HIPAA for Dummies: A Quick Fact Sheet

 The Essential HIPAA Law Quick Fact Sheet (Printable)

HIPAA
HIPAA


What does HIPAA stand for? 

The Health Insurance Portability and Accountability Act (HIPAA) law can be confusing, especially since so many people seem to disagree on what it means. This quick fact sheet provides everything you need to know about HIPAA in simple language and with examples, so you can see just how easy it is to understand these laws that impact your life every day!

HIPAA, or the Health Insurance Portability and Accountability Act, governs the use of medical information in the United States. If you’re not familiar with HIPAA laws, it’s important to understand how this law impacts you as an individual. Fortunately, the following quick fact sheet will get you started on understanding HIPAA laws for dummies and provide valuable information about what does and doesn’t fall under HIPAA laws to help keep your medical records safe.

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996, and it protects the privacy of your health information – who you’re seeing, what you’re taking, whether you’ve been treated before, or have any pre-existing conditions. The law also requires medical providers to create policies about how they communicate patient information and protects patients from fraudulent use of their data or identity theft.

HIPAA
HIPAA


Protected Health Information (PHI)

What is HIPA? It regulates the use and disclosure of certain types of protected health information (PHI) in certain circumstances by healthcare providers, health plans, and those who work on their behalf. The regulation was created to improve access to health insurance coverage by removing barriers due to past or present health conditions while ensuring that individuals' privacy is maintained. 

Who is affected by HIPAA?

Who does the law apply to?

The law applies to all healthcare providers, health plans, and healthcare clearinghouses. In general, the law applies if you electronically transmit any of the following information in connection with transactions for which you are a covered entity, meaning one of the parties involved in the transaction.

  • Health statistics approximately a person that could identify that man or woman;
  • Health care treatment or other interaction with an individual; -Benefits paid in connection with these transactions.

How are health care providers, health plans, and clearinghouses involved with HIPAA?

Health care providers are subject to HIPA if they transmit any health information in electronic form, even if not on the internet. Health plans are covered under HIPPA if they transmit health information electronically and offer or market health insurance coverage within the US. Health plans that only offer or market coverage outside of the US do not have to abide by HIPPA standards, but can use it as guidance. Clearinghouses process and route health information electronically between hospitals, doctors, laboratories, pharmacies, and other healthcare entities.

HIPAA
HIPAA

Business Associates

More and more, businesses rely on HIPAA-covered entities and business associates to deliver necessary services. Whether they are sending us their patients' personal health information (PHI) in the form of x-rays, lab reports, or patient histories; or whether they are performing day-to-day work tasks to help manage our business, HIPAA ensures that these people are qualified, conscientious individuals who have agreed to keep our data secure.


Enforcement, Fines, Penalties, & Civil Lawsuits

Enforcement of HIPAA laws includes financial penalties, possible criminal prosecution, and civil lawsuits. The U.S. Department of Health and Human Services Office for Civil Rights is the primary enforcement agency. Penalties can be as high as $50,000 per violation or up to a total of $1.5 million in a year if certain violations occur, but lesser penalties may apply depending on who commits the violation and the degree of severity.

HIPAA
HIPAA


Effect on other laws

The Health Insurance Portability and Accountability Act (HIPAA) is a United States law enacted in 1996 to improve portability and keep private health insurance secure. HIPA contains three self-explanatory Titles. The administrative parts of HIPAA do not affect other laws, but the privacy part does affect other laws as it relates to confidentiality with protected health information. For example, HIPA determines who has access to protected health information so that medical professionals can diagnose a patient.

HIPAA
HIPAA


Uses and Disclosures

A healthcare provider must obtain the patient's written consent before disclosing any personal health information to a third party. Generally, this means that the patient is asked to sign a form, known as a HIPAA release or authorization. Healthcare providers may also disclose limited information about your treatment to a family member, friend, or co-worker if it is necessary for them to help with your treatment decisions.

HIPAA
HIPAA

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