Explore the Difference Between HIPAA Covered Entity & Business Associate

As a medical practitioner do you want to save your healthcare business from cyberattacks? Then you must pay special attention to HIPAA compliance. Implementing the privacy and security rules set by the Health Insurance Portability and Accountability Act is the only way to secure your confidential healthcare information from hacking or unauthorized access.

What is HIPAA compliance? It is the most frequently asked question. The answer is obvious. HIPAA is a federal law that is designed to protect highly sensitive patient health information from being disclosed without the patient’s consent.

It is a series of regulatory standards that directs the HIPAA covered entities for lawful use and disclosure of protected health information (PHI). It’s pertinent to mention here that HHS’ Office for Civil Rights is responsible for enforcing its Privacy and Security Rules.

Failure to comply with the guidelines and standards of HIPAA can land medical practitioners and business associates into legal troubles. For example, they might have to face cancellation of licence, multiple million-dollar fines, etc.

Before further discussions, let’s shed light on some facts about the healthcare data breach. It has been estimated that approximately 44 healthcare hacking incidents were reported in April 2021. Which affected almost 2,260,008 patients. One of the major reasons behind such theft was the failure to prevent unauthorized access or disclosures of protected health information (PHI).

However, if you don’t want to be the next victim of cyberattacks, then you must ensure HIPAA compliance in all your administrative workflows, related to storing and sharing patients’ information. Most importantly, you should make sure that your medical billing process is compliant with the regulatory laws, related to protecting patient health data as well as billing, coding standards.

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What is Protected Health Information?

Protected health information (PHI) is any information either its demographic or any other that can be used to identify a patient. For example, patients’ name, addresses, phone numbers, progress reports, medical claims, Social Security numbers, medical records, biometric identifiers, including finger, retinal and voiceprints or any other characteristic that would uniquely identify an individual.

In short, PHI is the term given to health data, received, stored, or transmitted by covered entities and their business associates under HIPAA, in order to get payments for the medical care services rendered or any other purpose, related to providing healthcare.

Who Needs to Be HIPAA Compliant?

HIPAA compliance is crucial for the covered entities and business associates that deal with the patient’s health information. But here’s a question that arises: what is HIPAA covered entity? If you are looking for this answer too, then you are at the right place. In this article, you can get a complete understanding of HIPAA covered entities, privacy and security rules.

Covered Entities:

A covered entity under HIPAA is any organization or individual that collects, creates, or transmits protected health information electronically.

HIPAA-covered entities include:

  • Providers :Regardless of the size of medical practice, either large or small, every healthcare provider, who exchanges or transmit health information electronically and submit HIPAA transactions.

These providers include, but are not limited to:

  • Doctors.
  • Clinics.
  • Psychologists.
  • Dentists.
  • Chiropractors.
  • Nursing homes.
  • Pharmacies.

Health Plans

  • Health insurance companies.
  • Health maintenance organizations.
  • Government insurance agencies such as: Medicare, Medicaid,
  • Employer-sponsored health plans.

Healthcare Clearinghouses

A healthcare clearinghouse works as a middleman between medical practitioners and insurance companies. It checks the medical claims for errors that can later lead to claim denials. Clearinghouses also play a crucial role in processing nonstandard health information to conform to standard data formats.

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HIPAA Business Associates

What is a business associate under HIPAA? & difference between HIPAA covered entity and business associate. These are the major concerns for both those who intend to enter the medical field or running a healthcare business.

Business associates are the organisations that are being engaged by a covered entity under HIPAA to help carry out its health care activities and functions i.e. medical billing. They are directly or indirectly involved in the use or disclosure of protected health information on behalf of or provide services to, a covered entity.

The examples of business associates under HIPAA include:

  • Medical billing companies.
  • Practise management firms.
  • Third-party consultants.
  • EHR platforms.
  • IT service providers
  • Faxing companies.
  • physical storage providers.
  • cloud storage providers.
  • shredding companies.
  • email hosting services.
  • A legal practitioner who has access to protected health information.

While collaborating with a business associate, the covered entity must have a written contract or another arrangement executed by a Los Angeles business lawyer with the business associate that:

Clearly define why the business associate has been engaged to do and what are their core responsibilities?

Ensure the HIPAA compliance of business associates.

The Core Rules of HIPAA

Here are the core HIPAA rules to stay compliant and prevent your medical practices from any inconvenience regarding patient health information.

The Privacy Rule

HIPAA’s privacy rule, passed in 2003, set the standards for:

  • How can PHI be shared?
  • What PHI is shared?
  • When it is shared?
  • Under which circumstances, it can be used or disclosed.

Compliance with HIPAA privacy rules, ensure the secured information exchange between concerned parties i.e. physicians and insurance companies. It’s pertinent to mention here that the Privacy Rule only applied to the Covered Entities, but following addendums to the HIPAA law have expanded its standards and regulations to business associates too.

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The Security Rule

The Security Rule requires the implementation of three types of safeguards that protect your health information from unauthorized access whether or not you transfer the data.

Administrative safeguards: Such standards deal with the implementation of clear policies, and procedures regarding the use of data, unwanted disclosure and consequences of breaching HIPAA rules by your in-house administrative teams.

Physical safeguards: Protect the physical security of systems, devices, access control systems etc.

Technical safeguards: Protects personal health data from theft or ransom attacks.

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