

According to the HHS, "Providing individuals with easy access to their health information empowers them to be more in control of decisions regarding their health and well-being. For example, individuals with access to their health information are better able to monitor chronic conditions, adhere to treatment plans, find and fix errors in their health records, track progress in wellness or disease management programs, and directly contribute their information to research.".

Transparency: Inform patients about their rights under HIPAA, including their right to access, amend, and obtain copies of their PHI.
Engagement: Involve patients in their care by offering secure communication channels and respecting their preferences for how their information is shared and used.
Accessibility: Ensure patients can easily request and receive information about their health records, and provide mechanisms to report concerns or file complaints.

FAQs

What is the purpose of a BAA?

A BAA is a legal document that ensures third-party vendors handling PHI on behalf of a covered entity comply with HIPAA regulations, safeguarding patient information and defining each party’s responsibilities.

Can a covered entity share PHI with family members without patient consent?

Generally, PHI can be shared with family members if the patient provides consent or if it is necessary to prevent harm to the patient or others. However, the specific circumstances should be carefully evaluated according to HIPAA regulations.

How does HIPAA affect telemedicine practices?

HIPAA applies to telemedicine by requiring the use of secure platforms for transmitting electronic PHI, ensuring proper encryption, and following the same privacy and security rules as in-person interactions to protect patient information during virtual consultations.

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