Understanding HIPAA Disclosure: What It Is and How It Works

Understanding HIPAA Disclosure: What It Is and How It Works

Whether you’re a healthcare provider or medical practitioner, understanding the significance of proper HIPAA disclosure is crucial to delivering quality patient care. Staying compliant with data protection laws can help you secure your patient’s confidential data. With the advent of artificial intelligence (AI) and other emerging healthcare technologies, it’s crucial to conduct safety measures and follow best practices when disclosing sensitive information.

Read on to learn how HIPAA disclosure works and how it helps show that you are taking your patient’s privacy seriously. 

Understanding HIPAA Disclosure: What It Is and How It Works

What Is HIPAA Disclosure?

The Health Insurance Portability and Accountability Act, known as HIPAA, established rules for the protection of personal health information (PHI). Under this legislation, healthcare organizations and other covered entities (including health insurance companies and clearinghouses) must seek the consent of patients before disclosing PHI to another individual or entity.

About the HIPAA Privacy Rule and Disclosures

Before transmitting or disclosing any electronic or physical data, healthcare providers and practitioners must first ask for written authorization from their patients. The HIPAA Privacy Rule also highlights individuals’ right to access their own records and request corrections if they find any mistakes. Authorized representatives obtaining medical records of their family members are also allowed access to the patient’s sensitive health information.

Permissible HIPAA disclosures

According to the HIPAA Privacy Rule, covered entities can only use and disclose PHI without an individual’s authorization for the following situations:

  • When individuals or their personal representatives request access to their PHI or an accounting of disclosures of their records
  • When the Department of Health and Human Services (HHS) conducts a review or compliance investigation

Disclosures for treatment, payment, and healthcare operations

Under the same rule, it is only optional for covered entities to obtain consent from individuals when disclosing PHI for treatment, payment, and healthcare operations. Find out below the difference between the three:

  • Treatment refers to the provider’s provision, coordination, and management of healthcare services.
  • Payment covers the activities of providers to obtain premiums, benefits, and reimbursements for healthcare services and treatments.
  • Healthcare providers pertain to quality assessment, competency assurance, fraud or abuse detection, business planning, and other administrative tasks.

Disclosures to patients and personal representatives

In the absence of the patient, the personal representative is responsible for exercising the individual’s rights. According to 45 CFR 164.528, covered entities should provide a patient’s representative access to their PHI. Moreover, the substitute may also authorize disclosures of the medical records of the individual they represent.

Each individual has an authorized representative like what is indicated below:

  • Deceased person: Next of kin or other family member
  • Unemancipated minor: Parent or guardian
  • Adult or emancipated minor: Legal guardian

As prohibited under federal law, organizations and other covered entities should treat the personal representative as the individual for PHI disclosure purposes.

Disclosures for public health and safety

The HIPAA Privacy Rule permits healthcare authorities to access PHI for public health and safety purposes. For instance, medical providers can make public health reports accessible without authorization after identifying threats to public safety. This provision aims to prevent the further spread of harmful diseases in the cities and communities.

Aside from viral illnesses, other examples of public health activities include child abuse incidents, tracking FDA-regulated products, and post-marketing or workplace surveillance. Access to medical records can only be made available by public health authorities, including state and local health departments, the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention, and the Occupational Safety and Health Administration (OSHA).

Disclosures requiring authorization

As per the HIPAA Privacy Rule, any personal health information is only available to the person it belongs. While some exceptions exist, the HHS generally requires healthcare organizations to obtain patient consent before disclosing their medical records to third-party entities.

Understanding HIPAA Disclosure: What It Is and How It Works

When Is Patient Authorization Necessary?

HIPAA emphasizes the importance of patient authorization at all times. This particularly applies to healthcare organizations needing to disclose their patient’s data outside public health and safety concerns.

Obtaining valid authorization forms

A valid HIPAA authorization form clearly states the PHI description, the recipient’s name, the purpose of use, the expiration date, and the signature of the person making the authorization. Upon signing, the patient can revoke the authorization at any given time.

Minimizing disclosures and the “minimum necessary” standard

The HIPAA Privacy Rule has a minimum necessary standard that requires covered entities to review their current data security measures. Furthermore, this provision specifies that covered entities should develop policies and procedures appropriate for their staff and organizational demands.

Applying the minimum necessary rule

The minimum necessary rule only applies to certain situations. For instance, hospitals may implement policies allowing medical practitioners to access an individual’s medical record for diagnosis and treatment. Doctors must explicitly state a justified reason why they need to access a patient’s medical records without consent. However, they must implement case-by-case reviews for recurring or routine requests. Covered entities must also limit the information disclosed for each request, which should be relevant to the specified purpose.

Exceptions to the minimum necessary requirement

According to HIPAA, some cases do not need the minimum necessary standard, such as: 

  • Disclosure request for treatment purposes  
  • Individuals subject to the information  
  • Disclosures under an individual’s authorization
  • Disclosure request for law enforcement purposes
Understanding HIPAA Disclosure: What It Is and How It Works

3 Best Practices for HIPAA Disclosures

In today’s evolving healthcare landscape, strict adherence to data protection measures is vital to avoid the devastating effects of security and privacy breaches. Providing quality care to patients also involves maintaining their trust by ensuring that their data is kept safe and secure from malicious entities or individuals.

Here are three best practices to consider when it comes to HIPAA disclosures:

1. Train employees on HIPAA requirements

HIPAA training helps reduce compliance violations among your healthcare staff. When your employees are aware of the potential risks associated with unjustified PHI exposure, they can avoid mistakes while performing their roles accordingly.

2. Practice end-to-end encryption when sending PHI

Encrypting emails during transit and storage can help secure confidential PHI. Additionally, your email accounts must have strong passcodes and robust access controls like multi-factor authentication. Make sure to sign a Business Associate Agreement (BAA) with your HIPAA-compliant email provider before sending ePHI.

3. Conduct risk assessments

By reviewing your organization’s policies and audit controls, you can identify if your stored data are vulnerable to breaches. It also helps to perform regular data privacy assessments to determine potential security gaps and implement the necessary interventions before it’s too late.

Kent Cañas

Kent is a content strategist currently specializing in HIPAA-compliant online fax. Her expertise in this field allows her to provide valuable insights to clients seeking a secure and efficient online fax solution.

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