Rethinking the Role of Compliance


Through a series of interlocking regulatory rules, HIPAA compliance is a living culture that health care organizations must implement into their business in order to protect the privacy, security, and integrity of protected health information.

What is HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) went into effect as part of the Social Security Act of 1996 in order to protect health care coverage for individuals who have lost or changed their jobs, and to ensure security of electronic transfers of electronic protected health information (ePHI).

Hospitals, private  practices, dental offices, clinics, pharmacies, health plans, healthcare clearinghouses, and any other covered entity or person handling ePHI have all had to work earnestly to achieve and maintain compliance with the extensive set of strict requirements associated with HIPAA. In a time of increasingly costly and frequent data breaches, it is more important than ever to provide assurances when it comes to protecting vendor data and patient ePHI.

HIPAA compliance is often implemented 1 of 3 ways:

Self-attestation requires copious amounts of supporting documentation, policies and procedures, and full-time resources dedicated to monitoring and reporting. We often see organizations jury-rig a system of datasheets and reports together to make compliance a checkbox exercise. This approach provides little if any long-term operational security value and proves grossly expensive Thus, other options must be exercised.
If the first option sounds like an overhaul or inefficient use of internal resources, hiring a third party to manage your compliance posture may prove useful. While this may provide a robust approach to managing HIPAA compliance, it must be an ongoing contract to truly provide operational security benefits. And as one can imagine, the cost of having a third party on retainer can add up very quickly.
If self-assessments are too risky or time consuming, and outsourcing is too expensive, buying software to store the appropriate data may be a great option. However, GRC tools do not report and monitor in realtime and therefore do not offer improved operational security. These products are also expensive, and often require maintenance or add-ons to improve the products

The 5 Main HIPAA Rules to Understand

1. Privacy Rule

The privacy rule protects the ePHI and medical records of individuals by setting limits and conditions on the various uses and disclosures that can and cannot be made without patient authorization.

2. Security Rule

The security rule defines and regulates the standards, methods, and procedures related to the protection of ePHI with regard to storage, accessibility, and transmission. The 3 safeguard levels of security are broken into administrative, technical, and physical.

3. Transaction Rule

HIPAA does not require physicians to conduct transactions electronically, but if a physician practice does conduct any the transactions named under HIPAA, the organization must submit the transactions according to the HIPAA standards. The transaction codes ensure safety, accuracy, and security of medical records or ePHI.

4. Identifiers Rule

HIPAA uses three unique identifiers for covered entities conducting HIPAA-regulated administrative and financial transactions. These identifiers are the National Provider Identifier (NPI), National Health Plan Identifier (NHI), and the Standard Unique Employer Identifier Number (EIN).

5. Enforcement Rule

The Enforcement Rule expands the rules and establishes criminal and civil penalties for any violations of privacy and security required by HIPAA. Covered entities and their business associates must enforce rules for the application of security and privacy requirements, accounting disclosure requirements, sales and marketing restrictions, accounting disclosure requirements, and the enforcement of all security requirements across business associates’ contracts as well

In conclusion

These rules are a lot to digest. HIPAA compliance is important and required for any
covered organization, but with all the hustle and bustle of a modern health care
organization, meeting these requirements frequently becomes a check-box exercise, leaving your organization and patient data vulnerable to breaches.

Not only will this result in fines and legal consequences, but also lasting reputational damage if and when a vulnerability is exposed. The bottom line: making HIPAA compliance a priority is essential.

The twist: HIPAA compliance does not have to cost you an arm and a leg.

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