HIPAA Rules
Privacy Rule
Purpose: Protects the privacy of individuals' medical records and other personal health information (PHI).
Key Provisions:
- Requires appropriate safeguards to protect the privacy of PHI.
- Sets limits and conditions on the uses and disclosures of PHI without patient authorization.
- Gives patients' rights over their health information, including rights to examine and obtain a copy of their health records, and request corrections.
Security Rule
Purpose: Ensures the confidentiality, integrity, and security of electronic protected health information (ePHI).
Key Provisions:
- Requires covered entities to implement administrative, physical, and technical safeguards to secure ePHI.
- Includes measures such as encryption, access controls, audit controls, and data backup.
Breach Notification Rule
Purpose: Requires covered entities and business associates to provide notification following a breach of unsecured PHI.
Key Provisions:
- Individuals must be notified of any breach that affects their PHI.
- In cases where a breach affects more than 500 individuals, it must be reported to the Department of Health and Human Services (HHS) and the media.
- Covered entities are required to notify the HHS of breaches affecting fewer than 500 individuals annually.
Enforcement Rule
Purpose: Establishes procedures for investigating HIPAA violations and imposing penalties.
Key Provisions:
- Defines the civil monetary penalties for HIPAA violations, which can range from $100 to $50,000 per violation, depending on the level of negligence.
- Establishes a tiered approach to penalties, depending on the severity of the violation.
Transaction and Code Sets Rule
Purpose: Standardizes the electronic transmission of healthcare information between healthcare providers and insurers.
Key Provisions:
- Requires the use of specific code sets for diagnoses, treatments, and billing.
Identifiers Rule
Purpose: Establishes standard identifiers for healthcare providers, employers, and health plans.
Key Provisions:
- Includes the National Provider Identifier (NPI) for healthcare providers and other standardized identifiers for employers and health plans.
Key Terms
Covered Entities: Health plans, healthcare clearinghouses, and healthcare providers that transmit health information electronically.
Business Associates: Entities that perform activities involving the use or disclosure of PHI on behalf of a covered entity.
HIPAA compliance is mandatory for all healthcare providers, insurers, and business associates handling PHI or ePHI.