Therefore, there must be checks and balances and policies in place within the organizational structure to guarantee that electronic protected health information (EPHI) is: Any activity revolving around regulated data systems may be audited. Regulations such as HIPAA require transparency first and foremost. The US Office for Civil Rights (OCR) offers six programs teaching compliance rules, and there are numerous private groups and consultants that can be hired as well. There is no official compliance certification for HIPAA, but many companies offer credentials to show that compliance training has been completed. HIPAA compliance training programs reduce an organization’s risk of regulatory action. Lastly, providers could face criminal prosecution for their violations. The entity is then audited and faces fines. Under Omnibus, the HIPAA Breach Notification Rules states all business associates must notify all patients of the breach and bear the cost of such notifications. It further increases compliance violation penalties to a maximum of $1.5 million per incident.Īs you can see, a HIPAA violation can be a severe financial burden for a healthcare organization. The HIPAA Omnibus Rule, established in 2013, implements modifications to HIPAA concerning any associate of a covered entity. The HIPAA Enforcement Rule states guidelines for investigating compliance violations of HIPAA.The Security Standards for the Protection of Electronic Protected Health Information, or Security Rule, sets the standard for data security of patient records.The Standards for Privacy of Individually Identifiable Health Information, or Privacy Rule, establishes nationwide standards for the protection of patient health information.Organizations must submit and process claims following a standardized electronic data interchange (EDI) protocol.Every healthcare entity (providers, plans, employers and individuals) must have a 10 digit national provider identifier number (NPI).It also states rules for company-owned life insurance policies.( 1)įor anyone working in healthcare information technology, HIPAA compliance means adhering to the requirements of Title II, known as the provisions of Administrative Simplification. Under the last title, provisions are laid out for individuals who choose to give up their US citizenship (expatriate) and how this affects their income tax. The fourth title defines the health insurance reform in greater detail and states the provisions for those who seek continued coverage under the act and the laws regarding pre-existing conditions.( 1) HIPAA Title V Title III of the HIPAA act provides guidelines for tax provisions and medical care.( 1) HIPAA Title IV All healthcare organizations must also implement security measures for health data access and comply with privacy laws.( 1) HIPAA Title III Title II states that the US Department of Health and Human Services must establish a national standard for electronic healthcare transaction processing. It also prohibits group plans from denying persons with preexisting conditions and diseases access to coverage and bars them from setting lifetime coverage limits.( 1) HIPAA Title II The first title provides protection for maintaining health insurance coverage for any individual changing or losing their job. In August of that year, the Health Insurance Portability and Accountability Act (HIPAA) was signed by President Bill Clinton and contains five main sections (titles): HIPAA Title I The United States passed legislation in 1996 in an effort to ensure the privacy and safeguarding of all individuals’ medical data.

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