Risk Assessments Archives

Suze Shaffer October 1, 2025October 7, 2025

An annual HIPAA risk analysis is necessary because it’s the foundation of an effective compliance program — and it’s required by law. Here’s why it matters:

It’s a Legal Requirement

Under the HIPAA Security Rule (45 CFR §164.308(a)(1)(ii)(A)), covered entities and business associates must conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information (ePHI).
The Office for Civil Rights (OCR) repeatedly enforces this requirement, and failure to perform or update a risk analysis is one of the most common causes of HIPAA fines.

Threats and Technology Change Constantly

Healthcare organizations face evolving cybersecurity threats. Ransomware, phishing, insider misuse, and software vulnerabilities.
An annual risk analysis ensures you’re identifying new threats and changes in your environment, such as:

Updated systems or software
New staff or vendors
Relocated offices or added telehealth operations
Cloud service or EHR changes

Without regular reviews, unnoticed gaps could leave patient data exposed.

It Protects Against Fines and Breaches

Most OCR enforcement actions begin with the finding that the organization failed to conduct an updated risk analysis.
By performing one each year (and after significant changes), you demonstrate due diligence. This shows regulators, you are actively identifying, documenting, and mitigating risks. This can reduce penalties if a breach occurs and protects your organization’s reputation.

It Drives Continuous Improvement

A risk analysis isn’t just about compliance — it’s a management tool. It helps you:

Prioritize security investments
Strengthen policies and procedures
Train employees based on real vulnerabilities
Build a strong compliance record

An annual HIPAA risk analysis keeps your organization compliant, secure, and prepared for evolving risks. It’s not a one-time task — it’s an ongoing process that proves your commitment to protecting patient data and maintaining trust.

If you need assistance with HIPAA Compliance, check out our HIPAA Keeper™. Our online compliance system has everything you need to get compliant and stay compliant. Your HIPAA Compliance Officer will have a HIPAA security analyst to guide and assist them every step of the way.

For more information or to speak to someone about HIPAA Compliance call us at 877.659.2467 or use the contact us form.

Suze Shaffer December 16, 2017February 1, 2024

By Aris Medical Solutions

MIPS (Merit-based Incentive Payment System) and MACRA (Medicare Access and CHIP Reauthorization Act) is designed to create better patient outcomes and reward those providers that accurately document the progress of their patients. This all sounds great but it takes additional time until this new workflow is established. This is very frustrating to providers who just want to take care of their patients. It is a “learned” function and can be dealt with accordingly if you keep your patience. I know what you are thinking…. and it is easier said than done.

So many practices think since “meaningful use” went away they no longer need to conduct a risk analysis. This is incorrect information. Part of the requirements are that you must still conduct a risk analysis or update the one you already have. When “updating” your risk analysis, be very careful. You are attesting that you have reviewed your vulnerabilities and mitigated those risks.

Conducting a thorough risk analysis is more than just checking a box. It is meant to assist the organization in identifying possible vulnerabilities so you have the opportunity to mitigate them to prevent data breaches. If you merely change the date on your risk analysis and later suffer a breach; that could come back to harm you. If you skip over this or do not take this seriously, you are literally putting your practice at risk.

The best way to tackle this elephant in the room is… one step at a time!

Review your technology devices. Determine if anything has been or needs to be replaced and/or updated.
Understand where and how data is created, accessed, and stored. This includes reviewing the workflow of everyone involved with PHI and ePHI.
Conduct your risk analysis and update the risk management plan. If you choose to “update or review” your existing risk analysis, make sure you do not overlook anything.
If you have not not done so already, create a Incident Response Team (IRT). Utilizing the Security Incident Report will help in determining whether the security incident should be treated as a data breach or not.
When it comes to the actually MIPS documentation, there are organizations that will assist you at no cost to the practice. Don’t chance missing this opportunity to ensure your documentation is accurate.

For more information on how Aris Medical Solutions can help your organization with HIPAA Compliance and Protecting your Data call 877.659.2467 or click here to contact us.

“Protecting Organizations through Partnership, Education, and Support”

Tag: Risk Assessments

Are annual HIPAA risk assessments necessary?

MIPS, MACRA, and Risk Assessments

By Aris Medical Solutions