What is HIPAA?

The Health Insurance Portability and Accountability Act (HIPAA)

What is HIPAA?

Anyone working in the medical field is familiar with “HIPAA”—but what does it mean for the average patient? As it turns out, HIPAA is relevant both for medical professionals and for individual patients.


Not only does this set of rules and regulations lay out the structure through which medical providers must work, but it offers specific guarantees to individuals who want to access their own health information.


Here is everything you need to know about HIPAA and what it means:

Defining HIPAA

HIPAA is short for the Health Insurance Portability and Accountability Act.

Signed into law in 1996 and updated over the years, the legislation is comprised of five individual titles, each with different goals around the use and portability of an individual’s healthcare plan. 

HIPAA also plays a major role in the regulation and availability of private medical information.


HIPAA as originally passed contained five distinct titles:


         Title I: Primarily concerned with healthcare access and the “portability” of healthcare plans in situations such as a job loss. Title I also put into place governing regulations concerning group health plans.


         Title II: Fraud, Information, Privacy, and Medical Liability Reform. Perhaps the best-known set of rules to come out of Title II pertain to privacy.


The HIPAA Privacy Rule, as it’s known, created a set of regulations designed to monitor and secure an individual’s right to privacy in medical information.


The Security Rule is also contained in Title II. For the relevance of most individuals, Title II and these two rules are where the most important aspects of HIPAA can be found.


        Title III: Tax-related health provisions pertaining to medical savings accounts.


        Title IV: The application and enforcement of requirements for group health insurance.


        Title V: Tax deduction issues for employers.


While all of these Titles have plenty of relevance for anyone in the medical field, it’s important to understand where much of the regulations have their most direct impact on the day-to-day workings of healthcare providers.


Specifically, the HIPAA Privacy and Security Rules are important for both providers and patients to understand fully.

The Privacy Rule: What HIPAA is All About

HIPAA is perhaps most famous for its “privacy rule,” also known as the “Standards for Privacy of Individually Identifiable Health Information.”


According to the Department of Health & Human Services, this rule established “a set of national standards for the protection of certain health information.” When many people refer to HIPAA rules, they’re often referring to this privacy rule specifically.

But what is that rule specifically?


The privacy rule regulates the disclosure (or non-disclosure, as the case may be) of private health information.


Because health information must often be transmitted—often electronically—between medical professionals, HIPAA regulates the way in which private medical information could be shared. HIPAA helps protect the privacy of an individual by forbidding doctors and medical professionals for sharing private medical information outside of these regulations.


Because of this important rule, a “HIPAA violation” often refers specifically to privacy violations.


Although there are many different aspects of HIPAA—including both patient-side and provider-side concerns—the word “HIPAA” is often thrown around in specific reference to this privacy rule.


HIPAA then puts certain safeguards into place to ensure that this rule is honored.

This includes regulations and protocols that medical providers will then have to observe as they provide their medical services. That means that HIPPA’s Privacy Rule is just as important for medical professionals to understand as it is for patients.


For more information on the HIPAA Privacy Rule, visit the website of the Department of Health & Human Services.



An Individual's Rights Under the HIPAA Privacy Rule

HIPAA regulations make it possible for the individual to achieve a lot when it comes to their own personal health information and health information management.

These individual rights under HIPAA include:


  •          Health information access. Under HIPAA, an individual has certain rights when it comes to accessing their own private medical and health information.


 This includes the ability of an individual to both review and receive copies of their individual health information. This access can be important for individuals to not only change medical providers in a timely manner, but for use in other applications with third parties.


  •           Health information sharing. An individual has the right to share medical and health information with anyone of his or her choosing.


That includes family members, friends, and even third-party applications for better regulating one’s own health. This responsibility is not without risks, but HIPAA puts the power of sharing medical information in the individual’s hands. Current regulations prohibit doctors and medical providers from requiring a separate trip for an individual who wants to gain access to this information.


  •            Risk. With the freedom of healthcare information access comes the requirement of responsibility on the part of the individual.


Because an individual is free to grant access to private medical information to third parties—such as mobile applications—it’s important for every patient to be discerning about this access and to work exclusively with third parties who are qualified to give proper medical advice. Because a doctor or medical provider cannot prevent someone from using their own medical information in a potentially risky way, there is some risk carried by each individual who has full knowledge of their medical records and history.


For more information about individual rights under HIPAA, visit this PDF from the Department of Health & Human Services.


This PDF helps explain these individual rights and why patients might want to use them as they figure out the best way to seek treatment in the future.

The HIPAA Security Rule

Although HIPAA and the HIPAA Privacy Rule often go hand-in-hand in the vernacular, there’s another rule that’s vital for medical providers to pay attention to: the Security Rule.


According to the original legislation, HIPAA required the Department of Health & Human Services to create regulations and systems in place for the protection of private medical information.


Security and privacy often go hand-in-hand; although the Privacy Rule contains a multitude of regulations for the protection of privacy, the second issue of security confronts the issue of electronic medical databases and who is allowed to access private health information.

According to HHS, “Prior to HIPAA, no generally accepted set of security standards or general requirements for protecting health information existed in the healthcare industry.”

HIPAA was partially created to address the rise of new computerized medical information and create a standardized methodology in place to deal with the potential privacy and security violations that electronic medical records might encounter.

HIPAA’s Security Rule creates protections for individually-identifiable information made accessible through medical records.


This pertains to “electronic protected health information,” or e-PHI. However, as HHS notes, the Security Rule does not apply to PHI, or protected health information made available through written or vocalized information.


That means that many of the regulations posed to e-PHI do not get in the way of the more “old-fashioned” ways an individual might be able to discuss or retrieve their information from a medical provider.

Other Individual Rights Under HIPAA

HIPAA is highly comprehensive legislation that inserts a wide variety of regulations into the medical system. For that reason, the complicated nature of this legislation can sometimes mean that both patients and providers don’t fully understand the individual rights made available through it.


Here are a few of the points that consumers and providers will want to keep in mind:


      –   A patient has the right to ask to be contacted at different places for their convenience—for example, asking to be called at the office rather than at home.


      –   Disagreements are also covered under HIPAA. One example is when someone views their medical information and finds out that there may be incorrect or misleading information on it that would influence their future medical care. An individual can requested that this be changed—at the very least, a hospital will be required to note the disagreement in the file for future reference.


      –   Timeliness.For the most part, your medical files should be made available to you within 30 days. This is something that medical providers will also want to pay attention to, as failing to deliver this information in a timely manner can be perceived as not living up to the obligation in full.

But not all of HIPAA is patient-centered; there are also a wide degree of regulations in place for medical providers who have to ensure that their daily activities fall within the confines of HIPAA. This has created an industry and service known as HIPAA Compliance.

How Does HIPAA Affect Medical Practices

HIPAA primarily affects medical practices through its regulatory burden—every medical practice needs to maintain the standards of HIPAA at all times. Because HIPAA penalties can incur serious costs to any medical business, these procedures need to be in place as a matter of principle.


Medical practices should always look for HIPAA-compliant partners and systems whenever possible. Not only do medical practices need to be careful especially as it relates to the transmission and protection of information, but they need to first be aware of all the areas in which HIPAA regulations pertain.


There are a few keys and principles most medical practices can stick to:


      –   Commitment to privacy. Maintaining a strict policy of privacy as it relates to medical information is a must. Understanding the proper disclosures—such as disclosure of medical information for the purposes of identifying a deceased person—might apply.


      –   Understanding that electronic information is just as ironclad as paper information. Treat both with equal care.


      –   Maintaining a high level of security and avoiding hacking/phishing attempts, particularly with work-based emails.


What is HIPAA Compliance?

HIPAA compliance refers to the strategies and systems put in place to ensure that the regulations of HIPPA are met daily.


Because HIPAA violations can be very serious, it’s important that medical providers make HIPAA compliance not only a priority, but that HIPAA compliance then becomes automatic through the structures put in place.


HHS made a page titled HIPAA for Professionals available to help elucidate exactly what the professional role in HIPAA compliance is. This refers more than just the structure regulating electronic medical records—it also pertains to the habits and priorities professionals must have in place in order to keep their services compliant with HIPAA regulations.


Because HIPAA is a large and complicated set of regulations, it can be difficult to understand at first. But HIPAA compliance is possible—and it can be done simply—by seeking out the right services and putting the right structure in place.


For medical providers, it’s of the utmost importance to stay current and within the law as it relates to HIPAA. HIPAA violations can be very serious. As a matter of principle, all medical and health providers should make HIPAA compliance a priority for their services.

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