What Is HIPAA?

What Is HIPAA?

HIPAA stands for Health Insurance Portability and Accountability Act. The U.S. Congress passed HIPAA in 1996. It aims to protect health information privacy, help individuals keep health insurance, and help control administrative costs within the industry. HIPAA’s organization is based on separate “titles,” or sections that focus on unique aspects of health insurance reform. In today’s healthcare landscape, HIPAA is extremely valuable and highly regarded.

HIPAA Titles

There are five main HIPAA titles:

I. Health Insurance Reform
II. Administrative Simplification
III. Tax-related Health Provisions
IV. Group Health Plan Requirements
V. Revenue Offsets

HIPAA Title I

Titles I and II feature the most widely-accessed guidelines since the implementation of HIPAA. Title I acts to regulate breadth and availability of group health plans, as well as certain health insurance policies for individuals. It deals with the access, portability, and renewability of health care.

HIPAA Title II

Title II discusses the prevention of healthcare abuse and fraud, administrative simplification, and medical liability reform. This title holds high significance, as it provides guidelines and regulations for patient privacy and security, as well as the types of criminal and civil penalties faced by individuals and entities who violate them.

HIPAA Patient Rights

For consumers, HIPAA outlines a detailed policy on privacy and patient rights regarding interactions with providers and privacy of PHI, or protected health information. In most cases, healthcare providers must receive authorization from the patient before disclosing the patient’s PHI. However, certain exceptions apply, such as when the PHI disclosure involves treatment, operations, payment, or information that is mandated by law.

Under HIPAA, patient privacy grants patients the right to:

  • File complaints
  • Request certain confidential communications
  • See a list of some disclosures made of their PHI
  • See and receive a copy of their PHI, or protected health information
  • Request that their PHI receives special treatment
  • Request corrections or the addition of omitted information in their records
  • Receive privacy practice notices for any health care provider, health plan, or health clearing house

Importance and Compliance

It is critical for individuals and entities in the healthcare industry to follow HIPAA’s guidelines and requirements. Depending on the type and nature of a violation, civil or criminal penalties may include devastating fines of up to $1.5 million per year or even imprisonment for up to 10 years. This is why businesses should be certain that their medical billing and coding, as well as overall systems and processes, are handled in a HIPAA compliant manner.