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    what are two common terms in the hipaa privacy rule that help dictate how patient information can be shared?


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    Understanding the 5 Main HIPAA Rules

    What HIPAA Stands For : A Complete Overview of HIPAA Rules and 2021 Changes. Understand HIPAA Privacy Rule and HIPAA Security Rule.

    Understanding the 5 Main HIPAA Rules

    25 Nov

    Understanding the 5 Main HIPAA Rules

    By Greg Garner

    For 2022 Rules for Healthcare Workers, please click here.

    For 2022 Rules for Business Associates, please click here.

    All of our HIPAA compliance courses cover these rules in depth, and can be viewed here.

    HIPAA Exams is one of the only IACET accredited HIPAA Training providers and is SBA certified 8(a).

    5 Main HIPAA Rules

    Privacy Rule (45 CFR §164.530)

    The Privacy Rule protects the PHI and medical records of individuals, with limits and conditions on the various uses and disclosures that can and cannot be made without patient authorization. This rule also gives every patient the right to inspect and obtain a copy of their records and request corrections to their file. There are specific forms that coincide with this rule: Request of Access to Protected Health Information (PHI); Notice of Privacy Practices (NPP) Form; Request for Accounting Disclosures Form; Request for Restriction of Patient Health Care Information; Authorization for Use or Disclosure Form; and the Privacy Complaint Form.

    Security Rule (45 CFR §164.308)

    The security rule defines and regulates the standards, methods and procedures related to the protection of electronic PHI on storage, accessibility and transmission. There are three safeguard levels of security. The Administrative safeguards deal with the assignment of a HIPAA security compliance team; the Technical safeguards deal with the encryption and authentication methods used to have control over data access, and the Physical safeguards deal with the protection of any electronic system, data or equipment within your facility and organization. The risk analysis and risk management protocols for hardware, software and transmission fall under this rule.

    Transactions Rule

    This rule deals with the transactions and code sets used in HIPAA transactions, which includes ICD-9, ICD-10, HCPCS, CPT-3, CPT-4 and NDC codes. These codes must be used correctly to ensure the safety, accuracy and security of medical records and PHI.

    Identifiers Rule

    HIPAA uses three unique identifiers for covered entities who use HIPAA regulated administrative and financial transactions. These identifiers are: National Provider Identifier (NPI), which is a 10-digit number used for covered healthcare providers in every HIPAA administrative and financial transaction; National Health Plan Identifier (NHI), which is an identifier used to identify health plans and payers under the Center for Medicare & Medicaid Services (CMS); and the Standard Unique Employer Identifier, which identifies and employer entity in HIPAA transactions and is considered the same as the federal Employer Identification Number (EIN).

    Enforcement Rule

    This rule is derived from the ARRA HITECH ACT provisions for violations that occurred before, on or after the February 18, 2015 compliance date. This expands the rules under HIPAA Privacy and Security, increasing the penalties for any violations. This addresses five main areas in regards to covered entities and business associates: Application of HIPAA security and privacy requirements; establishment of mandatory federal privacy and security breach reporting requirements; creation of new privacy requirements and accounting disclosure requirements and restrictions on sales and marketing; establishment of new criminal and civil penalties, and enforcement methods for HIPAA non-compliance; and a stipulation that all new security requirements must be included in all Business Associate contracts.

    For 2022 Rules for Healthcare Workers, please click here.

    For 2022 Rules for Business Associates, please click here.


    The HIPAA Privacy Rule is the specific rule within HIPAA Law that focuses on protecting Personal Health Information (PHI). It established national standards on how covered entities, health care clearinghouses, and business associates share and store PHI. It established rules to protect patients information used during health care services.

    HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. HIPAA’s original intent was to ensure health insurance coverage for individuals who left their job. Since 1996, HIPAA has gone through modification and grown in scope.

    HIPAA Rules and Regulations are enforced by the Office of Civil Rights (OCR) within the Health and Human Services (HHS) devision of the federal government. Enforcement is ongoing and fines of $2 million-plus have been issued to organizations found to be in violation of HIPAA.

    HIPAA or the Health Insurance Portability and Accountability Act of 1996 is federal regulations that was established to strengthen how Personal Health Information (PHI) is stored and shared by Covered Entities and Business Associates. HIPAA regulation covers several different categories including HIPAA Privacy, HIPAA Security, HITECH and OMNIBUS Rules, and the Enforcement Rule. All Covered Entities and Business Associates must follow all HIPAA rules and regulation.

    New for 2021: There are two rules, issued by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), which implement interoperability and provides patient access provisions. These were issues as part of the bipartisan 21st Century Cures Act (Cures Act) and supported by President Trump’s MyHealthEData initiative. MyHealthEData gives every American access to their medical information so they can make better healthcare decisions. More information coming soon.

    Source : www.hipaaexams.com

    Summary of the HIPAA Privacy Rule

    Summary of the HIPAA Privacy Rule

    Summary of the HIPAA Privacy Rule

    This is a summary of key elements of the Privacy Rule including who is covered, what information is protected, and how protected health information can be used and disclosed.  Because it is an overview of the Privacy Rule, it does not address every detail of each provision.

    Summary of the Privacy Rule PDF - PDF


    The Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”) establishes, for the first time, a set of national standards for the protection of certain health information. The U.S. Department of Health and Human Services (“HHS”) issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).1 The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule — called “covered entities,” as well as standards for individuals' privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights (“OCR”) has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties.

    A major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being. The Rule strikes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. Given that the health care marketplace is diverse, the Rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed.

    This is a summary of key elements of the Privacy Rule and not a complete or comprehensive guide to compliance. Entities regulated by the Rule are obligated to comply with all of its applicable requirements and should not rely on this summary as a source of legal information or advice. To make it easier for entities to review the complete requirements of the Rule, provisions of the Rule referenced in this summary are cited in the end notes. Visit our  Privacy Rule section to view the entire Rule, and for other additional helpful information about how the Rule applies. In the event of a conflict between this summary and the Rule, the Rule governs.

    Statutory and Regulatory Background

    The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, was enacted on August 21, 1996. Sections 261 through 264 of HIPAA require the Secretary of HHS to publicize standards for the electronic exchange, privacy and security of health information. Collectively these are known as the Administrative Simplification provisions.

    HIPAA required the Secretary to issue privacy regulations governing individually identifiable health information, if Congress did not enact privacy legislation within three years of the passage of HIPAA. Because Congress did not enact privacy legislation, HHS developed a proposed rule and released it for public comment on November 3, 1999. The Department received over 52,000 public comments. The final regulation, the Privacy Rule, was published December 28, 2000.2

    In March 2002, the Department proposed and released for public comment modifications to the Privacy Rule. The Department received over 11,000 comments.The final modifications were published in final form on August 14, 2002.3 A text combining the final regulation and the modifications can be found at 45 CFR Part 160 and Part 164, Subparts A and E.

    Who is Covered by the Privacy Rule

    The Privacy Rule, as well as all the Administrative Simplification rules, apply to health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA (the “covered entities”). For help in determining whether you are covered, use CMS's decision tool.

    Health Plans. Individual and group plans that provide or pay the cost of medical care are covered entities.4 Health plans include health, dental, vision, and prescription drug insurers, health maintenance organizations (“HMOs”), Medicare, Medicaid, Medicare+Choice and Medicare supplement insurers, and long-term care insurers (excluding nursing home fixed-indemnity policies). Health plans also include employer-sponsored group health plans, government and church-sponsored health plans, and multi-employer health plans. There are exceptions—a group health plan with less than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity. Two types of government-funded programs are not health plans: (1) those whose principal purpose is not providing or paying the cost of health care, such as the food stamps program; and (2) those programs whose principal activity is directly providing health care, such as a community health center,5 or the making of grants to fund the direct provision of health care. Certain types of insurance entities are also not health plans, including entities providing only workers’ compensation, automobile insurance, and property and casualty insurance. If an insurance entity has separable lines of business, one of which is a health plan, the HIPAA regulations apply to the entity with respect to the health plan line of business.

    Source : www.hhs.gov

    The HIPAA Privacy Rule: Patients' Rights

    Posted: Jul 01 2014  | Revised: Jul 01 2014

    The HIPAA Privacy Rule: Patients' Rights

    Posted: Jul 01 2014  | Revised: Jul 01 2014


    The right to receive a notice of privacy practices

    a. How do patients get a notice of privacy practices?

    b. What does a notice of privacy practices include?

    c. Why do health care providers ask patients to sign a form after they receive a notice of privacy practices?

    d. Where can a patient ask questions or complain about privacy practices?

    The right to access and request a copy of medical records

    a. Does this right apply to electronic records?

    b. Can a patient request that someone else be given access to her information?

    c. Will a patient be charged fees to receive copies of medical records?

    d. Can patients still access their records if a physician no longer practices medicine?

    e. How long does a covered entity have to deliver a patient's requested records?

    f. When can patients be denied access to their medical information?

    g. What should patients do when they have trouble accessing or obtaining a copy of their medical records?

    The right to request an amendment to medical records

    The right to request special privacy protection for PHI

    a. Can a patient pay out of pocket to restrict disclosures to insurers?

    b. Can an individual make special requests regarding confidential communications about health information?

    The right to an accounting of disclosures

    a. How much information will an accounting of disclosures include?

    b. How long will it take to receive an accounting of disclosures, and will it cost anything?

    The right to access a minor child's medical records

    a. Do parents have the right to see their minor children's medical records?

    b. Can a doctor provide medical information to a child's school without a parent's permission?

    c. Are a child's medical records in school files covered under HIPAA?


    1.  Introduction

    This guide explains the rights that patients have under the HIPAA Privacy Rule.  It also answers many questions the Privacy Rights Clearinghouse receives from individuals on a regular basis.

    For more information about HIPAA and medical privacy, see Privacy Rights Clearinghouse: Medical Privacy.

    2. The right to receive a notice of privacy practices

    Patients have the right to receive a notice explaining how a provider or health plan uses and discloses their health information.

    a.  How do patients get a notice of privacy practices?

    Health care providers usually give patients this notice on their first visit and post it in the facility where patients may see it.  Health plans (insurers) typically send their notices by mail after patient enrollment.

    b.  What does a notice of privacy practices include?

    A notice of privacy practices (NPP) will often contain jargon that can be difficult for patients to understand.  For explanations of commonly used HIPAA terms, see Privacy Rights Clearinghouse Fact Sheet 8a: HIPAA Basics.

    A notice of privacy practices (NPP) must:

    describe how the HIPAA Privacy Rule allows the covered entity to use and share protected health information (PHI), and state that it will obtain the patient's permission for any other reason;

    tell patients about their rights under the HIPAA Privacy Rule;

    tell patients how to file a complaint with the covered entity;

    tell patients how to file a complaint with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights;

    provide information about a patient’s rights to restrict fundraising solicitations; and

    explain the need to obtain a patient’s written authorization for marketing or the sale of the patient’s PHI.

    For more information about notices of privacy practices, see HHS' website or 45 CFR § 164.520.

    For more information about how covered entities such as health care providers and health insurers may use or disclose PHI, see PRC Fact Sheet 8b: The HIPAA Privacy Rule: How May Covered Entities Use and Disclose Health Information.

    c. Why do health care providers ask patients to sign a form after they receive a notice of privacy practices?

    Health care providers will ask patients to sign a form saying that they received a copy of the notice of privacy practices.  The law does not require patients to sign this. However, signing does not waive a patient’s rights under HIPAA, and does not mean that the patient agrees with the privacy policy.

    If a patient refuses to sign, it does not prevent a health care provider from using or disclosing information in ways already permitted under HIPAA.  A provider may not deny treatment if a patient refuses to sign an acknowledgement of having receive a notice of privacy practices.

    d. Where can a patient ask questions or complain about privacy practices?

    The notice of privacy practices will provide information about who to contact with privacy questions and how to complain.  This is a good place to start when a question arises.  If a patient doesn’t have a copy of the notice, there may be one on the provider's or health plan’s website.  If there isn’t one online, a covered entity's administrative office will be able to provide the information and a copy of the notice.

    3. The right to access and request a copy of medical records

    Source : privacyrights.org

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