HIPAA Compliance for Virtual Private Practices: Your Complete Guide

November 30, 2023

As registered dietitians, it is crucial to protect your patient’s health information when conducting virtual consultations. With the growth of telehealth services, understanding and implementing HIPAA compliance measures has become more important than ever.

You might be feeling like you have way more questions than answers about HIPAA; if so, this article is for you.

HIPAA (Health Insurance Portability and Accountability Act) is a federal law that ensures the privacy and security of individuals’ health information. In virtual private practices, this means having the necessary measures to protect patient data before, during, and after telehealth consultations.

When registered dietitians and other health and wellness professionals transition their practice online, they need to have a system to keep their clients’ private information safe. This includes being mindful of potential risks of privacy breaches associated with their software. By protecting yourself and your clients’ privacy, you can avoid the pain and inconvenience of a privacy breach.

In this blog post, we’ll cover the key important measures to have a HIPAA-compliant virtual private practice. Let’s start with what HIPAA is, exactly.

What is HIPAA?

Close-up of a HIPAA Business Associate Agreement document with a pen on top, highlighting the title section, with blurred papers and a smartphone in the background.

HIPAA stands for Health Insurance Portability and Accountability Act, which is a US federal law that ensures the privacy and security of individuals’ health information.

HIPAA regulations apply to all healthcare providers who collect, store, or transmit protected health information, abbreviated PHI. 

What does HIPAA protect? All of our PHI. 

PHI includes any information that could be used to identify an individual, such as a person’s:

  • Name
  • Date of birth
  • Home address
  • Phone number

Why is HIPAA compliance important?

Gone are the days of our client information being neatly tucked away into a single folder and locked in a filing cabinet. 

Modern healthcare is steadily moving online; as more healthcare visits occur by telehealth, HIPAA compliance becomes ever more important. With each virtual visit, more and more data is being transmitted between care providers and other stakeholders.

Ensuring HIPAA compliance not only protects your patient information but also helps maintain your trust and credibility. As healthcare professionals, it is our ethical responsibility to safeguard sensitive information. 

Understanding HIPAA can be confusing, but we’re here to help make things simpler. And this is important: failure to comply with HIPAA regulations can result in hefty fines and legal consequences.

Who must follow HIPAA guidelines?

The HIPAA regulations apply to all “covered entities“, which include:

  • Healthcare providers (e.g., registered dietitians)
  • Health plans (e.g., health insurance)
  • Clearinghouses (companies that process health information on behalf of others)

In addition to covered entities, business associates must follow HIPAA guidelines. Business associates are individuals or companies that provide services to covered entities and have access to PHI.

Note: While not all health and wellness professionals are “covered entities” and not subject to HIPAA guidelines, maintaining confidentiality in healthcare is still best practice.

The history and evolution of HIPAA

Image of the Hubert H. Humphrey Building sign in the foreground, with the address "200 Independence Avenue, SW" and the emblem of the U.S. Department of Health and Human Services. The building's facade features a repetitive geometric pattern of windows, under overcast skies.

Although protecting private information has always been important, there hasn’t been a comprehensive piece of federal legislation in place to protect it until HIPAA

HIPAA was originally passed in 1996, and the Privacy Rule (which governs the use and disclosure of PHI) was implemented in 2003. In 2013, the HIPAA Omnibus Rule was introduced, which expanded on previous regulations to include business associates.

In recent years, there has been a growing awareness and focus on cybersecurity threats in healthcare, leading to the introduction of the HIPAA Security Rule in 2005. This rule requires covered entities and business associates to implement physical, technical, and administrative safeguards to protect electronic PHI, abbreviated ePHI.

Note: Keep in mind that HIPAA guidelines are at the federal level; you may be subject to additional regulations based on the state you live in

The role of technology in meeting HIPAA requirements

With the growing use of technology in healthcare, it is crucial to understand how different tools and platforms can impact HIPAA compliance. When choosing software for virtual consultations, it’s important to ensure that the platform complies with HIPAA guidelines.

What’s the simplest solution? Choosing tools with built-in HIPAA compliance, such as Practice Better. With HIPAA compliance built in from the start, you get peace of mind that the private information you’re responsible for is safe.

Best practices for ensuring HIPAA compliance

HIPAA compliance doesn’t just happen on its own. In this section, we share practical steps you can take to ensure that your virtual private practice stays on top of HIPAA compliance.

Staff trainings

Top of the list? Hosting staff trainings on a regular basis. 

It’s essential to educate your staff, students, and interns on HIPAA requirements and how to handle PHI securely.

Privacy trainings are available online for you and your staff. 

Auditing and monitoring

To maintain compliance in your workplace,  it’s important to regularly audit and monitor your systems for any potential vulnerabilities or breaches.

The Office of the National Coordinator for Health Information Technology (ONC) has provided this Security Risk Assessment Tool that you can use to evaluate your risk systematically. 

Staying on top of changes

HIPAA regulations are constantly evolving, so it’s vital to stay informed of any changes or updates and implement them accordingly. You may want to consider joining a professional organization that provides regular updates on HIPAA guidelines.

The 3 rules of HIPAA

A cover sheet with "HIPAA REQUIREMENTS" printed in bold, with a medical caduceus symbol below the text, resting on a wooden table alongside a yellow highlighter, a binder clip, and a black leather folder. It represents the 3 rules of HIPAA.

What are the three rules of HIPAA? To ensure HIPAA compliance, it’s essential to understand and implement the three rules of HIPAA. In this section, we’ll cover the three rules: information important to you running a virtual practice.

We’ll also clear up confusion about the security rule vs. the privacy rule: they’re two different things, even though they sound similar. Let’s start with the privacy rule first. 

Privacy rule

The first of the three rules of HIPAA is the Privacy Rule. 

What is the goal of the privacy rule? The Privacy Rule sets the standards for maintaining and protecting PHI. 

This rule explains what information is considered protected health information (PHI), who can access it, and how it can be used.

Core Principles and Objectives

There are a few main principles of the privacy rule of HIPAA. These are

  • Limiting use and disclosure of PHI to what is necessary for treatment, payment, and healthcare operations.
  • Providing individuals with the right to access their own PHI.
  • Implementing administrative, physical, and technical safeguards to protect PHI from threats or hazards. We’ll explain more about this in this article – keep reading!

Protected Health Information (PHI)

PHI includes any information that could be used to identify an individual, such as their name, date of birth, home address, and social security number.

Covered entities and business associates

Business associates for a dietitian in private practice might include the person you hire to submit your claims to insurance for billing and your CPA who advises you on the financial health of your business. 

As mentioned previously, covered entities and business associates are responsible for maintaining HIPAA compliance.

Patient rights under the privacy rule

As healthcare professionals, it’s essential to be aware of our client’s and patients’ rights under the privacy rule. These include:

  • The right to access their own PHI
  • The right to request corrections or updates to their PHI
  • The right to receive an account of disclosures (a record of who has accessed their PHI)

Penalties for non-compliance

Failure to comply with HIPAA regulations can result in severe consequences, starting with financial penalties and higher penalties including imprisonment. 

Security rule

The second of the three rules of HIPAA is the Security Rule. 

The Security Rule requires covered entities and business associates to implement safeguards to protect electronic PHI. These include physical, technical, and administrative measures to prevent unauthorized access or disclosure.

Safeguarding electronic PHI (ePHI)

As a business owner, you can take practical measures to safeguard ePHI, including:

  • Implementing access controls such as unique user IDs and passwords
  • Encrypting electronic PHI when transmitted or stored
  • Regularly backing up data and having a plan in place for disaster recovery

Administrative, physical, and technical safeguards

Protecting PHI requires policies and procedures in place to physically protect data, to prevent a data breach, and having policies in place that keep your staff and contractors well-trained and empowered to do their part. 

Administrative safeguards

  • Creating and implementing policies and procedures for the use and disclosure of PHI
  • Conducting regular risk assessments and implementing security measures based on the results
  • Training employees on HIPAA compliance and regularly reviewing protocols with them
  • Prevent incidental disclosures by regularly reminding employees to discuss patient needs in private, to prevent anyone from accidentally overhearing protected information.

Physical safeguards

  • Implementing security measures to control access to physical spaces where PHI is stored
  • Properly disposing of physical records containing PHI

Technical safeguards

  • Using firewalls, encryption, and other security measures to protect electronic systems and data containing ePHI
  • Regularly updating software and operating systems to ensure the latest security patches are in place

Risk analysis and risk management

How robust and comprehensive is your plan? Your risk analysis will help you to find any weak areas in your plan. These audits are key to maintaining HIPAA compliance in your virtual private practice. 

By regularly auditing your systems, you can ensure that your virtual private practice remains HIPAA compliant. 

Breach notification requirements

In the event of a breach, covered entities are required to notify affected individuals and the Department of Health and Human Services (HHS) promptly. 

Examples of security breaches

Despite all of these measures in place to protect our client and patient data, security breaches still happen regularly

Breach notification Rule

The third and final rule of HIPAA is the Breach notification rule. 

The breach notification rule & HIPAA: what do you need to know? Let’s dive in. 

Definition of a breach

A breach is defined as the acquisition, access, use, or disclosure of PHI in a manner not permitted by HIPAA regulations. 

In simple terms, a breach happens if a person or organization gains access to data that they’re not permitted to have, see, or use. Even if it was an accident, it still counts as a breach.  

Notification requirements for breaches

If you have a data breach, you must alert your clients or patients involved. This notification must be sent by first-class mail or e-mail if the affected person has agreed to receive such notices electronically.

Timelines for reporting breaches

If a breach occurs, it is your role to report the breach without delay. The maximum amount of time to report a breach is sixty days. 

Investigation process for potential breaches

If you suspect a breach, it’s crucial to conduct a thorough investigation to determine the nature and scope of the incident. This includes identifying what information was compromised, who may have accessed it, and how the breach occurred. 


The Impact of HIPAA on Healthcare Providers

As healthcare providers, we are responsible for protecting our patients’ sensitive information. HIPAA regulations may seem daunting, but they are in place to safeguard patient privacy and trust. 

By taking the necessary steps to maintain HIPAA compliance in your virtual private practice, you adhere to legal requirements and demonstrate your commitment to protecting your patients’ rights and well-being. 

Stay informed and stay compliant, because, at the end of the day, it’s about upholding ethical standards and providing quality care to those who trust us with their health information. 

Challenges faced by covered entities in compliance

HIPAA compliance can be a challenge for covered entities, especially in the rapidly evolving world of technology. 

With new advancements and tools continuously emerging, it’s essential to stay up-to-date and ensure that all systems and processes comply with HIPAA regulations. This may require additional resources and investments, but ultimately, it is necessary to protect patient privacy and maintain trust in our healthcare.

Benefits of HIPAA compliance for patients and providers

HIPAA compliance is crucial for all healthcare providers, including those with virtual private practices.

Maintaining HIPAA compliance not only protects patient information but also benefits healthcare providers. By implementing security measures and protocols to safeguard PHI, we can prevent data breaches and maintain our reputation as trusted professionals. 

It also promotes a culture of ethical standards and trust between patients and providers, ultimately leading to better communication and quality of care. 

In short, by being HIPAA compliant, we not only fulfill our legal obligations but also uphold ethical standards and build a strong foundation of trust in the healthcare industry.

Common misconceptions and myths about HIPAA

Despite its importance, many misconceptions and myths surround HIPAA compliance. Some of the most common ones include:

MythFact
I don’t need to worry about HIPAA if I don’t bill insurance.if you have client information, it is your responsibility to protect it, even if you’re a cash-pay business.
I don’t need to follow HIPAA if I only have paper documents.Even if your documentation is not digital, you still need to have measures in place to keep that private information confidential. 
HIPAA is the only law that governs medical records.There are federal and state-level laws that govern medical records. 
HIPAA only covers individual appointments, not group appointments.HIPAA protects all appointments, whether they take place individually, in a group setting, or within online courses to increase income

The future of HIPAA

With the healthcare industry constantly evolving, it’s crucial to stay informed about any changes or updates to HIPAA regulations. 

As technology continues to advance, we can expect to see more emphasis on data protection and security in the healthcare field. This means that staying compliant with HIPAA will remain a top priority for covered entities, and regular updates and audits will be necessary to ensure continued compliance. 

Conclusion

HIPAA compliance is important, but it can feel confusing. After reading this article, you have a much better understanding of what HIPAA is, who it protects, and what your role is for keeping private information, private. 

The three core tenets of HIPAA – the Privacy Rule, the Security Rule, and the Breach Notification Rule – form the backbone of patient information security in any healthcare setting, including virtual private practices. They serve as safeguards, ensuring patient confidentiality and trust, integral elements in the healthcare industry. 

Upholding these standards and remaining HIPAA compliant require continuous effort, vigilance, and adaptability as things change. As healthcare providers, staying informed about HIPAA regulations, implementing necessary safeguards, and consistently auditing our systems is critical. By doing so, we adhere to legal requirements and reinforce the trust of those who entrust us with their sensitive health information.


Practice Better is the complete practice management platform for nutritionists, dietitians, and wellness professionals. Streamline your practice and begin your 14-day free trial today.

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