The Health Insurance Portability and Accountability Act (HIPAA) was developed in 1996 with the objective of protecting patients’ personal health information electronically.

This includes laws on how information is stored and shared. It also clearly outlines the rights of patients regarding their medical records.

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It’s important that clinical medical assistants understand HIPAA so that they know how to respect patients’ boundaries. This also helps medical assistants to avoid penalties for violations of the rules.

Read on to learn more about HIPAA for medical assistants, including the rules, processes, and procedures designed to protect patient confidentiality.

Overview Of The HIPAA

The HIPAA is a set of privacy rules established by the U.S. Department of Health and Human Services (HHS). The main purpose of the act is to protect the privacy and security of patient information while also ensuring their access to it.

It applies to all individuals and healthcare organizations that conduct electronic transactions of protected health information (PHI). PHI includes all health information that is put into medical records, including a patient’s name, date of birth, medical record number, and other identifying information.

Written, spoken, and electronic conversations between health personnel regarding treatment also form part of personal health information, along with all types of billing information.

Only authorized health personnel should have access to PHI to provide patient care. Access is strictly prohibited to other employees whose patient has not given their consent to view their PHI.

Entities and Business Associates Under HIPAA

All covered entities under the HIPAA must comply with all HIPAA regulations that protect the privacy and security of patient information.

These entities include healthcare providers, such as all doctors, dentists, chiropractors, psychologists, clinics, and nursing homes. Health plans are also listed as an entity. This includes health insurance companies, HMOs, and all company/government plans that pay for healthcare.

Lastly, all healthcare clearinghouses that process standard and nonstandard health information they receive are also required to abide by HIPAA.

Penalties For Violating HIPAA Regulations

Violating HIPAA law can result in serious consequences, both civil and criminal. Every medical assistant should be aware of these consequences, as accidental violations are very possible.

Depending on the severity of the violation, fines can range from $100 to $50,000 per violation. Apart from the financial consequences, organizations can also suffer reputational damage as a result of a lawsuit, leading to loss of business and other opportunities.

In some cases, HIPAA violations can result in the loss of a healthcare license, leaving the person responsible for the violation jobless.

The HIPAA Privacy Rule

The HIPAA Privacy Rule outlines guidelines for maintaining the privacy of medical records and PHI and limiting the extent to which the information is disclosed for necessary treatment.

Patients have rights under the Privacy Rule, a few of which include the following:

  • The right to access and obtain a copy of their medical records and PHI.
  • The right to request restrictions on how their PHI is used and disclosed.
  • The right to request changes and amendments to their records.
  • The right to file a complaint if they believe their rights have been violated.

Other types of information that are covered in this rule include permitted and authorized uses and disclosures, minimum necessary requirements for disclosure, notice for privacy practices, and penalties for non-compliance.

The HIPAA Security Rule

The HIPAA Security Rule requires that covered entities and business associates implement administrative, physical, and technical safeguards to ensure the confidentiality of electronic PHI (ePHI).

The rule requires the following from covered entities:

  • All ePHI created or received must remain strictly confidential.
  • Protection must be ensured against anticipated external threats to the security of ePHI.
  • Protection must be ensured against impermissible uses or disclosures.
  • The workforce must be trained to comply with security rules.

Data breach notification requirements

Should a data breach occur, covered entities are required to provide written notification to affected individuals no later than 60 days after discovering the breach. If the breach affects 500 or more individuals, covered entities must notify HHS at the same time as they notify affected individuals.

Lastly, if the breach affects 500 or more individuals in a state or jurisdiction, covered entities must give notice to major media organizations in the area.

Business associate agreements

Business associate agreements are contracts between covered entities and their business associates that outline the responsibilities of each party concerning protecting personal health information.

Covered entities may disclose information to business associates who intend to use the information purely to assist the covered entity with its health care functions. For example, this includes businesses that help with claims processing, quality assurance, billing, data analysis, and so on.

Some of the key provisions that should be included in a business associate agreement include:

  • Permitted uses and disclosures of PHI by the business associate.
  • Requirements for the business associate to implement appropriate safeguards to protect the confidentiality of PHI.
  • A requirement that the business associate reports any security incidents or breaches to the covered entity.
  • A requirement that the business associate ensures that any subcontractors it engages also comply with the Security Rule’s requirements.
  • A requirement that the business associate returns or destroy all PHI upon the termination of the agreement.

HIPAA Enforcement And Compliance

The HIPAA enforcement and compliance process involves the investigation of possible HIPAA violations, issuance of penalties for non-compliance, and corrective action plans to address identified violations.

A medical assistant who fails to comply with HIPAA may face legal penalties if a complaint is taken up with the Office for Civil Rights (OCR). The consequent punishments can be very costly and can cause serious reputational damage. For this reason, CMAs must take compliance with HIPAA rules very seriously.

HIPAA training requirements for CMAs

Organizations should provide annual HIPAA training to the workforce, including medical assistants. This is to keep all health personnel up to date with best practices and to remind them of the importance of patient privacy.

The HIPAA training requirements for CMAs may vary depending on their specific job responsibilities.

In general, however, training should cover the following:

  • HIPAA regulations and privacy rule requirements
  • HIPAA security rule requirements
  • Patient confidentiality and privacy policies and procedures
  • How to report a potential HIPAA violation or breach
  • Plans to improve HIPAA compliance

HIPAA audit preparation

Healthcare organizations should be ready at all times for a possible audit from the OCR. As a medical assistant, you can be prepared for this by remaining aware of your roles and responsibilities when it comes to HIPAA compliance.

Some healthcare providers, health plans, and clearinghouses conduct an internal audit from time to time as a way to ensure that all policies and procedures are up to date and that all necessary safeguards are in place. This is a great way to identify vulnerabilities and improve on them before it’s time for a regulatory audit.

Bottom Line

In conclusion, understanding the HIPAA rules and regulations is essential for Clinical Medical Assistants to respect patients’ privacy and avoid any penalties for violating the rules. For this reason, every medical assistant should stay up to date with their HIPAA training in preparation for regulatory audits.


What is HIPAA and why is it important for medical assistants to understand it?

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law established by the U.S. Department of Health and Human Services. Its main purpose is to protect the privacy and security of patients’ protected health information.

Every medical assistant must understand HIPAA rules and regulations to respect patient rights and avoid violation penalties.

What training do CMAs need to receive regarding HIPAA compliance?

Medical assistants need to undergo HIPAA training to remain compliant with the rules and avoid accidental violations. All HIPAA training courses should cover HIPAA rules and regulations, identifying protected health information, understanding patient rights, how to handle HIPAA violations and breaches, and security measures for remaining compliant.