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Posts Tagged ‘hipaa-compliant email’

Opportunistic TLS vs Forced TLS for SMTP

Tuesday, January 23rd, 2024

Email sometimes seems like magic because of how quickly messages are transmitted across the internet. While the rapid delivery speeds justify this presumption, a lot must happen for an email to reach you. Email sending relies on a protocol called the Simple Mail Transfer Protocol (SMTP) to make its way across the internet to your recipient’s server. From there, the recipient uses another protocol, such as ActiveSync, POP3, MAPI, IMAP, or a Web-based interface, to pick it up and read it.


Unfortunately, these protocols aren’t always secure by default. Under its original design, emails are sent as plain text. Anyone along the email’s journey can see (and even change) their contents. This can include those in charge of the servers, the government, and even hackers that intercept the data.


Thankfully, engineers are aware of this glaring security hole, and they have introduced several mechanisms that can be leveraged to protect email. This article reviews how SMTP TLS works and the differences between opportunistic TLS and forced TLS.


secure email sending on laptop

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HIPAA-Compliant Secure Email: Understanding Encryption

Tuesday, August 15th, 2023

Email encryption is an important topic to understand when evaluating HIPAA-compliant, secure email vendors. Encryption is an addressable standard for HIPAA compliance, but if you send sensitive information via email, encryption is the easiest way to meet the standard.

The two most common email encryption methods include SMTP TLS and Secure Portal Pick Up. This article will discuss their differences and guide users on selecting the right option for HIPAA-compliant secure email.

secure email sending

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HIPAA Email Rules: 8 Requirements for Secure Email

Tuesday, August 1st, 2023

The Health Insurance Portability and Accountability Act (HIPAA) is a complicated law that sets the standards for collecting, transmitting, and storing protected health information (PHI). When information is stored or exchanged electronically, the HIPAA Security and Privacy Rules require covered entities to safeguard its integrity and confidentiality. One of the most common ways that PHI is shared electronically is via email. Understanding how HIPAA rules apply to email is essential to meet HIPAA requirements and protect sensitive data.

hands on keyboard checking off tasks

The HIPAA Email Security Rule

It’s important to note that HIPAA does not require the use of any specific technology or vendor to meet its requirements. Generally speaking, the Security Rule requirements for email fall into four categories:

  1. Organizational requirements state the specific functions a covered entity must perform, including implementing policies and procedures and obligations concerning business associate contracts.
  2. Administrative requirements relate to employee training, professional development, and management of PHI.
  3. Physical safeguards encompass the security of computer systems, servers, and networks, access to the facility and workstations, data backup and storage, and the destruction of obsolete data.
  4. Technical safeguards ensure the security of email data transmitted over an open electronic network and the storage of that data.

Below, we discuss some of the main requirements that apply to email and the steps you need to take to secure email accounts that transmit and store PHI.

HIPAA Email Rules-Compliant Email Checklist

While email encryption gets most of the spotlight during discussions on email security, HIPAA regulations for email cover a range of behaviors, controls, and services that work together to address eight key areas.

1. Access: Access controls help safeguard access to your email accounts and messages. Implementing access controls is essential to keep out unauthorized users and secure your data. Some key steps to take include:

  • Using strong passwords that cannot be easily guessed or memorized.
  • Creating different passwords for different sites and applications.
  • Using two-factor authentication.
  • Securing connections to your email service provider using TLS and a VPN.
  • Blocking unencrypted connections.
  • Being prepared with software that remotely wipes sensitive email off your mobile device when it is stolen or misplaced.
  • Logging off from your system when it is not in use and when employees are away from workstations.
  • Emphasizing opt-out email encryption to minimize breaches resulting from human error.

2. Encryption: Email is inherently insecure and at risk of being read, stolen, eavesdropped on, modified, and forged (repudiated). Covered entities should go beyond the technical safeguards of the HIPAA Security Rule and take steps beyond what is required to futureproof their communications. Some email encryption features to adopt include the following:

  • The ability to send secure messages to anyone with any email address.
  • The ability to receive secure messages from anyone.
  • Implementing measures to prevent the insecure transmission of sensitive data via email.
  • Exploring message retraction features to retrieve email messages sent to the wrong address.
  • Avoiding opt-in encryption to satisfy HIPAA Omnibus Rule.

3. Backups and Archival: HIPAA email rules require copies of messages containing PHI to be retained for at least six years. To address these requirements, organizations must consider the following:

  • How are email folders backed up?
  • Are there at least two different backups at two different geographical locations? The processes updating these backups should be independent of each other as a measure against backup system failures.
  • Have you maintained separate, permanent, and searchable archives? While the emails should be tamper-proof, with no way to delete or edit them, they should be easily retrievable to facilitate discovery, comply with audit requests, and support business-critical scenarios.

4. Defense: Cyber threats against healthcare organizations are continually increasing. Some may be surprised to learn that HIPAA secure email requirements mandate that organizations take steps to defend against possible attackers. To defend against malicious messages, consider implementing the following technologies:

  • Server-side inbound email malware and anti-virus scanning to detect phishing and malicious links
  • Showing the sender’s email address by default on received messages
  • Email filtering software to detect fraudulent messages and ensure it uses SPF, DKIM, and DMARC information to classify messages
  • Scanning outbound email
  • Scanning workstations for malware and virus
  • Using plain text previews of your messages

5. Authorization: A crucial aspect of HIPAA secure email requirements is ensuring that bad actors cannot impersonate your company or employees. Configuring your domains with SPF and DKIM is essential to verify your identity as an authorized sender of mail from your domains. Also, ensure that users cannot send messages through your email servers without authentication and encryption.

6. Reporting: Setting accountability standards for email security is essential to establishing and improving your HIPAA compliance posture. Some important steps to take include:

  • Creating login audit trails.
  • Receiving login failure and success alerts.
  • Auto-blocking known attackers.
  • Maintaining a log of all sent messages.

7. Reviews and Policies: Humans are the greatest vulnerability to any security and compliance plan. Create policies and procedures that focus on plugging vulnerabilities and preventing human errors. Some ways to reduce risk include:

  • Inviting independent third parties to review your email policies and user settings. Fresh, unbiased eyes can weed out issues quickly.
  • Disallowing the use of public Wi-Fi for devices that connect to your sensitive email.
  • Creating email policies prohibiting users from clicking on links or opening attachments that are not expected or requested.

8. Vendor Management: Most people do not manage their email in-house. Properly vetting and researching whoever will be responsible for your email services is essential. Perform a yearly review of your email security and stay on top of emerging cybersecurity threats to take proactive action when necessary for sustained HIPAA compliance.

LuxSci’s secure email solutions were designed to help organizations tackle complicated HIPAA email rules. Contact us today to learn more how we can help you secure sensitive data.

Is Medical Billing Information Protected Under HIPAA?

Tuesday, August 9th, 2022

Electronic medical billing requires access to protected health information to accurately bill and receive payment for medical treatments. While not covered entities, medical billing companies are often contracted as business associates and fall under HIPAA regulations.

Title II of HIPAA applies directly to medical billing companies. It dictates the proper uses and disclosures of protected health information (PHI) and simplifies claims and billing processing.

electronic medical billing

What is Protected Health Information (PHI)?

Protected health information is “individually identifiable” health information. It specifically refers to three classes of data:

  1. An individual’s past, present, or future physical or mental health or condition.
  2. The past, present, or future provisioning of health care to an individual.
  3. The past, present, or future payment-related information for the provisioning of health care to an individual.

As listed in item three, payment-related information tied to healthcare provisioning is protected data under HIPAA. This can include information about insurance carriers and payments, billing statements, receipts, credit card numbers, bank accounts, and other financial information.

To be classified as PHI, payment-related information must be tied to an individual identifier. For example, a medical bill with a patient’s address can be tied back to a specific individual. These identifiers can sometimes be quite indirect. There are 18 types of identifiers for an individual (listed below). Any of one of these, combined with information on healthcare payments, would constitute PHI:

  • Name
  • Address (all geographic subdivisions smaller than a state, including street address, city, county, zip code)
  • All elements (except years) of dates related to an individual (including birth date, admission date, discharge date, date of death, and exact age if over 89)
  • Telephone number
  • Fax number
  • Email address
  • Social Security number
  • Medical record number
  • Health plan beneficiary number
  • Account number
  • Certificate/license number
  • Any vehicle or other device serial number
  • Device identifiers or serial numbers
  • Web URL
  • Internet Protocol (IP) address numbers
  • Finger or voiceprints
  • Photographic images
  • Any other characteristic that could uniquely identify the individual

The Risks to Medical Billing Companies

It should be evident that medical billing companies work with a lot of PHI. As such, they must take steps to protect that information under HIPAA regulations.

Third-Party Risk

Many healthcare systems contract medical billing companies to process claims and bill patients and insurance companies. These companies can present significant risks to protected health information if not adequately vetted. All third-party companies that handle PHI on behalf of a covered entity must sign a business associate agreement. This document discusses how sensitive medical billing information will be stored, secured, and transmitted. It is also essential to ensure that the billing companies understand their obligations under the privacy and security rules and have implemented the proper physical, technical, administrative, and organizational standards. This can be verified via security audits and assessments.

Third parties like medical billing companies are often targets for cyberattacks. From 2020 to 2021, cyberattacks on business associates increased by 18%. The rich trove of financial and health data they have is often more comprehensive and less secure than a hospital’s electronic health records system. Unlike covered entities who frequently work under HIPAA regulations, third parties may not wholly understand it. As a result, they may fail to take the technical steps needed to secure sensitive data.

How to protect electronic medical billing information

Like many healthcare organizations, financial institutions are also undergoing digital transformation and are moving to digitize healthcare payment processes. Digitization is an effective way to reduce payment times and improve patient satisfaction. However, it also introduces risk. Digital systems that contain healthcare billing information must implement the proper safeguards, including:

  • Organizational requirements that describe how policies and procedures will be implemented and obligations concerning business associate contracts.
  • Administrative requirements related to how employees access PHI.
  • Physical safeguards that encompass the security of computer systems, servers, and networks, access to the facility and workstations, data backups and storage, and the destruction of obsolete data.
  • Technical safeguards that ensure the security of data transmitted over an open electronic network and the storage of that data.

Protecting Electronic Medical Billing Information In Databases

Digital billing information that is stored in electronic databases or online web portals must be secured in the following ways:

  • Using a secure and HIPAA-compliant web and database host.
  • Limiting access to only authorized users.
  • Requiring unique logins and complex passwords with multifactor authentication to access ePHI.
  • Encrypting the contents of the database so they cannot be accessed if there is a breach.
  • Making regular backups of the database and storing them independently of the main system.

Sending Healthcare Billing Notifications Digitally

Many people now prefer to receive electronic medical billing notifications via email. A survey of 3,000 US consumers found that 85% are already using e-billing, and 47.6% find it is faster to pay bills electronically. However, using email, text messaging, or other digital communication forms introduces new risks and requires remediation to protect ePHI in transmission. These safeguards include:

  • Encrypting messages in transit
  • Authenticating user identities and sending domains
  • Requiring unique user logins and complex passwords
  • Protecting against threats with anti-virus software, email filtering, and other malicious scanning tools.
  • Creating audit logs and reviewing them for suspicious activities.

Services like LuxSci’s Secure High Volume Email can integrate with existing systems to send automated encrypted billing notifications via API or SMTP.

Will Email Ever Be Truly Secure?

Tuesday, November 6th, 2018

Email gateways are a leading cause of security breaches. The optimistic view is that effective email security practices, firewalls, mobile device security, wireless security, endpoint security, web security, behavioral best practices, data loss prevention and network access control – among other solutions – can ensure foolproof security. The realistic view is that email – or anything for that matter – cannot be truly secure.

To err is human. Technology advancement is a boon and a bane: cyber attacks are more sophisticated than before. You can trust no one security solution, place your full trust on end-to-end encryption (currently the most secure way to communicate securely and privately online) or predict when someone will break into your device and access your email.

The road to HIPAA compliance is paved with many risks, possibilities and outcomes. Well-researched and thoughtful implementations are essential but there are many decisions to make and loose ends to tie up. Your ePHI protection, privacy and confidentiality practices may be excellent, but your employees may still mistakenly dispose of a fax machine or hard drive that contains retrievable PHI. Or some of your staff may fail to observe the policy of what needs to be encrypted and what does not.


And if you thought that email encryption, cryptographic protocols and even your computer system and CPU were protecting your data at all times, think again…

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