HIPAA Series #1: Compliance for Healthcare Providers – What You Need to Know

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a public law enacted to improve the efficiency and effectiveness of the U.S. healthcare system. In particular, it focuses on protecting patients’ privacy by limiting how entities can use their healthcare and personal information. This patient’s healthcare record, called Protected Health Information (PHI), includes 18 identifiers that can identify a specific individual.

To achieve this objective of protecting the PHI, HIPAA established the Security, Privacy, and Breach Notification rules that must be followed by all the covered entities and their business associates.

All of these can seem overwhelming for healthcare providers, and this is why in this article, we simplify your roles, responsibilities, and rights under HIPAA.

Read the Full HIPAA Series

Our HIPAA Series covers 10 important topics related to HIPAA rules, regulations, and compliance. If you missed one of the posts in the series, navigate to them here:

1. HIPAA Series #1: Compliance for Healthcare Providers – What You Need to Know
2. HIPAA Series #2: What is Protected Health Information (PHI) Under HIPAA?
3. HIPAA Series #3: An Overview of HIPAA’s Privacy and Security Rules
4. HIPAA Series #4: Ensuring Privacy and Security in Virtual Care
5. HIPAA Series #5: Steps for Reporting and Mitigating Breaches Under HIPAA
6. HIPAA Series #6: Building a Culture of Compliance
7. HIPAA Series #7: The Role of Business Associates Under HIPAA
8. HIPAA Series #8: The Importance of HIPAA Audits
9. HIPAA Series #9: HIPAA and Cybersecurity
10. HIPAA Series #10: HIPAA and Data Sharing

Roles and Responsibilities of Healthcare Providers

HIPAA states that healthcare providers, health plans, and healthcare clearinghouses are “covered entities,” and hence all HIPAA provisions apply to them. For this purpose, healthcare providers include doctors, nurses, dentists, chiropractors, clinics, nursing homes, psychologists, and pharmacies.

Under HIPAA, they play the following roles.

Custodians of Patient Information

Healthcare providers are the primary custodians of patient information, and they are responsible for handling PHI throughout its entire lifecycle, from creation to disposal. Also, they must take appropriate steps to protect PHI in paper and electronic formats from unauthorized access and use.

In this role, healthcare providers also have to ensure that their support staff and business associates have the required training and knowledge to handle PHI.

Communicators

Healthcare providers closely interact with PHI to diagnose and treat health conditions for their patients. They may even have to coordinate care with other providers, health insurance companies, caregivers, and family members, and through all these interactions, they must keep the PHI secure and private.

When needed, they are also responsible for getting explicit consent and authorization from patients before using or sharing their PHI with third parties.

Lastly, it’s also a healthcare provider’s responsibility to educate patients on their rights under HIPAA, including how their PHI will be used.

Responsibilities

Based on the above roles, we can break down the healthcare providers’ responsibilities as:

1. Create and implement policies for using, disclosing, storing, handling, and sharing PHI.
2. Get consent and authorization from patients before using their data.
3. Ensure your subordinates have the required knowledge to protect PHI.
4. Work with professionals on implementing physical and technical safeguards for protecting PHI.
5. In case of a breach, inform the concerned patients and authorities within 60 days of knowing about the breach.
6. Organize and initiate regular audit checks to identify and fix compliance gaps.
7. Enter into agreements with business associates and ensure they adhere to the terms and conditions.
8. Monitor business associates’ compliance with HIPAA.
9. Maintain documents and records to demonstrate compliance.
10. Create the processes for handling patient requests for access and change. Take corrective action when needed.

So far, we have seen the rights and responsibilities of healthcare providers under HIPAA. At the other end, they also have certain rights under this legislation.

Rights of Healthcare Providers

Healthcare providers have the following rights under HIPAA.

Using PHI

Rule 45 CFR § 164.506 provides the right to use and disclose PHI without patient authorization for purposes related to treatment, payment, and healthcare operations. Under this rule, healthcare providers can coordinate and consult with other healthcare providers for the efficient treatment of a patient. Similarly, PHI can be used for billing, claims processing, and collecting payments for services provided to patients. Lastly, providers can use PHI for activities such as quality assessment, training, and business planning. That said, providers must limit their use of PHI where possible.

Business Associate Agreements

Under Rule 45 CFR § 164.502(e), healthcare providers can enter into business agreements with other entities called business associates. These agreements lay down how and where PHI is used and the responsibilities of each party for protecting PHI and maintaining compliance with HIPAA.

Defense Against Complaints and Lawsuits

A healthcare provider has the right to defend against any complaint or lawsuit. They can even provide evidence of compliance with HIPAA regulations and demonstrate adherence to the standard of care. Moreover, providers must document their efforts to comply with HIPAA regulations, which can be used as evidence in their defense.

Thus, these are the rights of providers under HIPAA.

Final Words

If you are a healthcare provider, you are a covered entity under HIPAA and must preserve the security and privacy of your patient’s PHI. Besides being a healthcare provider, you are also a custodian of PHI and responsible for communicating to your patients how their PHI will be used. When required, you may also have to get their explicit consent. These roles lead to certain responsibilities necessary for meeting HIPAA’s objectives. At the same time, HIPAA also grants the right to use PHI, enter into agreements, and defend against lawsuits with evidence. We hope this information provides a better idea of your dos and don’ts under HIPAA.