Let’s Talk About HIPAA

A lot of people talk about HIPAA, but how many of them have actually read the law? Not very many, from what I have seen and heard people say about HIPAA. Let’s set the record straight.

HIPAA rules do not apply to all communications that may involve health information. As we pointed out in an earlier blog post, that means that an inquiry about your vaccination status will probably not violate HIPAA.

Entities that must follow the HIPAA regulations are called “covered entities.”

Covered entities include:

• Health Plans, including health insurance companies, HMOs, company health plans, and certain government programs that pay for health care, such as Medicare and Medicaid.
• Most Health Care Providers—those that conduct certain business electronically, such as electronically billing your health insurance—including most doctors, clinics, hospitals, psychologists, chiropractors, nursing homes, pharmacies, and dentists.
• Health Care Clearinghouses—entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa.

In addition, “business associates” of covered entities must follow parts of the HIPAA regulations.

Often, contractors, subcontractors, and other outside persons and companies that are not employees of a covered entity will need to have access to your health information when providing services to the covered entity. These entities are called “business associates.” Examples of business associates include:

• Companies that help your doctors get paid for providing health care, including billing companies and companies that process your health care claims
• Companies that help administer health plans
• People like outside lawyers, accountants, and IT specialists
• Companies that store or destroy medical records

Covered entities must have contracts in place with their business associates, ensuring that they use and disclose your health information properly and safeguard it appropriately. Business associates must also have similar contracts with subcontractors. Business associates (including subcontractors) must follow the use and disclosure provisions of their contracts and the Privacy Rule, and the safeguard requirements of the Security Rule.

If you do business with a covered entity and are presented with a Business Associate Agreement–read it! Some of them can be quite broad and contain language that goes beyond the requirements of HIPAA.

Who Is Not Required to Follow These Laws

Many organizations that have health information about indivuduals do not have to follow these laws.

Examples of organizations that do not have to follow the Privacy and Security Rules include:

• Life insurers
• Employers
• Workers compensation carriers
• Most schools and school districts
• Many state agencies like child protective service agencies
• Most law enforcement agencies
• Many municipal offices

What Information Is Protected 

• Information your doctors, nurses, and other health care providers put in your medical record
• Conversations your doctor has about your care or treatment with nurses and others
• Information about you in your health insurer’s computer system
• Billing information about you at your clinic
• Most other health information about you held by those who must follow these laws

How This Information Is Protected

• Covered entities must put in place safeguards to protect your health information and ensure they do not use or disclose your health information improperly.
• Covered entities must reasonably limit uses and disclosures to the minimum necessary to accomplish their intended purpose.
• Covered entities must have procedures in place to limit who can view and access your health information as well as implement training programs for employees about how to protect your health information.
• Business associates also must put in place safeguards to protect your health information and ensure they do not use or disclose your health information improperly.

This may be more than you wanted to know about HIPAA. But if you want to dig even deeper into HIPAA, you can visit www.hhs.gov.