What is PCI Compliance in Healthcare?

It ensures that healthcare organizations implement safeguards to protect cardholder data, reduce the risk of data breaches, and prevent payment fraud. By following PCI DSS requirements, providers not only protect their patients’ financial information but also align with broader regulatory expectations for data security. This article outlines how PCI compliance functions within the healthcare setting, identifies who is responsible for compliance, and presents key best practices to help providers maintain a secure and trustworthy payment environment.

Defining PCI Compliance in Healthcare

PCI compliance in healthcare means following the Payment Card Industry Data Security Standard (PCI DSS), a set of security rules that protect credit and debit card information. This is especially important when healthcare providers accept card payments from patients, whether it’s in person, online, or through a billing system tied to bundled payment healthcare models. In a bundled payment healthcare setup, for instance, providers often handle multiple services under a single payment, which can involve more complex billing and financial transactions. That makes securing payment data even more critical. PCI DSS helps ensure that all patient card information is encrypted, access is limited, and systems are regularly monitored. Staying compliant not only prevents data breaches but also builds financial trust with patients, an essential part of delivering secure, high-quality care.

Why PCI Compliance Matters for Healthcare Providers

PCI compliance is crucial for healthcare providers to avoid costly fines, protect their reputation, and maintain patient trust. With high transaction volumes and sensitive medical and financial data flowing through various channels, like front desks, online portals, and phones, the risk of breaches is significant. This is especially true in models like capitation payments in healthcare with recurring transactions. Ensuring PCI compliance safeguards patient data across all touchpoints, reducing risk and supporting a secure, patient-focused experience.

PCI Compliance Requirements Overview

Broken down into chunks, core PCI compliance requirements are observed in this manner: 

• Build and Maintain a Secure Network

Install firewalls to separate patient payment systems from clinical networks.

Eliminate default passwords on all devices used in the office.

• Protect Cardholder Data

Use encrypted card readers at reception or billing desks to secure transactions.

Encrypt any stored cardholder information and limit data retention.

• Maintain a Vulnerability Management Program

Keep antivirus and anti-malware tools up to date on all payment-related devices.

Apply software updates and security patches promptly.

• Implement Strong Access Control Measures

Restrict access to payment systems based on staff roles.

Require individual logins and regularly review access permissions.

• Monitor and Test Networks Regularly

Use logging tools to track access to cardholder data.

Conduct routine security scans and network tests to identify vulnerabilities.

• Maintain an Information Security Policy

Develop clear guidelines for protecting patient payment data.

Train all staff on data security protocols and PCI requirements.

Following these practices ensures secure healthcare payment processing, reduces the risk of data breaches, and supports compliance with industry standards.

Who Needs to Be PCI Compliant in Healthcare?

Types of healthcare organizations that must comply are the following:

Hospitals – Large facilities handling high volumes of patient payments across departments.

Private Clinics and Practices – From solo providers to group practices accepting card payments.

Billing Departments – Internal or third-party teams that process, store, or transmit payment data.

Telehealth Service Providers – Platforms offering virtual care with integrated payment options.

Any healthcare organization that stores, processes, or transmits cardholder data, no matter the size or payment volume, must be PCI compliant. Compliance is based on how payment data is handled, not on the size of the business.

Levels of PCI Compliance and Validation

PCI compliance is divided into four levels, determined by the number of credit or debit card transactions an organization processes annually. Each level comes with different validation and reporting requirements.

Level 1

Who qualifies: Over 6 million transactions per year

Requirements: Annual Report on Compliance (ROC) by a Qualified Security Assessor (QSA), quarterly scans by an Approved Scanning Vendor (ASV), and regular penetration testing

Level 2

Who qualifies: 1 to 6 million transactions per year

Requirements: Annual self-assessment questionnaire (SAQ), quarterly ASV scans, and possible additional testing depending on risk level

Level 3

Who qualifies: 20,000 to 1 million e-commerce transactions annually

Requirements: Annual SAQ, quarterly ASV scans, and validation as needed

Level 4

Who qualifies: Fewer than 20,000 e-commerce or up to 1 million total transactions

Requirements: Annual SAQ and quarterly ASV scans (if applicable), typically fewer reporting demands

Most small-to-mid-sized healthcare practices fall under Level 3 or 4, meaning they can often validate compliance through self-assessment and scheduled vulnerability scans rather than formal audits.

Common Challenges in Achieving PCI Compliance for Healthcare Providers

• Limited IT or Cybersecurity Expertise: Many practices lack in-house specialists to manage PCI requirements, leading to security gaps. The solution here would be to work with external PCI compliance experts or managed IT services.
• Outdated EHR or Billing Systems: Legacy platforms may not support encryption or secure data handling. Hence, the solution here would be to integrate secure, PCI-compliant payment solutions that work with existing systems.
• Confusing HIPAA with PCI Compliance: HIPAA protects health data, but not payment card data. The two are separate and must be addressed individually. Lastly, the solution here would be to educate staff on both standards and maintain distinct compliance processes.

Streamlining technology, training staff, and leveraging outside support can help healthcare providers close these compliance gaps efficiently.

PCI Compliance vs. HIPAA Compliance

Focus of Protection:

• HIPAA safeguards protected health information (PHI), such as medical records, diagnoses, and treatment histories.
• PCI DSS protects cardholder data, including credit/debit card numbers and payment details.

Regulatory Frameworks:

• HIPAA is a federal law enforced by the U.S. Department of Health and Human Services (HHS).
• PCI DSS is an industry standard governed by the Payment Card Industry Security Standards Council.

Technical Safeguards:

• Both require access controls, encryption, and regular monitoring, but each targets different types of data and threats.

Compliance Requirements:

• Healthcare organizations that handle both PHI and payment data must comply with both HIPAA and PCI DSS to ensure complete protection of patient information.

Understanding the distinction and overlap between these two standards is essential for maintaining full data security and regulatory compliance in healthcare environments.

Best Practices for Maintaining PCI Compliance in Healthcare

Some of the most notable actionable tips entail:

• Use point-to-point encryption (P2PE) to secure transactions from the moment of capture.
• Avoid storing cardholder data unless it’s essential, and if stored, ensure it’s encrypted and access-controlled
• Train staff regularly on secure payment handling procedures and PCI responsibilities.
• Conduct regular PCI self-assessments or audits to identify and correct compliance gaps.
• Partner with PCI-compliant payment processors that support secure integrations with your systems

How to Get Started with PCI Compliance

Users ought to follow a step-by-step guide to get started with PCI compliance:

1. Identify where and how payment card data is collected, stored, and transmitted.
2. Determine your PCI compliance level based on annual transaction volume.
3. Complete the appropriate Self-Assessment Questionnaire (SAQ)
4. Schedule quarterly vulnerability scans with an Approved Scanning Vendor (if applicable)
5. Implement required security measures and address any identified gaps

FAQs

What is PCI compliance in healthcare?

PCI compliance in healthcare means following PCI DSS standards to securely handle patient card payments.

Who needs to follow PCI compliance in healthcare?

Any healthcare entity handling payment card data must follow PCI compliance, no matter its size.

Is HIPAA compliance enough for PCI?

No, HIPAA and PCI are separate, thus, compliance with one doesn’t satisfy the other.

What happens if a healthcare provider is not PCI compliant?

Non-compliance can lead to fines, penalties, and damage to the provider’s reputation after a breach or failed audit.

How often should PCI compliance be reviewed?

PCI compliance should be reviewed annually, with continuous monitoring for security risks.

References

Digital Guardian: What is PCI Compliance?

https://www.digitalguardian.com/blog/what-pci-compliance

ERMprotect: How Healthcare Providers Can Protect Credit Cards By Getting PCI DSS Certification

https://ermprotect.com/blog/pci-dss-compliance-for-healthcare

The HIPAA Journal: What is PCI Compliance in Healthcare?

https://www.hipaajournal.com/pci-compliance-in-healthcare

Investopedia: PCI Compliance: Definition, 12 Requirements, Pros & Cons

https://www.investopedia.com/terms/p/pci-compliance.asp