Claire Smith Last Updated On: June 27, 2023

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Health Insurance Portability and Accountability Act

HIPAA Insurance

The Health Insurance Portability and Accountability Act (or HIPAA) was implemented in 1996 by the federal government to ensure individual privacy in healthcare. This is incredibly important because it upholds your right to fair and compassionate care.

The purpose of the HIPAA is to ensure the protection of individual’s healthcare information and offer citizens a better overall experience in their access to healthcare. Entities that do not comply with the HIPAA are subject to monetary civil or criminal prosecution. Ignorance of the HIPAA is not a valid defense in the court of law.

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Understanding HIPAA Requirements

Title II of the HIPAA contains standards and rules to ensure that individual healthcare information is not shared without consent or knowledge of the individual. This Title contains five sections that ensure these standards are met.

Let’s take a look at them here.

  1. The National Provider Identifier Standard requires that every healthcare entity (meaning individuals, employers, health plans, healthcare providers, etc.) must have a ten-digit National Provider Identifier (NPI) number. This ensures organization and accountability.
  2. The Transactions and Code Set Standard requires healthcare organizations to follow a standardized routine for Electronic Data Interchange (EDI). This pertains to the submission and processing of insurance claims and again ensures organization and accountability.
  3. The HIPAA Privacy Rule is also referred to as the Standards for Privacy of Individually Identifiable Health Information. This is one of the most important sections of the HIPAA for consumers to understand since it directly pertains to the protection of their healthcare information. Under this section, covered entities are given standards to ensure that the disclosure of individual healthcare information is handled in an ethical manner.

Covered entities include healthcare providers, health plans such as (but not limited to) and HMO or Medicaid, healthcare clearinghouses that process information between other entities, and business associates.

The only health insurance plan that does not qualify as a covered entity is one with less than 50 participants, managed solely by an employer who maintains they are not a covered entity.

A covered entity can only disclose individual healthcare information if:

  • Said information is being disclosed directly to the individual it pertains to.
  • Information is about treatment, payment, and healthcare operations.
  • Individual is given due opportunity to agree or object to the disclosure of personal information.
  • There was an incident to an otherwise permitted use and disclosure.
  • It is a part of a limited data set for research, public health, or healthcare operations.
  • It is one of the following twelve national priority purposes:
  1. When required by law
  2. Public health activities
  3. Victims of abuse or neglect or domestic violence
  4. Health oversight activities
  5. Judicial and administrative proceedings
  6. Law enforcement
  7. Functions (such as identification) concerning deceased persons
  8. Cadaveric organ, eye, or tissue donation
  9. Research, under certain conditions
  10. To prevent or lessen a serious threat to health or safety
  11. Essential government functions
  12. Workers compensation
  1. The HIPAA Security Rule sets the standards for patient data security with regards to electronic health information only, meaning that information transmitted orally or in writing is not covered. This is another crucially important section to understand. Covered entities must rely on professional ethics and good judgment to:
  • Ensure the confidentiality, integrity, and availability of all electronic protected health information
  • Detect and safeguard against anticipated threats to the security of the information
  • Protect against anticipated impermissible uses or disclosures
  • Certify compliance by their workforce
  1. The final section of Title II is the HIPAA Enforcement Rule, which establishes guidelines for investigations into violations of the HIPAA.

Final Words

We know that the ins and outs of HIPAA can be a little dry, but the real life implications of HIPAA affect flesh and blood people, like you. The most important thing to take away from the HIPAA is that the act is there to protect your privacy and ensure the utmost quality of your healthcare.

Have a question about HIPAA requirements? Contact our experts here! – (877) 292-8295

Claire Smith Claire is a creative entrepreneur with a variety of marketing and content creation skills, including blog and web copy writing, research, and strategy. She has a Masters in Cultural Studies from Queen's University and is known for thinking laterally about marketing, based on her deep knowledge of people and behavior.

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