Hipaa compliance understanding its applicability
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HIPAA Compliance: Understanding Its Applicability PowerPoint PPT Presentation


What is HIPAA? HIPAA: Health Insurance Portability and Accountability Act It was passed by Congress in 1996 It includes requirements for: Transfer and continuation of health insurance coverage for millions of American workers and their families when they change or lose their jobs Reducing healthcare fraud and waste The protection and confidential handling of protected health information HIPAA Privacy Rule Establishes national standards to protect individuals’ medical records and other personal health information Imposes restrictions on the use/disclosure of personal health information Gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections. Applies to: health plans, healthcare clearinghouses, and those healthcare providers that conduct certain healthcare transactions electronically.  What is Protected Health Information (PHI)? Protected Health Information (PHI) or “Individually identifiable health information” is information, including demographic data, that relates to: the individual’s past, present or future physical or mental health or condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, and any information that identifies the individual   Individually identifiable health information can be the name, address, birth date, Social Security Number and so on What is Notice of Privacy Practices? Each covered entity must provide a notice of its privacy practices. The notice, in plain language, must include: the ways in which the covered entity may use and disclose protected health information the covered entity’s duties to protect privacy, provide a notice of privacy practices, and abide by the terms of the current notice the individuals’ rights, including the right to complain to HHS and to the covered entity if they believe the

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HIPAA Compliance: Understanding Its Applicability

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Hipaa compliance understanding its applicability

HIPAA Compliance: Understanding Its Applicability


Hipaa compliance understanding its applicability

What is HIPAA?

  • HIPAA: Health Insurance Portability and Accountability Act

  • It was passed by Congress in 1996

  • It includes requirements for:

    • Transfer and continuation of health insurance coverage for millions of American workers and their families when they change or lose their jobs

    • Reducing healthcare fraud and waste

    • Industry-wide standards for healthcare information on electronic billing and other processes

    • The protection and confidential handling of protected health information

      Whom Does HIPAA Apply To?

      Applies to:

      • Health Plans

      • Healthcare Providers

      • Healthcare Clearinghouses


Hipaa applicability health plans

HIPAA Applicability – Health Plans

  • For health plans, HIPAA rules apply to individual and group plans that provide or pay the cost of medical care.

  • Health plans include:

    • health, dental, vision, and prescription drug insurers

    • health maintenance organizations (“HMOs”)

    • Medicare, Medicaid and Medicare supplement insurers

    • Long-term care insurers

    • Employer-sponsored group health plans

    • Government and church-sponsored health plans,

    • Multi-employer health plans


Hipaa applicability healthcare providers

HIPAA Applicability – Healthcare Providers

HIPAA rules apply to every healthcare provider, regardless of size, who electronically transmits health information in connection with the following transactions:

  • claims,

  • benefit eligibility inquiries,

  • referral authorization requests, or

  • other transactions for which HHS has established standards under the HIPAA Transactions Rule

    Healthcare providers include:

  • All “providers of services” (e.g., institutional providers such as hospitals) and

  • “providers of medical or health services” (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for healthcare


Hipaa applicability healthcare clearinghouses

HIPAA Applicability – Healthcare Clearinghouses

  • Healthcare clearinghouses are entities that process nonstandard information they receive from another entity into a standard format or data content, or vice versa.

  • Healthcare clearinghouses include:

    • billing services,

    • repricing companies,

    • community health management information systems, and

    • value-added networks and switches if these entities perform clearinghouse functions.


Hipaa applicability business associates

HIPAA Applicability – Business Associates

  • According to HIPAA rules, a business associate is a third party person or organization that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of individually identifiable health information.

  • Business associate functions or activities on behalf of a covered entity include:

    • claims processing,

    • data analysis,

    • utilization review, and

    • Billing

  • Business associate services to a covered entity are limited to:

    • legal,

    • actuarial,

    • accounting,

    • consulting,

    • data aggregation,

    • management,

    • administrative,

    • accreditation, or

    • financial services


Hipaa compliance understanding its applicability

Want to learn more about HIPAA, its requirements and best practices to comply with them? ComplianceOnline webinars and seminars are a great training resource. Check out the following links:

  • How to examine security policies, practices, and risk issues to comply with HIPAA

  • How to use social media and texting without breaking HIPAA rules

  • How to Conduct risk analysis to comply with HIPAA

  • HIPAA/HITECH Assessment for Healthcare Business Associates

  • How to comply with HIPAA Omnibus Rule

  • Understanding new rules and responsibilities of Privacy Officer under HIPAA

  • HIPAA Security and Breach Rule Compliance


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