Navigating Protected Health Information (PHI) and HIPAA Compliance

by | August 14, 2023 | 10:03 am
Protected Health Information and HIPAA Compliance

In recent years, there has been a growing trend of healthcare records being compromised through data breaches and other cyberattacks. According to The HIPAA Journal, more than 380 million healthcare records have been exposed since 2009, impacting millions of individuals across the United States. Maintaining the privacy and security of protected health information (PHI) is a major concern and challenge for many healthcare organizations.

And these privacy concerns affect any organization handling PHI, from schools and long-term care facilities to medical equipment suppliers and more. If your business is navigating the challenges of health privacy and HIPAA compliance, there are some things you should know.

What is Protected Health Information?

Protected health information refers to information about a person’s health status, provision of healthcare, or payment for healthcare. Any part of a person’s medical records or medical payment history can be considered PHI.

In addition to information about medical conditions, PHI might include personal details like:

  • Names and aliases, including social media handles
  • Addresses
  • Dates, including birth dates, dates of treatment, and payment dates
  • Contact information, including phone numbers, fax numbers, and email addresses
  • Identification numbers such as SSNs, health plan numbers, and account numbers
  • Biometric identifiers
  • Digital identifiers like website URLs and IP addresses
  • Photographs

The federal government uses laws like HIPAA to keep these sensitive personal details confidential, protect patients, and ensure PHI is handled appropriately.

Medical information is considered PHI when it is managed by “covered entities” as defined by HIPAA — health plans, healthcare clearinghouses, and healthcare providers that handle electronic payments or claims. Third-party vendors who are working with these entities to carry out healthcare activities must also comply with HIPAA.

In some situations, PHI can be publicly shared, but only after de-identification, which is the process of removing individually identifiable details to preserve participants’ privacy. De-identification is essential for mitigating privacy risks while making valuable data available for use in studies, policy assessment, and other research endeavors.

What are the Challenges of Handling PHI?

Because PHI is highly regulated and protected, there are many challenges for companies and organizations that handle medical information, including:

  • HIPAA Compliance: Navigating complex and ever-evolving HIPAA requirements and avoiding compliance penalties.
  • System Security: Preventing malicious actors from hacking into computer systems and accessing PHI.
  • Access Management: Protecting records while also giving employees the access they need; managing user profiles, authentication, authorization, and restrictions.
  • Employee Training: Ensuring team members understand their responsibilities and follow best practices for handling PHI.
  • Third-party Relationships: Maintaining compliance when working with consultants, agencies, and other outside vendors.

There’s a lot that goes into safeguarding patient data, and keeping up with constantly evolving guidelines can feel overwhelming. But you don’t have to do it alone.

Many businesses that handle PHI often partner with third-party vendors for extra support. For example, an IT consultant could help bolster your security efforts and prevent data breaches, and a medical billing company could help streamline the claims process. Building relationships with trusted partners allows you to leverage their expertise and focus on growing your business.

Working With a HIPAA-Compliant Medical Billing Partner

If keeping up with HIPAA guidelines and PHI best practices adds too much to your plate, consider outsourcing some things to a HIPAA-compliant medical billing company. This partner can handle day-to-day tasks like insurance verification, claim submission, payment posting, denial management, and other medical billing services. Here are some benefits of bringing in a third-party vendor to streamline this part of your operations:

  • Cost Savings: Reduce costs associated with software licenses, billing staff, and ongoing maintenance.
  • Reduced Administrative Burden: Thanks to additional help with the process of managing your business’s daily workflow, your team is free to focus on things like patient care and business growth.
  • Regulatory Expertise: Companies that offer medical billing services typically stay up-to-date with the latest guidelines and reduce the risk of compliance violations.
  • Faster Claims Processing: By leveraging efficient workflows and automation, medical billing companies can keep the claims process flowing smoothly.

Next Steps 

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