12 Things Medical Students Should Know About HIPAA Compliance

12 Things Medical Students Should Know About HIPAA Compliance

The Health Insurance Portability and Accountability Act (HIPAA) is an acronym for Health Insurance Portability and Accountability Act. On August 21, 1996, it was signed into law. However, over the course of its 25-year existence, it has undergone multiple important revisions to the original guidelines. Overall, the fundamental goal is to safeguard sensitive patient information.

Things Medical Students Should Know About HIPAA Compliance

As a medical student, you should know everything about HIPAA compliance. Once you get to the field and start your practice as a medic, you’ll have to follow the prevailing law in the letter. Otherwise, you’ll be risking heavy penalties. Here are 11 things you should know about HIPAA compliance:

1. It’s Inescapable 

There’s no way around HIPAA compliance as long as you handle protected health information. In this sense, all medical students must undergo relevant training. Do note that it’s not just a one-off thing. The compliance guidelines evolve year after year.

So, you’ll still need to enrol in related courses even when you become a medical professional. It’s the only way you’ll be able to understand the latest requirements and subsequently implement the necessary protocols in handling patient data.

2. Protected Health Information (PHI)

It’s imperative to understand the kind of patient information that HIPAA terms as sensitive. Here are some of the main ones:

  • Physical and mental health conditions of patients, including the past ones and those predicted to occur in the future
  • Payments made by patients for healthcare services
  • Demographic data
  • Medical histories
  • Test results
  • Insurance information

Also included under PHI is all individually identifiable health information. In other words, any data that can be used to identify, contact, or locate a person. These include:

  • Full names
  • Geographical data like zip code
  • Bank account numbers
  • Phone numbers
  • License numbers
  • Fax numbers
  • Vehicle license plate numbers
  • Web (Uniform Resource Locators) URLs
  • Email addresses
  • Social security numbers
  • Internet Protocol (IP) addresses
  • Medical record numbers
  • Fingerprints
  • Voiceprints
  • Health insurance beneficiary numbers
  • Mug shots

None of these pieces of information should leak to unauthorized persons. If that happens, the individual or organization responsible will have violated the guidelines.

3. Covered Entities 

HIPAA defines covered entities as those individuals or institutions that directly handle PHI in making transactions. These include:

  • Doctors
  • Nurses
  • Pharmacists
  • Clinics
  • Nursing homes
  • Psychologists
  • Health insurance companies
  • Healthcare clearinghouses
  • Home health agencies
  • Government programs that pay for healthcare
  • Military health programs

The transactions in question include activities like coordination of benefits, eligibility checks for patients, payment of medical bills, checking healthcare status, and processing healthcare claims, among several others.

All of the above-mentioned covered entities are subject to HIPAA laws. If you work for one of these organizations, it is in your best advantage to follow the recommendations.

Furthermore, the requirements apply to the covered entities’ business relationships. A business associate is defined as any person or corporation that provides services to covered entities and requires access to PHI.

 

Cloud storage providers, credit card businesses, data storage corporations, consultants, attorneys, claims processors, accounting firms, collection agencies, and medical device makers are just a few of the important business connections.

They normally have to sign an agreement with the covered businesses before they may access PHI, vowing not to reveal sensitive patient data to any third parties.

 

4. The Privacy Rule 

All covered entities must have policies and processes in place to guarantee that all PHI is handled properly, according to the law. Surprisingly, HIPAA does not specify the particular processes for protecting sensitive data. It is the responsibility of the entity in question to develop its own policies in compliance with industry norms.

As a result, the company must ensure that each employee receives sufficient training on how to apply the company’s rules and procedures. It is required to keep track of these training sessions. Furthermore, employees must openly state that they have comprehended the material of the coaching sessions and are prepared to follow the guidelines as they work.

5. The Minimum Necessary Rule

HIPAA instructs covered entities to use caution in limiting the use of PHI to the bare minimum required to achieve any intended goal. For example, if a doctor transmits the entire copy of a patient’s medical record when only a portion of it is needed, he is breaking the minimum necessary requirement. Similarly, a doctor treating a patient needs their medical background but not their Social Security number.

However, the minimum necessary rule doesn’t apply in the following scenarios:

  • PHI disclosures mandated by law
  • Healthcare practitioners requesting PHI so that they treat a patient
  • PHI requests by the Department of Health and Human Services (HHS)
  • Patients requesting copies of their medical records
  • PHI requests backed by the patient’s authorization
Medical concept. Text MEDICAL RECORDS with pencil and stethoscope on wooden background.

6. Patient Rights 

Under the HIPAA guidelines, patients have several rights in connection with their PHI. These are as follows:

  • Patients can request access to their medical records by filling an authorization form.
  • They can request changes to their PHI if they suspect they’re erroneous in some aspects. In this case, the covered entity should confirm the validity of the claims and make the necessary arrangements.
  • They have the right to limit the disclosure of their sensitive data.

Upon admission to any healthcare institution, patients must be given the Notice of Privacy Practices, which details their rights regarding their PHI, and what the covered entities can do with the sensitive information.

7. The Security Rule 

This rule states that both covered entities and their business associates must have administrative, physical, and technical safeguards to protect PHI from unauthorized access. Here’s a breakdown of the three kinds of safeguards required:

Administrative:

Every institution that handles PHI must have a set of protocols that outline how sensitive patient data should be handled. Following that, the personnel of that particular organization must be taught the protocols.

Most significantly, the healthcare organization must do a risk analysis to determine all probable HIPAA violations. They can offer appropriate mitigating strategies based on the findings.

 

Physical:

To prevent illegal access to hardcopy patient medical records, secure locking measures must be installed. If at all possible, they should be equipped with alarms that sound anytime unauthorized access to data is attempted.

Even better, offices containing sensitive data-holding workstations must be off-limits to unauthorized visitors. Each employee must be aware of which workstations they are permitted to use and which they should avoid.

When it comes to disposing of gadgets, all sensitive information must be erased before they are discarded. You are aware that dumped devices may fall into the hands of astute individuals who will attempt to recover any data left on them, either purposefully or by accident.

 

Technical:

For online transmission of PHI, the devices and software in use must have data protection measures like firewalls, encryption, and strong passwords. Additionally, each employee with access to PHI must have a unique identifier for logging in to the various platforms.

This helps in keeping track of the persons handling PHI at any given moment. In case of a breach, it becomes easy to trace the events that led to it.

8. The Penalties 

HIPAA classifies violations into four distinct levels, each with its accompanying fine as follows:

Level 1:

Those violations couldn’t be avoided, given that the entity in question couldn’t know about the impending data breach in good time. The penalties for such violations range from a minimum of USD$100 to a maximum of USD$50,000, with an annual cap of USD$1,500,000.

Level 2:

Those unintentional violations for which the entity in question should have been realized before they occurred. These carry penalties between USD$1,000 and USD$50,000 per violation, with a yearly limit of USD$1,500,000.

Level 3:

Those violations arising out of willful negligence, but correction measures are taken within 30 or so days. These violations attract fines between USD$10,000 and 50,000 per violation, with a penalty cap of USD$1,500,000 during a single calendar year.

Level 4:

Finally, the most serious HIPAA violations are those caused by purposeful carelessness with no prompt endeavour to prevent PHI leaking. As a result, the sanctions for this type of offence begin at USD$50,000.

Given the foregoing, it should be evident that any infringement can financially ruin you in an instant. The punishments are excessive, especially if the entity in question is not financially well-established. As a result, it pays to be as compliant as possible.

 

For an employee who violates HIPAA regulations for individual gain or to cause malicious harm, the following jail terms are applicable:

  • Knowingly gaining access to PHI: A jail term not exceeding one year
  • Collecting PHI under false pretence: A jail term not exceeding five years
  • Knowingly breaching HIPAA to gain monetary benefits or cause harm to the patients: A jail term not exceeding ten years
  • Aggravated identity theft: Compulsory two-year jail term

The US Department of Justice investigates and prosecutes such criminal violations of HIPAA requirements. In addition to serving time in prison, the culpable employee faces professional boards disqualifying him or her from practising. That’s a major setback for your career. You’re essentially deprived of your chance to work as a medical practitioner after all those years of study and hard work.

9. The Breach Notification Rule 

You now know that any entity that tries to correct the situation before it becomes unreasonably out of hand faces a softer penalty. You must notify the affected persons as well as the Department of Health and Human Services as soon as you discover a breach of PHI. The following are the categories for PHI breaches based on the number of people affected:

  • Minor Breach: Affects less than 500 patients. This must be reported by the end of the year in which the breach occurred.
  • Meaningful Breach: Affects more than 500 patients. It must be reported within two months from the time of detection. On top of notifying the affected persons and HHS, the mainstream media must also be notified.

In reporting a breach, you must include the following information in the report:

  • Whether you’re a covered entity or business associate
  • Name of the covered entity or business associate
  • Type of covered entity—an either health plan, healthcare provider, or healthcare clearinghouse
  • Street Address
  • Contact information
  • Number of persons affected by the breach
  • Type of the breach, such as hacking, improper disposal, or theft
  • Location of the breach, for instance, desktop PC, laptop, email, electronic medical record, network server, etc.
  • Type of PHI involved in the breach
  • Brief description of the breach
  • The safeguards in place before the breach took place
  • Actions are taken in response to the breach

With such detailed information, the Office for Civil Rights is in a good position to investigate the circumstances surrounding the breach. As a covered entity, here are some of the actions you can take the moment you detect a breach:

  • Adopt new encryption technologies
  • Change passwords to stronger that are difficult to crack
  • Improve the physical security of storage areas
  • Sanction the persons involved. If possible, terminate their contracts.
  • Set new risk management rules and retrain employees on the same

When you prove to the authorities that you tried your best to rectify the situation, the fines may be a bit more manageable.

10. How OCR Enforces HIPAA 

The HHS Office for Civil Rights is responsible for enforcing the HIPAA rules. First and foremost, they investigate any complaints they receive from affected persons. The intrusion of privacy must have taken place after the laws were signed into place. For instance, the Privacy Rule took effect on April 14, 2003, while the Security Rule started operating on April 20, 2005. The OCR doesn’t look into any breach of PHI before these dates.

In addition, the complaint must be filed against one of the mentioned covered entities. The OCR will not pursue a complaint against institutions such as life insurance, employers, schools, state agencies, or municipal offices. Additionally, the complaint must be filed within 180 days of the date of discovery. If a complaint is filed after the specified time period, the complainant must establish good cause for the delay.

Aside from complaints, OCR may undertake compliance reviews to determine whether or not a company is HIPAA compliant. Because compliance audits happen at any time, it’s best to be prepared at all times.

 

11. Designated HIPAA Security Official

Because of the importance of HIPAA compliance, all healthcare businesses must have a full-time professional responsible for formulating and implementing HIPAA rules and procedures.

That isn’t to argue that one person must be in charge of all HIPAA-related tasks. Several more people with particular roles may work under the designated security official with general responsibilities, depending on the size of the business. The designated security official’s typical tasks are as follows:

 

  • Formulating policies and procedures to detect and prevent PHI breaches.
  • Correcting PHI breaches in case they occur.
  • Staff training on organizational security awareness.
  • Investigating unfortunate data breaches so as to come up with measures to avoid a repeat of the same mistake in the future.
  • Conducting a risk assessment of the organization’s PHI in regards to third parties like Business Associates.
  • Looking into disaster recovery and business continuity after catastrophic breaches.

If you’re interested, you can apply for a position like this. The ideal applicant for the job should be well-versed in HIPAA and have excellent organizational abilities. They must also be skilled in IT and have a thorough understanding of the organization’s computer systems. They will be able to adequately prevent data breaches in this manner.

12. Security Breaches Keep Increasing 

The healthcare business, like many others, is having difficulty transitioning to a paperless environment. Patient medical records can be uploaded to cloud storage platforms instead of being kept as printed versions. This approach is extremely useful for anyone who needs patient information.

However, enhanced convenience comes with an increased risk of hacking. According to studies, the majority of breaches are caused by hacking. There are those out there who have made it their mission to disturb the calm of hardworking people and organizations. Once hackers gain access to PHI, they can block the rightful owners of the information from utilizing it unless they pay a fee.

Others do it to defame organizations with which they have a quarrel. When the public learns that a hospital isn’t being careful enough with sensitive patient data, they will simply avoid doing business with it. As a result, patient volume is minimal, resulting in small revenues.

As a result, it’s vital to remain vigilant when using the internet. To be safe, use a HIPAA IT solution that encrypts all messages and files before transmitting them to the intended recipient.

The message’s contents must then be decrypted by the recipient. It’s also critical to avoid messaging services like email that have very lax security features. And on top of that, ensure that every platform with PHI is password-controlled.

Bottom Line 

Being HIPAA compliant is not prohibitively expensive. However, the infractions may cause you to become bankrupt. As a result, make it a point to follow the established rules. And it all begins with education. Get the right training from the word of mouth and keep your abilities up to date when the compliance rules change. You’ll always be on the right side of the law this way.

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