How to check your hipaa compliance
June 07, 2022
Last updated on June 07, 2022
6 min read
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With developments in technology, an increasing number of healthcare providers are adopting electronic medical records into their operations. This streamlines the flow of record-keeping and maximizes efficiency in their enterprises, but it comes with downsides, primarily related to data privacy and security.

When recording medical data and transmitting it from one location to another, protecting patient information must be the first priority. This is where HIPAA compliance comes in.

What is HIPAA?

The US Department of Health and Human Services implemented the Health Insurance Portability and Accountability Act (HIPAA) to protect and secure Protected Health Information (PHI). 

Key HIPAA terms you should know

To better understand HIPAA compliance and what it covers, you must know a few important terms:

Covered entities

These are healthcare providers and organizations that interact with, manage, or create patient information. Examples include hospitals, clinics, pharmacies, health care providers, and health insurance companies.

Business associates

These are vendors that provide covered entities with specialized services, such as professionals in law, finance, or IT. They may come into contact with patient records but don’t directly serve patients. 

Personal Health Information (PHI)

This is the official designation for patient records. All HIPAA rules about privacy, security, and reporting protect and manage PHI.

Business entities and associates with access to PHI must implement physical, network, and process security measures that meet HIPAA standards. HIPAA regulations outline standards for critical aspects of healthcare data management, including:

  • A patient's right to privacy

  • The need for adequate protection measures to safeguard private data, and

  • The conditions healthcare institutions must meet if such data is breached

All covered entities (including all that serve, finance, bill, or run a healthcare institution) and their business partners must be HIPAA-compliant.

With such strict regulations in place, noncompliance incurs proportional penalties, including fines and a loss of federal funding for covered entities.

Sanctions and fees for HIPAA violations

Civil penalties start at $100 and can reach $25,000 per HIPAA violation. Criminal punishments are harsher, and willful HIPAA breaches are fined $50,000. 

The maximum criminal punishment for a HIPAA breach by an individual is $250,000, with the potential for prison time. Additionally, victims of these violations may seek restitution. 

There are different penalties for HIPAA violations for covered entities and business associates. Criminal offenses due to negligence can mean a 1-year jail term, while falsely obtaining protected health information is a 5-year felony.

How to check if you are HIPAA compliant

HIPAA compliance is required for all healthcare providers, not just to avoid fines but to safeguard critical patient data. 

This brief HIPAA compliance guide will help you evaluate your organization's compliance. You must focus on three crucial factors:

1. Confirm that your organization falls under HIPAA

The Privacy Rule is the foundation for HIPAA's regulations and establishes the parameters within which authorized workers can access Protected Health Information. It is designed to safeguard the privacy of patient data throughout their healthcare journey. It restricts data access and usage while allowing the flow of information to facilitate high-quality health care. 

If you are a medical provider or provide services to a medical institution, HIPAA applies to your operations, and you must comply with all regulations.

2. Acknowledge what data is covered under HIPAA

HIPAA mandates these details as "individually identifiable health information," and they all fall under PHI:

  • Name

  • Date of birth

  • Date of death

  • Contact information

  • Social Security number

  • Medical records

  • Photographs

  • Biometric data

HIPAA’s Security Rule has established national standards to protect electronic PHI from covered entities. Under this rule, you will find specific IT security protocols, procedures, and safeguards that you must have in place for storing and transferring PHI. 

3. Partner with HIPAA-compliant service providers

Even if your vendor claims to be HIPAA compliant, you must still do your due diligence and ensure their policies align with regulations. Ask for documentation to confirm compliance and avoid any issues that might impede your partnership in the future.

All business associates partnered with covered entities fall under HIPAA regulations, even those not strictly in the medical industry. For example, your choice of a billing system provider must be designed with HIPAA standards in mind. The provider is expected to have protocols to protect the limited patient data they can access.

Before finalizing a partnership with a new vendor, ask about and look for security features that will not compromise PHI. 

Avoiding HIPAA violations

Many people assume that hackers or similar malicious third parties are to blame for security breaches in the healthcare industry. Unfortunately, most violations arise from simple negligence and lack of compliance. 

Seemingly minor missteps like discussing patient information in public or accidentally sending the wrong patient data are major violations that can lead to heavy sanctions.

To avoid violations, every element of your business operations must have systems in place to maintain compliance at all times. 

Here is a short checklist to start with:

  • Employ strict data access and governance policy to maintain that all of your administrative and organizational actions adhere to HIPAA guidelines

  • Restrict data access and employ high-end technology for security, such as data encryption

  • Track and secure all mobile devices that have access to patient data

  • Conduct routine compliance audits on your business associates, contractors, and your own company

  • Work only with security companies with procedures in place for HIPAA compliance

  • Designate a HIPAA Compliance Officer to manage your enterprise’s compliance efforts

Stay HIPAA compliant with NY BillPro’s Medicaid billing software

The medical industry is always moving forward, so why should your billing system be any different? NY BillPro is a HIPAA-compliant software system that allows you to move faster and smarter with your billing process.

About 3.6 million Americans miss or postpone medical care due to transportation difficulties. Medicaid covers non-emergency medical transportation (NEMT) for medical appointments, but rising gas prices make it more challenging for patients to access it and for organizations to bill clients.

BillPro provides a unique, proven solution with software that manages each step of the complex billing process. You can forget about manually managing multiple bills, denials, and appeals. NY BillPro's secure cloud storage, encryption, two-factor authentication, and password security ensure that the flow of data remains safe, secure, and HIPAA compliant.


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