FAQ’s

Answers to Your Most Common
HIPAA Questions

Organizations across the country rely on HIPAA EXPRESS® to achieve full compliance — faster, smarter, and stress-free.

Am I required to encrypt my emails?

It depends upon what you are emailing. If you are sending PHI, yes, you should encrypt. If you are sending records, you can easily encrypt through Winzip. Your other option is to put the document on a secure server that is encrypted. There are any number of Google Drive, GoDaddy, Dropbox, and others. Windows 7 and 10 include full drive encryption. You can also encrypt PDFs, CDs, and USB drives. Faxing is not considered an electronic communication under HIPAA and is therefore considered secure, though not infallible (e.g., faxing PHI to the wrong party).

No, faxing does not make you a Covered Entity (CE). However, you may be subject to other regulations around the privacy and security of PHI.

Clients have the right to request alternate communication methods. If a client requests text messaging, explain the risks and obtain written permission. If a patient texts you, it’s reasonable to assume they understand the risks.
If text messages between providers contain PHI, they must be encrypted. Generic texts such as “your 4:00 canceled” do not need encryption.

Check the credentials of the consultant, company, or author. Excellent certifications include:

  • AHIMA: Certified in Healthcare Privacy and Security (CHPS)

  • HIMSS: CAHIMS, CPHIMS

  • ISACA: CISA, CISM, CRISC, CSX

  • (ISC)²: CISSP, HCISPP

  • IAPP: Certified Information Privacy Professional (CIPP)

Everyone must take common sense steps to protect patient information privacy and security, especially electronic PHI.

If you are sending PHI, you must encrypt. For records, you can encrypt via Winzip or use secure, encrypted servers. You can also use full-drive encryption, encrypted PDFs, CDs, and USB drives. Faxing PHI is considered secure, though not error-proof.

All workforce members must be trained on your organization’s specific HIPAA policies and procedures, not just general HIPAA knowledge. Training should occur when an employee starts, before accessing PHI, and after any breach.

No. Organizations, not technology, are HIPAA compliant. You must perform due diligence on your Business Associates (BAs) to ensure they comply with HIPAA.

Verify the subpoena’s validity. Document all disclosures. Ensure the patient has been notified or obtain a protective order that restricts PHI use and requires destruction or return after litigation.

No. HIPAA allows you to continue obtaining patient consent, maintaining consistency with your state law.

A BA is anyone working for you who isn’t a workforce member (e.g., third-party vendors). Employees, volunteers, and treatment team members are not BAs. You must assess risks, ensure BAs protect PHI, and terminate agreements if violations persist.

HIPAA issues overlap with other privacy regulations. Following HIPAA provides legal protection (“affirmative defense”) if a breach occurs.

You should be able to produce:

  1. Your HIPAA policies and procedures manual

  2. Training logs and materials

  3. A security risk assessment (SRA)

  4. A remediation plan

  5. Due diligence documentation for Business Associates

Yes. Seeing names on a sign-in sheet is an “incidental disclosure” and not a breach. Some practices use peel-off labels or black out names after sign-in for added privacy.

All Covered Entities must comply, but HHS allows flexibility depending on your organization’s size, resources, and capabilities.

The “minimum necessary” rule does not apply to treatment-related disclosures, patient access to PHI, or authorized releases.

No, although some government and private payers may require electronic submission.

Skype is encrypted, but messages are stored and therefore considered stored PHI. Other secure options include TrueConf, Off-the-Record Messaging, Jitsi, Cryptocat, and Zfone.

Mobile devices must be encrypted due to risk of loss or theft. Practices should enforce policies on lockout, texting, camera use, device inspections, and remote wipe capabilities.