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HIPAA Compliance for Dental Offices 

While some dental offices are considered self-contained entities, HIPAA does apply to all dental offices. This applies to the process of sending pre-determinations, treatment authorization requests, claim status inquiries, eligibility requests, or claims electronically. 

Additionally, if the dental office transmits any of the above-listed transactions to a payer directly on paper, or if they use the service of a business associate with access to individually identifiable health information, HIPAA regulations for dental offices are also applicable, and HIPAA compliance must be met. 

Every dental office must develop policies that let employees understand use procedures, disclosure of PHI (protected health information), and how to safeguard this sensitive information. This is true for colleagues and patients and for third-party service providers and other business associates. 

An Overview of HIPAA Compliance

Before diving further into HIPAA compliance for dental offices, understanding HIPAA compliance, in general, may prove helpful. 

HIPAA, which stands for the Health Insurance Portability and Accountability Act, was established in 1996. It is a series of regulatory standards that mandate the proper use and disclosure of protected health information (PHI). The Department of Health and Human Services regulates HIPAA, and it is enforced by the OCR – Office for Civil Rights. 

PHI Defined 

PHI is any type of information that could be used to identify a client or patient of a HIPAA-beholden entity. PHI includes:

  • Medical records

  • Names

  • Phone numbers

  • Addresses

  • Full facial photos

  • Financial information

  • Social Security numbers 

  • And Eleven other PHI Identifiers

PHI that is accessed, stored, and transmitted electronically also falls under the HIPAA regulatory standards and is called ePHI or electronic protected health information. ePHI is regulated by HIPAA Security Rule, which is an addendum to the HIPAA regulation created to account for changes made in medical technology. 

The Rules of HIPAA

HIPAA includes several different rules. Here’s a quick look at the laws that all entities need to be aware of:

  • HIPAA Privacy Rule: Sets the national standards for patient rights and PHI. Some standards outlined include the patients’ rights to access PHI, the requirement of providers to fully protect PHI access, contents of use and disclosure of HIPAA release forms, and more. 

  • HIPAA Security Rule: Sets the national standard for the secure handling, transmission, and maintenance of ePHI specifically. 

  • HIPAA Breach Notification Rule: The Breach Notification Rule is the standards that must be followed if a data breach of PHI or ePHI occurs. 

  • HIPAA Omnibus Rule: An addendum to the HIPAA regulation enacted to apply HIPAA to business associates and other covered entities. 

Requirements for HIPAA Compliance 

To ensure HIPAA compliance, there is a set of national standards that must be addressed, including:

  • Select a Privacy Officer to oversee the implementation of a compliance program

  • Knowing the core rules and their required mandates

  • Complete Annual Security Risk Analysis and Management

  • Adopt Privacy Policies and Security Procedures

  • Breach Preparation

  • Ongoing training

  • Enacting proper business associate agreements and other collaborations

The Importance of HIPAA Compliance for Dentists 

For all healthcare entities, protecting patients’ PHI should be considered a top priority. One reason for this is because the healthcare industry is considered one of the most targeted when it comes to ransomware attacks. 

These attacks occur if a hacker infiltrates the internal network and then steals or encrypts sensitive data or demands money to return it. 

Some smaller medical practices (including dental offices) don’t think protection is necessary because the small size disqualifies them as a target for attacks. Unfortunately, this isn’t the case. Hackers are now targeting smaller practices and offices more than ever before. 

Modern dental offices hold all types of information about patents that some people think of as being innocuous; however, a lot of this information could be used to commit financial fraud or steal someone’s identity. Most dental files include PHI, such as names, phone numbers, addresses, insurance information, Social Security numbers, medical details, and credit card information. Because of this, HIPAA compliance is a must. 

HIPAA Rules Overview for Dental Offices 

The HIPAA Rule for Dentists comprises the Privacy Rule, Security Rule, and Breach Notification Rule.

It’s equally important for dental offices and dentists to make sure they are familiar with changes to the rules caused by the Final Omnibus Rule or HITECH Act. A few essential parts of HIPAA compliances for dental offices include:

  • Personal identifiers considered PHI

  • Permissible uses and disclosures of PHI

  • Safeguards for implementing and protecting patient privacy and health information

  • Explanation of the Minimum Information Necessary rule

  • Patient access to notice of privacy practices and medical information

  • Restrictions of using PHI for marketing

HIPAA Security Rules for Dental Offices 

There are three sets of requirements included in the HIPAA Security Rule. This includes administrative safeguards, technical safeguards, and physical safeguards. 

  • Administrative Safeguards: These administrative safeguards include the procedures and policies regarding the use or disclosure of PHI. These must be customized to your company’s business operations directly. In addition to that, all employees must receive annual training on your office’s procedures and policies and HIPAA requirements, a privacy officer must be appointed, and more.  

  • Technical Safeguards: This applies to security measures used for securing sensitive data. Includes things like data backup, firewalls, encryption, access controls, and two-factor authentication. 

  • Physical Safeguards: The security measures of your office’s physical site, like the office itself. For example, patient files must be inaccessible to any unauthorized people, including paper records. They should be kept in a locked filing cabinet or room. 

To ensure your dental office is compliant with all HIPAA requirements, you must create and implement a compliance program covering the administrative, technical, and physical safeguards mentioned above. 

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