5 Tips for Secure HIPAA Faxing

12 minute read

The Health Insurance Portability and Accountability Act (HIPAA) requires the protection and security of sensitive data related to patients. Entities including healthcare providers, health maintenance organizations (HMOs), insurance companies, or any other organization or business that works towards providing operations, payments, and treatment in healthcare need to meet HIPAA compliance. Keep reading for secure HIPAA faxing tips.

Diagram showcasing the various applications of HIPAA Fax in healthcare, including medical records, prescriptions, patient referrals, provider collaboration, patient billing, patient onboarding, and treatment plans.

As technology develops, the ways of data sharing have also increased. It is important for any business related to the healthcare sector to ensure that their chosen method of data transfer complies with HIPAA. HIPAA-compliant faxing ensures that the fax system used to transfer confidential information related to patients is encrypted and secured so that there is no option for a data breach.

Understanding HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was mandated by the US Congress in 1996. HIPAA law includes federal regulatory standards that outline the lawful use, privacy, and disclosure of protected health information in the United States of America. The Department of Health and Human Services (HHS)compliance regulates HIPAA compliances, and the Office of Civil Rights (OCR) enforces them. HIPAA mandates a national standard for preventing the disclosure of sensitive health information related to a patient without their knowledge and consent. The HIPAA Privacy Rule was issued by HSS for the implementation of this mandate.

The law demands that those in the healthcare industry and other organizations working directly or indirectly with patient data, must ensure protection of security, privacy, and integrity of protected health information (PHI). Compliance with the law will not just secure sensitive patient information, but also protect businesses in the healthcare sector from financial and legal penalties.

The HIPAA was created to:

  • Modernize the flow and transfer of healthcare information
  • Set standards for the maintenance of personally identifiable information (PII) by healthcare, insurance, and other related businesses so that the information is protected from theft and fraud
  • Address concerns related to limitation of health insurance coverage, like having coverage continuation despite the person switching jobs, and coverage of people having pre-existing conditions
  • Give patients control over who sees their information and who can access it
  • Penalize organizations who do not safeguard data and information

Understand HIPAA Compliance and Faxing

In today’s digitally connected world, transmitting information from one point to another within seconds is a reality. However, not all modes of digital communication are equal. For example, sending a confidential document over email is not the best way, as it is more vulnerable to hacking.

Despite the common notion that faxing is an outdated technology, it cannot be denied that fax still remains one of the most secure means to send out confidential information. When it comes to securing the privacy of patients’ PHI, faxes play a very critical role.

In the case of HIPAA compliance, there should be no scope for ignorance of security gaps as even the smallest error or breach of data can lead to the Federal Office of Civil Rights (OCR) imposing penalties on the defaulting entity.

While the fax system is highly secure, the entities covered under HIPAA compliance must ensure that the fax service they are selecting is HIPAA compliant and willing to sign a business associate agreement (BAA) to acknowledge their responsibilities in the case. The covered entities and the healthcare providers must also follow best practices of HIPAA compliance like using HIPAA complaint cover pages, securing multifunctional printers (MFPs) and fax machines, and ensuring that the PHI stored in digital format is not accessible by unauthorized persons.

The entities covered under HIPAA privacy rules are depending more and more on modern cloud-based fax systems to share information and data with other healthcare providers, insurance agencies, and other third-party business associates.

It is important for these businesses to ensure that the fax service provider they are working with does not just have a complete knowledge of HIPAA but is also compliant with it. An important thing that needs to be considered is that the service provider is hosting the data on the data center having robust security with need-to-know basis access. Also, they should be using a state-of-art encryption model for data, both stored and in transit.

What Happens If HIPAA Compliance is Violated?

HIPAA rules may be violated by businesses unknowingly. Some major violations include access or disclosure of PHI without permission and authorization, failure to delete PHI when not needed, failure to conduct risk assessment or risk management, lack of monitoring, lack of access controls, not signing a business associate agreement with other parties before sharing PHI, and improper or no documentation of compliance efforts.

However, not all HIPAA violations are measured the same, and they can have different penalties. Listed below are different levels of violation and the penalties for these infringements.

Tier 1 violation

This is for cases where a business was unaware of the violation despite taking steps to be HIPAA compliant. Here the fine can range from $100 to $50,000 per case.

Tier 2 violation

This type of violation covers instances where the business is aware of the violation, but the violation could not have been avoided despite taking precautions. The fine in such instances can be between $1,000 to $50,000.

Tier 3 violation

This type of violation includes cases where the businesses have willfully shown neglect but did attempt to rectify the violation. In such a situation, the fine can be anywhere between $10,000 to $50,000 per instance.

Tier 4 violation

This is the most severe type of violation. It includes willful neglect from the business without any attempts to rectify the situation. In such cases, the penalty begins at $50,000 per instance.

How to Make a Fax System HIPAA Compliant

Faxing generally is HIPAA compliant by itself, as it offers end-to-end security. Fax lines are believed to be conduits, as they can transmit PHI but not access them. However, HIPAA compliance also calls for safeguards before and after the transmission of documents over fax.

The key goal of HIPAA is to ensure that the businesses in the healthcare sector work on creating administrative, physical, and technical infrastructure and processes that keep the patients’ information safe and protected from unauthorized parties.

While HIPAA does not prohibit the use of fax for transmitting PHI, it does mandate that the information is secure and protected at the dispatch point, during transit, and at the receiving end.

Despite faxing being one of the most secure ways to transmit PHI documents, conventional fax methods come with their own risks. Despite having the best intentions, it becomes difficult for businesses to maintain security measures at all times when using a traditional fax machine. Some of the risks and challenges that are involved with manual fax machines can include:

  • Need to remove the incoming fax immediately from the output tray so that it does not fall into the wrong hands
  • Need to validate pre-programmed numbers periodically and contact the regular fax recipient regularly to make sure that their fax number has not changed
  • Need to position both the sender and the receiver fax machine at a secure location to prevent unauthorized access
  • Need for securely storing the hard copy of the document received to prevent it from access by unauthorized people

However, even using a traditional fax machine, there are some common best practices that can help businesses ensure that their faxing system is HIPAA-compliant.

  • The fax machines should be situated in a secure area, not accessible or visible by the general public
  • Only those having authorization should have access to the fax machine and proper security measures should be taken to ensure the same
  • The number and contact details of the receiving party should be verified before the fax is sent out
  • The recipients should be notified that a document has been sent to them over fax
  • A cover sheet stating that the faxed document contains confidential health information and is being sent after the authorization of the patient and it should not be shared with other parties without consent, should be sent with the faxed document
  • The fax transmission’s confirmation sheet copy should be kept that includes data including time of sending and number of the recipient
  • The delivery should be confirmed with the recipient over the phone
  • The fax document should be stored securely after receiving
  • The transaction and transmission log summaries should be retained

However, most providers have either transitioned or are implementing digital faxing due to its ease of use and heightened security. There are several ways organizations can ensure HIPAA compliance with online faxing:

  • Additional security measures like biometrics and identity verification should be implemented
  • Routine audits and security checks should be conducted
  • Computer systems should have automatic virus and malware scanners
  • Software and fax applications should be updated regularly
  • All third-party integrations should be authorized to handle and store PHI
  • Every account should have unique and strong passwords
  • Users must be alert against phishing scams and clickbait
  • APIs must be maintained and secure

5 Tips for Secure HIPAA Faxing

Using faxes for sending and receiving documents related to the PHI of patients is a very common practice in businesses from the healthcare sector. Fax is considered one of the most reliable and secure means of transmitting documents containing PHI with other healthcare providers, insurance agencies, and other related businesses.

However, it is still important for businesses to adopt some of the best practices when sending and receiving confidential information via fax. Listed below are five tips that should be followed to make the fax system used by businesses more HIPAA compliant.

1. Don’t store PHI in local devices

Many times, data breaches happen in the healthcare business because personal health information is stolen from physical storage devices like laptops, tablets, or removable drives. Migrating the data to a cloud-based storage system can help in solving this problem. In such a system, confidential data is stored remotely on the cloud.

A well-secure cloud storage server can significantly reduce the chances of data breach as it is secured with high-level encryption. This can remove the data from unauthorized access and reduce the chances of hacking. If there is a need to keep a copy of the fax documents on portable devices, one should ensure that the information is heavily encrypted and stored on the cloud server of the business.

2. Maintain an audit trail

HIPAA compliance in faxing can be maintained by creating audit logs. Audit logs allow businesses to track the activities on their network. Audit controls are a necessity for all entities and their business associates covered under HIPAA rules. This means that not just the company belonging to the healthcare sector but also the businesses directly or indirectly dealing with them should maintain audit logs.

When choosing the fax and cloud service provider, businesses should ensure that the provider has features to help them keep track of faxing activities so that they are HIPAA compliant when sharing patient information. As per HIPAA rules, the fax audit trails must be stored for at least six years and the logs should be in the raw format for at least 6 to 12 months before they can be compressed and stored.

It’s also important to advise staff that have access to and transmits documents regularly are reviewed regularly. It’s becoming more common for artificial intelligence (AI) to scan records and advise if there are unauthorized or unusual behaviors. Employees should be aware this is a regular practice.

3. Update and maintain software

Many security breaches are due to poorly maintained software and systems. Hackers and other nefarious players are always consistently for loopholes and flaws in systems, and their technology evolves quickly. As a result, the entire system needs to be automatically updated with any security upgrades.

This is when having reputable SaaS providers is ideal for HIPAA faxing. Organizations should be able to focus on security at their end (such as no sharing passwords, limiting access, ending user access when terminating employment) and the provided platforms should give them all the protection they need. This means the faxing software, any APIs, and the cloud storage facilities. There should be constant vigilance about security loopholes, caution around integration with other software that may create weaknesses, and updates and patches released regularly.

Use of purpose-built software can be problematic unless there’s a dedicated information technology team that monitors and updates platforms and software. It is not a situation where the organization can set it and forget it.

4. Educate employees

This is multi-faceted, because it’s not just educating about software and systems, but also about HIPAA. Training all staff on policies, procedures, and legislation is vital. This should include:

  • What HIPAA allows for, or does not
  • Correct password protocols
  • Phishing and hacking identification
  • Advise about the organizational and individual penalties from non-compliance
  • Keeping personal devices free of PHI, no photos of anything in the office
  • Limiting all email transmissions of PHI
  • Using a cover sheet for faxes

There should also be mandatory refresher courses, especially if procedures and legislation change. This training shouldn’t be a one-off every year, with a huge load of information, but drip-fed through the learning management system. This means no-one is overwhelmed with information and is more likely to retain it. It also keeps protocols fresh and at the top of mind.

5. Regulate devices

Almost half of all HIPAA breaches are due to theft of laptops or other electronic devices. While it should be a no-brainer to not leave devices in the car or unattended in public, there needs to be strict protocol around this. At the very least, there should be multi-factor authentication access to internal systems so even if hardware is obtained, no-one can access the system. This could mean password protection, use of a one-time password via phone or key fob, fingerprint scanning, face recognition, or a secret question.

Because HIPAA faxing is often in-built and embedded into medical platforms, having an understanding of how it works is vital. If someone accesses a device, they have access to everything; this represents a huge HIPAA violation.

Keep Your Fax Protocols HIPAA Compliant

Use of faxing, fax APIs, and cloud storage has made it easier for organizations to become HIPAA compliant. If use of HIPAA-compliant SaaS providers is prioritized, it can take a huge chunk of worries about security away. By utilizing platforms, processes and fax software that is approved and future-proofed for use, any organization can communicate in a secure and highly confidential manner.

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