HIPAA Compliance Terms and Requirements, and Elements of Compliance

The Health Insurance Portability and Accountability Act of 1996 is a set of rules that govern the fair use and sharing of protected health information (PHI). The Department of Health and Human Services (HHS) and the Office of Civil Rights (OCR) regulate and enforce HIPAA compliance. It updated the flow of health information, outlined how personal information held by healthcare and healthcare insurance businesses should be protected from fraud and theft, and addressed some restrictions on health insurance coverage. HIPAA compliance rules apply to anyone in the healthcare industry who provides treatment, payment or operation. Anyone with access to patient information who assists with treatment, payment or operation must also comply with HIPAA. Other entities, such as subcontractors and other business connections, are also covered by HIPAA.

Those who are subject to HIPAA compliance regulations are often referred to as Covered Entities or Business Associates. Entities that offer treatment, receive payment, or conduct clinical operations within the healthcare industry are covered entities. Business Associates are organizations that have access to PHI and provide assistance with treatment, payment or operation. HIPAA rules state that a private company, its subcontractors, or a public entity that manages PHI must comply with those rules.

HIPAA Compliance Rules

HIPAA regulation is comprised of different types of HIPAA regulations. Since its enactment in 1996, HIPAA has been in effect for more than two decades, during which HIPAA rules have been passed. The Health Insurance Portability and Accountability Act (HIPAA) establishes four rules to protect patient health information.

privacy rules

The HIPAA Privacy Rule establishes national guidelines for patients’ rights to their PHI. The HIPAA Privacy Rule specifically applies to covered entities and not business associates. The HIPAA Privacy Rule outlines a number of requirements, such as patients’ rights to access PHI, health care providers’ rights to deny access to PHI, the content and disclosure of use of the HIPAA Release Form and Notice of Privacy Practices, and more. . Regulatory standards should be established in the organization’s HIPAA policies and procedures.

The Patient Privacy Rule governs the extent to which medical records can be disseminated without the patient’s explicit consent. Under the HIPAA Privacy Rule, patients and their relatives (representatives) can access their medical records. Covered entities must respond to access and disclosure requests within 30 days of being sent.

According to the amendment, PHI is defined as any information stored by a firm or health facility that can be used to identify an individual and provide information about their current health status, payment history or health services. could. PHI includes demographic data such as:

  • Name
  • addresses
  • telephone number
  • Social Security Number
  • medical record
  • financial information
  • full face pictures

The term was established in an effort to provide connected individuals with control over their personal information. In this regard, health care professionals and organizations are obliged to obtain patient permission before using the information for marketing, fundraising or research to have protected health information.

safety rules

The HIPAA Safety Rule establishes national requirements for the safe maintenance, transport, and operation of electronically protected health information (ePHI). Because ePHI can be shared, the HIPAA security rule applies to both covered entities and business associates. The Safety Rule specifies criteria for the integrity and security of electronically protected health information (ePHI), including the physical, administrative and technical precautions that each health care organization must implement. In an organization’s HIPAA policies and procedures, the specifics of the rule must be documented.

As mentioned, there are three categories in the security rule.

Administrative: This includes policies and procedures affecting maintenance associated with EPHI and technologies, system architecture, risk management and all other security measures. Human resources and employee training are also included. Physical: Physical security measures prevent unauthorized people from accessing devices such as computers, routers, switches, and places to store data. Covered entities must maintain secure facilities where only authorized personnel can access the data. Technical: Cyber ​​security includes anything related to computer systems, mobile devices, encryption, network security, device security, and ePHI storage and transmission technologies.

The covered entity must comply with confidentiality, integrity, and availability regulations in the health care industry.

Violation Notification Rules

In the event of a data breach involving PHI or ePHI, covered entities and business associates must comply with the HIPAA breach notification rule. The rule specifies different reporting obligations for violations based on their extent and size. Organizations are obliged to report all violations, regardless of magnitude, to HHS OCR; However, reporting methods vary depending on the type of violation. No matter how the breach occurred, it must be done within 60 days of detection. A strong risk management plan can help with this.

The breach notification rule explains what should be done in the event of a security breach. It is nearly impossible to protect data with 100 percent efficacy, and organizations must have protocols in place so that the public and victims of HIPAA violations can be informed about what has happened and what they should do next. Covered entities must provide victims with formal, written notice of the data breach by mail or email. In the event of a breach affecting more than 500 patients in a particular jurisdiction, the media must also be notified.

rules for all

The new omnibus rule applies the requirements to more than just covered entities.

In essence, the Omnibus Rule stipulates that business associates and contractors are subject to compliance duties. As a result, this means that covered entities are liable for any potential breaches committed by business associates and contractors and should adjust their gap analysis, risk assessment and compliance processes accordingly. The HIPAA omnibus rule requires business associates to be HIPAA-compliant and sets the rules for business associate agreements (BAA). Business associate agreements are contracts that must be executed between a covered entity and a business associate, or between two business associates, prior to the transfer or sharing of any PHI or ePHI.

HIPAA Compliance Requirement

HIPAA regulations establish a standard procedure that all covered entities and business associates must follow.

Factors to be considered for HIPAA compliance include the following:


HIPAA mandates that covered entities and business partners conduct annual audits to identify administrative, technical and physical compliance gaps with HIPAA privacy and security standards.

treatment plan

After identifying their compliance gaps through self-audits, covered entities and business associates are required to establish remedial plans to correct compliance violations. These remedial plans should be clearly documented and there should be a time frame for closing the gap.

policies and procedures

Covered entities and HIPAA-regulated Business Associates are required to develop policies and procedures in accordance with HIPAA regulatory standards. This is one of the most common requirements throughout HIPAA regulations.

These rules and procedures must be constantly updated to reflect newly established technologies and organizational changes. New employees and those who have been with the company for several years should both receive annual training on company policies and procedures. Employee training should be documented and accepted as proof that the employee understands the subject.


To maintain HIPAA compliance, covered entities and business associates must document all compliance-related actions. This documentation is required during HIPAA inquiries with HHS OCR in order to pass the rigorous HIPAA audit.

business associate management

Both covered entities and business associates must document all vendors with whom they exchange PHI and complete business associate agreements to handle PHI safely and minimize liability. Changes in the nature of organizational interactions with vendors require an annual review of the BAA. BAA must be done before any PHI can be shared.

incident Management

In compliance with the HIPAA breach notification rule, if any covered entities or business associates have a data breach, they must establish a mechanism to document the breach and notify patients that their data has been exposed.

Elements of HIPAA Compliance

  • Enforcing written policies, procedures and standards of conduct
  • Establishment of a Compliance Officer and Compliance Committee
  • To demonstrate effective training and education.
  • Developing effective lines of communication.
  • Conducting internal monitoring and audit.
  • Policy enforcement through well publicized disciplinary guidelines.
  • To act promptly on the offenses found and to take remedial action.

Appsvolt can assist your company and internal IT department with remaining HIPAA compliance. In addition to our years of expertise in HIPAA compliance, we can help your business better serve patients and their data. We have developed a range of custom healthcare software solutions for our clients, including cloud-based dental EHR, practice management solutions, health and fitness mobile applications.

Kamal Shahi

With over a decade of experience; Expertise in managing, defining, controlling and troubleshooting software needs for clients across various technology and industry domains

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