HIPAA Compliance for Medical Practices
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HIPAA Compliance and HIPAA Risk management Articles, Tips and Updates for Medical Practices and Physicians
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What is a BAA? (HIPAA Business Associate Amendments)

What is a BAA? (HIPAA Business Associate Amendments) | HIPAA Compliance for Medical Practices | Scoop.it

What are a Covered Entity’s Obligations under the HIPAA Business Associate Amendment?

Since the term “HIPAA Business Associate Amendment” is simply another name for “Business Associate Agreement,” a provider’s rights and responsibilities under the HIPAA business associate amendment are the same as those under a regular business associate agreement.

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For Google to enter into a HIPAA business associate amendment with a provider, that provider must first have an existing agreement in place with Google. Once the agreement is in place, Google will enter into the amendment, provided that a provider represents:

 

◈ That the provider, through whomever signs the agreement (i.e., CEO, CIO, COO), has the authority to bind the business to the terms of the agreement;

 

◈ That the provider has read and understood the terms of the business associate amendment; and 

 

◈ The provider agrees to the terms of the agreement. 

If (and only if) a provider agrees to these terms, Google will enter into the business associate amendment. 

 

The business associate amendment requires that a provider cannot request Google use or disclose PHI in any manner that would not be permissible under HIPAA, if done by a covered entity itself (unless otherwise expressly permitted under HIPAA for a Business Associate).

In addition, the provider must make use of the available security controls provided by Google. Finally, the agreement requires that the provider not transfer PHI from one Google product to another, except when Google has expressly entered into a separate HIPAA business associate agreement for use of such Google services.

 

In turn, Google may only use and disclose PHI as permitted under HIPAA, and as outlined in the main agreement and the business associate amendment.

 

Google may also, as permitted by HIPAA, use and disclose PHI for the proper management and administration of Google’s business and to carry out the legal responsibilities of Google. Google will only use or disclose PHI for these purposes:

 

◈ Required by law; or

◈ If Google obtains written reasonable assurances from the person to whom the PHI will be disclosed that the PHI will be held in confidence, used only for the purpose for which it was disclosed, and that Google will be notified of any breach.

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Telehealth, Video Tech Tools and HIPAA Compliance

Telehealth, Video Tech Tools and HIPAA Compliance | HIPAA Compliance for Medical Practices | Scoop.it

elemedicine has been around for years, but as a healthcare service it has been underutilized.

 

Today, virtual visits for medical care have skyrocketed because of the COVID-19 outbreak and other factors.

 

Telehealth is experiencing a revolutionary moment like never before. By the end of 2020, virtual medical care usage is estimated to reach upwards of 1 billion interactions, according to analysts at Forrester Research. 

 

In addition, some restrictions that were barriers to entry before have been lifted in response to the public health pandemic. And in March 2020, the Trump Administration expanded Medicare's coverage allowing beneficiaries to receive more extensive care through telehealth visits. These are done using video and audio applications. 

 

With the advent of stay-at-home orders and social distancing, technology is healthcare's solution for delivering continuous patient care. Tech tools' enable widespread access, bringing an unprecedented reach to a larger patient population.

 

For medical practitioners, the shift of using video platforms to communicate can come with risk and HIPAA compliance concerns. OCR asks that telehealth sessions be conducted in a private environment.  Sometimes this could be achieved with a simple task such as closing an office door or lowering one's voice.  

 

The Office for Civil Rights has issued an announcement, guiding on which audio and video communication platforms are acceptable and not acceptable for patient interactions during the coronavirus pandemic. 

 

As stated officially by OCR on its website:

"OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency."

In this blog post, we will highlight some of the video communication platforms that follow OCR's public health emergency guidance. Of course, keep in mind that compliance regulations might change in upcoming months.

Telehealth video calling platforms to use amid the pandemic

Under OCR's notice, covered healthcare providers can use certain platforms for non-public facing video communications with patients, as these platforms are HIPAA compliant and will enter into Business Associate Agreements (BAAs).

Some of these are:

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • Doxy.me
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings / Webex Teams
  • Amazon Chime
  • GoToMeeting
  • Spruce Health Care Messenger

Zoom is on this list, but with the recent rise in security attacks from threat actors joining Zoom meetings uninvited, we have seen advice from various  entities to use a different video platform when communicating with patients, until all security and privacy issues with Zoom are fixed. No one wants to deal with Zoom-bombing during an important medical visit. 

It's important to note that these technological tools are third-party providers and they may pose privacy risks. However, using FaceTime, for instance, during the pandemic is not necessarily a compliance violation, depending on a case by case basis. 

What if patient does not have access to video telehealth formats

If the telehealth session is being conducted in good faith during this public health emergency, then OCR permits the use of audio methods like wireless phone, landline phones to conduct the session. If using email or texting, they ask the covered entity to try and utilize safeguards whenever possible, such as secure email or secure texting.  

Avoid using TikTok for telehealth sessions

On the other hand, OCR stated the following public-facing applications are not to be used when providing telehealth services, even during the public health crisis. OCR is not the sole government agency warning about TikTok's security implications. The wildly popular app has come under fire for underage privacy and international security concerns by U.S. lawmakers and security professionals.  Using public-facing communications could be an evidence of bad faith on the part of the provider, which could make the provider liable for OCR enforcement actions. 

Avoid using these platforms for telehealth:

  • Facebook Live
  • Twitch
  • TikTok

 

Not only that, the guideline explains to avoid using any public-facing technology, meaning the session can be seen by a group. 

For privacy protections and peace of mind, OCR advises to turn to HIPAA compliant technology platforms.

 

There are vendors available, who will enter into a HIPAA Business Associate Agreement with a covered entity. Check with the vendor to see if that's the case. When in doubt, reach out to third-party HIPAA experts to ensure your following compliance regulations as you transition to doing telehealth. 

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What is a HIPAA Service?

What is a HIPAA Service? | HIPAA Compliance for Medical Practices | Scoop.it

A HIPAA service is a service performed by one entity, that enables another entity to meet its HIPAA compliance obligations.

 

Under HIPAA, healthcare providers frequently contract with vendors who perform services involving protected health information.

 

The services include billing, collections, medical transcription, e-prescribing, and many others.

 

If a vendor is performing such a HIPAA service, the vendor is considered to be a business associate, and must comply with HIPAA regulations.

When is a HIPAA Service Used?

Healthcare providers frequently contract with other entities to perform services involving protected health information (PHI). Sometimes, healthcare entities will contract with a service for the sake of convenience. For example, if a patient has not paid for healthcare services, a healthcare organization may refer the patient’s account to a collections agency.

 

Once the account is referred, the collections agency seeks payment directly from the patient. By contracting with the collection agency to provide this service, the healthcare entity can spend time on other activities. 

Find out now by completing the HIPAA compliance checklist.

Healthcare providers also contract with other entities to provide a HIPAA service when the service the provider needs is outside its area of expertise. For example, the healthcare provider may not have a designated IT department capable of providing remote backup services.

 

Healthcare providers often contract with IT consultants and contractors to provide these and other security services that allow the provider to satisfy its obligations under the HIPAA Security Rule.

What is Required When a Provider Uses a HIPAA Service?

Entities with which providers contract to provide services involving creation, maintenance, receipt, or transmission of protected health information, are known under HIPAA as “business associates.” Before a business associate can create, maintain, provide, or transmit PHI, the business associate must enter into an agreement with the provider.

 

This agreement, known as a business associate agreement or business associate contract, must contain language requiring the business associate to provide satisfactory assurances to the provider that the business associate will appropriately safeguard the protected health information it receives or creates on behalf of a provider. The HIPAA Privacy Rule requires that these satisfactory assurances must be in writing. 

 

 

The business associate agreement must contain the following components, among others:

 

◈ A description of when the business associate is permitted to use PHI, and when the business associate is required to use PHI;

◈ A provision prohibiting the business associate from further using or disclosing the PHI other than as permitted or required by the contract or as required by law;

◈ A requirement that the business associate use appropriate safeguards to prevent a use or disclosure of the protected health information other than as provided for by the agreement.

 
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5 Ways to Stay HIPAA Compliant with Telemedicine

5 Ways to Stay HIPAA Compliant with Telemedicine | HIPAA Compliance for Medical Practices | Scoop.it

Here are 5 things you can do to stay HIPAA compliant while still providing an ideal telemedicine experience.

1. Pick the Right Location

HIPAA compliance goes beyond the actual technology and also affects the provider’s surroundings during the visit. Providers must select a secure and quiet location where the only people who can see or hear the visit are people who are directly related to care.

 

This means that offices in homes must be private and that sessions done from unfamiliar locations must also be secure. Often, telehealth visits are provided on the fly due to urgent complaints or last-minute needs from patients. Even in those situations, the provider must find a location where the patient cannot be overheard by those not involved in their care.

2. Secure the Patient Environment

It is highly recommended that the patient is in a private location where there are no uninvited individuals who can overhear. The burden of ensuring that patients are in a secure location actually falls on the patient, and not the provider. The patient is responsible to secure their own safe space for distance treatment under HIPAA.

 

That said, many providers take the extra step, and they will have patients shows them the room that they’re in, identify anyone who shares the space with them, provide an address for where they are currently located to match it with the address on file, and even discontinue the session if they’re not comfortable with the security.

 

These procedures vary considerably by the provider, and there are no clear-cut rules in HIPAA regulations that advise how to address these concerns. Limiting visits based on privacy concerns is an internal protocol for each practice.

3. Give Proper Instruction (At A Distance)

By working with a platform that notifies and shares best practices with patients, patients can be educated before beginning the session and reduce the burden on the provider to verify the patient’s location.

 

Notifications that are sent out in advance of the appointment should encourage pre-visit routines like preparing necessary information, testing connection speed and securing the environment.

 

Users should have an understanding of what is considered acceptable for the visit, and the notifications should be customizable to include any pertinent information for this specific connection attempt. The instructions for a behavioral health visit may be different than a well visit, and the customization of the notifications that go out gives providers an opportunity to ensure that their patients have this information without delay.

4. Utilize Proper Security Protocols

Most of the work to ensure HIPAA compliance should be done by the platform that you’re using. The connection should be encrypted and the platform secure.

 

Beyond that, providers have a responsibility to ensure that their own location is secure, and many choose to develop patient security protocols as well. The burden of ensuring HIPAA compliance is not as complicated as it can seem.

 

As long as no one aside from the healthcare provider and the treatment team has access to the patient’s information, you have done most of the work.

5. Don’t Sacrifice on Video Connection

The platform itself must encrypt the transmission of the video feed, but it can’t sacrifice connection strength to do it. By working with a platform that can provide a consistent connection with low bandwidth requirements, it is possible to get a HIPAA compliant platform that is easy to use even on mobile data.

Technical Dr. Inc.s insight:
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