Blog Posts on Patient Identification in Healthcare

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Hospital data breach results in an expensive lawsuit – Is yours next?

Hospital data breaches have been rampant for quite some years now. Last year’s figures alone are quite frightening- one states that 41 million patient records were exposed, essentially making the patients potential victims of medical identity theft. Thus, both data breaches and medical identity theft has been in the limelight. These unwanted nuisances have turned the attention towards healthcare providers who are suffering from these events. One such provider is the University of Missouri Health Care (MU Health), who suffered a data breach of 14 thousand records and also were hit by a lawsuit by the impacted patients.

This happened back in 2019. The provider was sued by patients who were affected by the breach in question. The patients reasoned that the breach had made their sensitive records prone to medical identity theft- their fear was not irrational.

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The actual story

On the first day of May 2019, the healthcare provider found out that an outsider somehow accessed email accounts of two employees for more than a week. Following the incident, the concerned officials said that they took the necessary steps to secure both accounts. 

It was not disclosed how the hacker got access and whether it was a phishing incident or not. However, the healthcare provider revealed that the affected account had sensitive patient data stored, such as names, DOB, medical record numbers, insurance details, as well as treatment details. The hospital data breach even consisted of the Social Security Numbers of some unlucky patients.

The data breach, fortunately, did not affect all the patients of MU Health. However, it did affect around 14,400 patients, which is no small number. As soon as the provider’s inquiry ended regarding the breach on the twenty-seventh day of July, it started to inform the patients regarding the breach. Oddly, the organization notified the patients after the required timeframe of 60 days as per HIPAA regulations.

The aftermath

Within the same week of notifying the patients, one of them filed a lawsuit, followed by 19 others. Their reason was very simple- the data breach would likely result in medical identity theft and lead to lower-quality care. The patients also believed that they were paying quite an amount of money, and thus, MU Health should add stringent security with their services.

Hospital data breach results in an expensive lawsuit - Is yours next?
Hospital data breach results in an expensive lawsuit - Is yours next?

#1 Biometric Patient ID Platform

Superior flexibility, power & ROI

Hospital data breaches can arm hackers with enough information to obtain medical services assigned to the patients. The hackers could either expose the data, sell it, or use it for themselves. These could lead to the patients paying for healthcare services they did not avail. These could also become denied claims for healthcare providers. Whichever way one looks at it, data breaches and medical identity theft is extremely undesirable. 

How do hospitals prevent medical identity theft?

Although it is quite prevalent nowadays, medical identity theft can actually be prevented. One way to make sure that the medical records are safe is by locking them with a key that hackers cannot forge. That is exactly what RightPatient does. It is a biometric patient identification platform that locks the patient records with their biometric data. Once the platform attaches the medical record with the data during enrollment, a third party cannot come and claim that record, preventing medical identity theft and ensuring accurate patient identification. RightPatient has been preventing medical identity theft for leading hospitals such as University Health Care System and Grady Health System.

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How to identify patients with opioid abuse or addiction treatment?

Addiction to opioids is a serious problem that is plaguing society. As a result, treatment of this needs to be taken as soon as possible because it becomes very difficult to overcome this,  at later stages. Attending opioid drug treatment centers in Columbus Ohio is the best way to stay away from the addiction of opioids and recover completely. There you will get the best assistance and guidance from the experts that force you to defeat your craving for taking opioids. It is very difficult to control your urge at your home. But in these places, you can easily quit your bad habits. The reason being, in rehab centers, you get chances to meet like-minded people who also want to quit their opioid habits.

Common signs to identify patients with opioid abuse

  • The inability to control opioid use
  • Uncontrollable cravings
  • Drowsiness
  • Changes in sleep habits
  • Weight loss
  • Frequent flu-like symptoms
  • Decreased libido
  • Lack of hygiene
  • Changes in exercise habits
  • Isolation from family or friends
  • Stealing from family, friends or businesses
  • New financial difficulties

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How can biometric patient identification help detect and prevent a patient’s opioid addiction?

In today’s world, a biometric patient identification platform is one of the best and secure way to identify patient’s data integrity. Global healthcare has moved away from its dependence on paper-based therapeutic studies toward the use of electronic health records (EHR). 

So if you or your loved one is abusing opioids, by using a biometric patient identification platform like RightPatient, hospitals can easily identify the patient’s addiction towards opioids. It can red-flag once they go through the identification process, detecting whether they are assuming someone else’s identity or not to attain the drugs. Several hospitals are using RightPatient to improve revenue cycle, enhance patient safety, and reduce the creation of duplicate records as well. 

Here, we have mentioned some benefits of utilizing this to instantly identify patients’ data integrity that includes:

  • Detailed and up-to-date data at the time of service
  • Highly coordinated and effective care
  • Safe sharing of patient information among doctors
  • More infrequent medical mistakes
  • More reliable prescribing practices

These advantages depend on clinicians, hospitals, and other healthcare departments to carefully test patient identifications during all therapeutic encounters. 

If you or your loved one is addicted, kindly visit an opioid treatment center that helps you know how to abstain yourself from the use of opioid and lead a simple life. Although there are many approaches to treat your addiction to opioids, enrolling yourself in a good rehab center is, of course, the most effective way. These centers offer you many programs according to your needs and help you to recover completely. When you make a decision in your mind to attend an opioid treatment program, make sure that you select the best one available in your locality. For this, you need to conduct thorough research and find out the one that suits your requirements as well as budget.

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There is a number of opioid rehabilitation centers in Philadelphia that offer excellent rehabilitation facilities and numerous programs including medical and behavioral treatments. These programs motivate you to quit taking opioids. These centers are located in almost all states of the USA. You can easily find rehab centers in your state that offer excellent facilities. If location is not a problem and geographical limits are not a major concern, you can also look for rehabs outside the USA. This provides you with a wide range of options to choose from. The main benefit of this is that you’ll be able to take advantage of the best rehab facilities for your loved ones in the event you are not satisfied with the existing opioid rehab centers in your state. There are several international options available in other countries too. You can avail the best of the bests. Before enrolling yourself in an opioid center, ensure that you make proper inquiries about their facilities, programs, and fee structure.

Facilities offered in opioid centers

  1. Opioid centers are committed to offering you expert advice and assistance which will help you to defeat your craving for taking opioids. They will also help you to understand the harmful effects of the opioid on your health as well as your family and social life.
  2. Opioid rehab centers offer gender-specific programs and treatments customized according to your specific needs. These programs encourage you to stay away from opioid use and you can live a sober life with your family.
  3. Most of the centers offer you medication treatment that reduces the craving of opioid consumption in you. They employ doctors, physicians, and specialists so that they can offer you proper medication to treat your addiction.
  4. Apart from this, they have several other programs including dual diagnosis, intensive outpatient, sober living, professionals programs, and family outreach programs to inspire you to defeat your urge and live a healthy and happy life.
  5. The rehab centers also have in-house psychologists, trainers, and psychiatrists to help and motivate you to stay away from opioids. They show you the right path following which you can lead a happy and fulfilling life.
  6. They also organize alumni programs where you can meet those individuals who came there as patients and now leading a fulfilling and healthy life.
How to identify patients with opioid abuse or addiction treatment?
How to identify patients with opioid abuse or addiction treatment?

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Opioid rehab centers are the best places to treat addiction. They not only teach you how to stay away from them, but also help you understand their bad effects on your personal, social, and family life. The experts in rehab centers motivate you to defeat your urge of taking opioids and show you the brighter side of life. You can completely rely on their services as they always encourage you to live a healthy, sober, and fulfilling life.

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How RightPatient Benefits Medical Identity Theft and the Healthcare Red Flags Rule

It’s no secret that medical identity theft is on the rise. Over 2 million Americans each year become victims of medical identity theft, and, unfortunately, that number only continues to grow.

It’s growing for a number of reasons. First of all, there were more healthcare data breaches in 2019 than the previous three years combined. These breaches compromised the medical records of over 40 million Americans

Let’s consider this in light of rising healthcare costs and a worsening opioid epidemic. These facts create a ripe market for medical identity theft. Patient identity data is readily available on the black market and there is a ton of demand for it.

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When medical identity theft is perpetrated, patients and healthcare providers suffer. Victims can face bills for services they never received, incorrect treatment data mixed into their medical record can affect future outcomes and quality of care, and the costs to restore their identity can be prohibitive. 

Healthcare providers lose millions of dollars for services that will never be paid for. Increasingly, they also face litigation costs from patient lawsuits for failing to protect their information. 

Providers also face another burden. In 2009, the FTC started to enforce the Red Flags Rule, which requires healthcare providers to develop programs that can help to detect and address situations that are “red flag” indicators of medical identity theft. The goal is to ensure vigilance and reduce the potential costs associated with medical identity theft.

However, implementing red flag processes, keeping them current, and ensuring compliance can be expensive and time consuming for healthcare providers. These processes must also be administered by front-line staff members, typically patient access employees that handle registration. 

This is an enormous responsibility for these employees when considering the potential consequences of medical identity theft. Compliance with red flag rules also places a substantial burden on registrars who are already buried with additional duties such as verifying insurance, collecting payment, and processing patients as efficiently as possible to reduce wait times and improve margins. 

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Now, against the backdrop of these market realities, imagine if the risk of medical identity theft could be substantially mitigated, if not eliminated altogether. This is where RightPatient comes into play. 

RightPatient validates that patients are who they claim to be when scheduling appointments by comparing a patient’s selfie photo to the photo on her driver’s license or other ID cards. When patients show up for visits, RightPatient accurately identifies them during registration and other points along the care continuum. 

How RightPatient Benefits Medical Identity Theft and the Healthcare Red Flags Rule
How RightPatient Benefits Medical Identity Theft and the Healthcare Red Flags Rule

#1 Biometric Patient ID Platform

Superior flexibility, power & ROI

RightPatient creates a closed-loop platform to prevent medical identity theft and other errors that can impact patient safety, revenue cycle, and data quality. This saves a lot of time, money, and hassle for patients and healthcare providers.

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Why The Coronavirus Makes Patient Identification More Critical Than Ever

In case you’ve been sleeping under a rock somewhere, the COVID-19 coronavirus is causing global concern, with some health professionals and media outlets already referring to the outbreak as a pandemic. 

The lack of available testing kits in the U.S. has hindered our ability to accurately determine the actual scale of the problem here. However, as of this writing, we do know that coronavirus has infected more than 108,000 people globally, with nearly 600 cases in the U.S. and 22 deaths. 

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Source: Pixabay

With the virus continuing to spread in the U.S., those experiencing symptoms are being advised to call their healthcare provider. While many healthcare providers and states are preparing to handle the growing outbreak, many patients are seeking treatment at emergency rooms where the risk of spreading the virus to other patients and health workers can increase dramatically.

In addition, some patients that do not meet certain testing criteria may not be immediately diagnosed as having coronavirus. Accurate patient identification is absolutely critical in these circumstances to help contain the growth of coronavirus infections. 

Imagine a patient who arrives at the ER with respiratory symptoms but does not meet the testing criteria. The patient could be treated without needed precautions and released. If the patient returned later with worsening or other symptoms and was misidentified, the clinical team would not have access to critical information that could immediately trigger the prerequisites of a coronavirus infection, putting every person in that facility at even greater risk. 

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Source: Pixabay

Biometric patient identification can certainly help to prevent these mistakes. However, the type of biometric technology being utilized can have significant consequences. For example, healthcare providers using contact-dependent devices such as palm vein biometrics may risk exacerbating the spread of the coronavirus. That particular modality requires patients to place their entire hand on a plastic mold to read their vein pattern. 

Under the current market conditions, would you want to touch that device, especially knowing that every other patient was being instructed to do the same? 

At a minimum, healthcare workers would need to disinfect the device after every patient encounter. This is not a practical or safe approach. 

IT companies in Hyderabad India have actually been instructed to suspend use of fingerprint biometric systems for employees as standard operating procedure if the coronavirus is detected on their premises. If this is being advised for employee time and attendance in an IT company, will healthcare providers continue to ask each and every patient to touch a biometric device across their locations? If not, how will the risk of patient misidentification contribute to the spread of coronavirus?

Since our inception, we have advocated for using the RightPatient platform with our photo-based engine. This was based on 18 years of experience in biometric software and our vision for the company. We are now the leader in this space with many providers using our platform. 

Why The Coronavirus Makes Patient Identification More Critical Than Ever
Why The Coronavirus Makes Patient Identification More Critical Than Ever

#1 Biometric Patient ID Platform

Superior flexibility, power & ROI

One factor involved in our decision-making process was hygiene and infection control. Our photo-based biometric patient authentication platform does not require patients to touch anything, which is ideal in a healthcare environment even under normal market conditions, but particularly now in light of the COVID-19 coronavirus. 

Our mission is to prevent medical identity theft and duplicate medical records to mitigate risk for healthcare providers while improving patient safety, data quality, and revenue cycle. Especially now, accurate patient identification is critically important but providers should think about the risks of a contact-dependent solution. They should also consider the experience, vision, and track record of their vendor to select a trusted partner that will always keep them ahead of the curve.

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Proper Patient Identification Can Help Fight the Opioid Crisis

The opioid crisis has been a menace since it started. It spread like wildfire throughout the country, and everyone involved in healthcare is still struggling to keep the situation under control. PDMPs (prescription drug monitoring programs) have been set up in almost every state to monitor activities like prescribing, distributing, and using controlled substances such as opioids. These PDMPs help identify patients who might be prone to drug abuse and provides the hospitals with opportunities to prevent such scenarios.

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If that is true, then why is the opioid crisis still a thing?

PDMPs are dependent on the data they are given to work with. They receive patient data like logs, records, patient profiles, and even counseling records. Thus, if the data is clean, then the PDMPs will work perfectly, and vice versa. Here lies the challenge- most of the data can be incomplete or unreliable, to begin with.

According to Injury Facts, the odds of a person dying from opioids are greater than dying from a motor vehicle collision. This has made opioid overdoses to be the fifth largest cause of deaths in the country. Everyone is on edge regarding the issue, and it is paramount that the data needed by PDMPs are accurate, valid. And consistent with the patients. Accurate patient data at all times can drastically reduce the opioid overdoses and bring the whole situation under control.

The biggest challenges- data quality and patient matching errors

Hospitals and health systems have been adapting EHR systems quite rapidly for the past few decades, which has helped digitize medical records. Even after all these years, proper patient identification is still a significant challenge for many. Much of the patient data have errors or are incomplete. Many of these can be traced back to duplicate medical records or overlays. According to a survey conducted by PDMP Training and Technical Assistance Center, the majority of the states are facing problems with patient records- 53% said that there are data quality issues.

Proper Patient Identification Can Help Fight the Opioid Crisis
Proper Patient Identification Can Help Fight the Opioid Crisis

#1 Biometric Patient ID Platform

Superior flexibility, power & ROI

Can proper patient identification be the answer?

Accurate patient matching is the only solution- something which can identify the accurate patients within seconds. RightPatient is just that- a biometric patient identification platform. It locks the patients’ medical records with their biometric data such as fingerprints or irises. After enrollment, the patient needs only to scan their biometrics, and the platform identifies the accurate EHR within seconds. Several health systems such as Novant Health and University Health Care System are using it and are reporting enhanced patient safety, improved revenue cycle, and reduced medical identity thefts. No longer can drug abusers come in and claim someone else’s identity- the system flags them within seconds. Health systems that are using RightPatient have dramatically reduced opioid issues within their premises. Since accurate patient record matching is the key, RightPatient is the perfect solution for the problem. Proper patient identification has never been easier and safer!

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How Do Progressive Hospitals Prevent Medical Identity Theft?

There are many things we need to be concerned about to avoid any identity theft and lose a significant amount of money. Social Security Numbers, bank accounts, credit cards, insurance, and even driver’s license need to be monitored continuously to make sure these are safe and sound. Another kind of theft has been increasing rapidly in numbers- medical identity theft. However, what are the problems associated with medical identity theft, and what can hospitals do to ensure that their patient data is safe and secure from such events? Let’s explore.

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What is medical identity theft?

As a refresher, medical identity theft occurs whenever an unauthorized person takes the credentials of a patient without the latter’s knowledge and uses it for personal gain. It can be used to obtain healthcare services such as prescription drugs, treatment, as well as medical equipment. Also, as we can see in the recent news, criminals are actively targeting medical data of patients, which has contributed to the meteoric rise of medical identity theft. These cause the patients to receive medical bills with shocking numbers- tens of thousands of dollars’ worth of services can be used or stolen by the criminals. One hundred seventy-one million patient records were exposed online, according to the Identity Theft Resource Center. On the other hand, the reputed Ponemon Institute estimates that patients pay around $13,500 either for the fixes or for the services used by the culprits.

How does it affect patients and hospitals?

Other than the previously mentioned financial impacts medical identity theft has on patients, it affects them in different ways as well. According to the Ponemon Institute, 3% of the patients were fired, 19% lost potential jobs. In contrast, a considerable number of patients faced embarrassment due to the exposure of sensitive healthcare data- all of which happened due to medical identity theft. It can also cause the medical data of the culprits to be embedded into the patient record. For instance, when a victim goes to their providers for healthcare services, the patient might be given treatment based on the culprit’s preferences, interfering with the preferences of the actual patient.

How Do Progressive Hospitals Prevent Medical Identity Theft?
How Do Progressive Hospitals Prevent Medical Identity Theft?

#1 Biometric Patient ID Platform

Superior flexibility, power & ROI

For hospitals, medical identity theft is equally damaging, if not worse. Half of the patients will switch their healthcare providers if their medical identities are stolen, according to the Ponemon Institute. Such an event would also impact their reputation, cause losses in millions due to denied claims, and so on. All in all, medical identity theft is a problem for everyone involved and can be very costly to fix.

How do hospitals prevent medical identity theft?

Many safeguards can prevent medical identity theft, but none are as effective as RightPatient. It is a biometric patient identification platform that ensures that the medical records are locked with the biometric data of the patients. The platform takes the biometric data such as fingerprints or irises of the patients and attaches them with the medical records. Without biometric verification, the records cannot be accessed by unauthorized parties, ensuring no medical identity theft takes place. RightPatient also ensures patient safety- the platform provides accurate medical records within seconds of scanning the patients’ biometric data. It reduces denied claims, improves revenue cycle, and saves hospitals and patients from unnecessary costs. Several pioneering healthcare providers like Terrebonne General Medical Center and Novant Health are using RightPatient. They are reducing denied claims, preventing medical identity theft, improving revenue cycle, and enhancing patient safety.

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Medical Identity Theft Prevention Enhances Patient Trust

What is one of the crucial things a company needs to ensure so that it can thrive? Is it the employees, revenue, or size? While many may answer something along the lines of the previously mentioned characteristics, one of the most critical assets a company can have is the trust of its customers. The healthcare system is no different- various health systems and hospitals are successful today only because of their patients’ trust in their services. Since it is healthcare, patients put their lives in the hands of the hospitals- trust plays a huge role here. That trust can be enhanced with medical identity theft prevention.

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According to Morning Consult, in terms of trust from consumers, healthcare lies in the middle, while insurance, finance, and real state are underneath it, whereas airlines and technology are above it.

Morning Consult conducted a study which had several respondents about their perception regarding various US brands as well as firms. From these people, a meager 16% responded that they trust health systems a lot, whereas 36% said that they believe these organizations somewhat.

Also, while ranking the most trustworthy companies, people, ideas, among other things, the respondents ranked their physicians even above notable choices such as Google, police, and leaders.

Thankfully, the report went deeper and gave areas of improvement for hospitals and health systems to build up trust among patients. When the sample of the study was asked what the most crucial factor which helps build trust towards an organization is, three-fourth of the respondents said that protecting their sensitive data was extremely important for trust-building.

All of these are straight from the customers themselves, and these are even more applicable to the US healthcare system. The health systems and hospitals need to ensure that the sensitive patient data they keep are safeguarded, especially now. Breaches seem to be very common nowadays, which leads to exposure to the patients’ confidential medical data as well as documents like medical images, medication, and so on. It costs both patients and healthcare providers alike- patients become victims of medical identity theft, whereas healthcare providers’ reputations are dented. People question the security surrounding the medical records since HIPAA requires strict safeguarding of such sensitive information.

Medical Identity Theft Prevention Enhances Patient Trust
Medical Identity Theft Prevention Enhances Patient Trust

#1 Biometric Patient ID Platform

Superior flexibility, power & ROI

These lead to losses for both patients and health systems- patients may sue the hospitals, the culprits may use the identities to avail services illegally, costing the patients a significant amount of money for services that they never used. Medical identity theft may also occur if an individual steals a patient’s medical credentials and uses it for his/her gain. In such cases, the preferences of the culprit may get mixed up with that of the patients. For instance, the patient might be allergic to certain medications, and may still receive that after the culprit uses his/her ID.

Dynamic healthcare providers such as Novant Health, Terrebonne General Medical Center, and University Health Care System are preventing such issues by using RightPatient. It is a biometric patient identification platform that locks the medical records after attaching those with the biometric data of the patients. Once a patient enrolls with the biometric data, for instance, irises or fingerprints, the records can be accessed using only the same data, creating medical identity theft prevention. The hospital can also identify the accurate patient record within seconds after the patient scans his/her biometric data for verification. RightPatient not only aids in medical identity theft prevention, but also eliminates patient matching errors, ensuring accurate patient identification, enhancing patient safety, and improving the revenue cycle as well. It saves lives as well as millions for both patients and health systems, enhancing patient trust.

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Wrong Patient Identification Causes Kidney Transplant Fiasco at a Hospital

Another day, another wrong patient identification. It just goes to show how common patient misidentification is in the US healthcare system. It has been plaguing the industry for several years and looks like there is no stopping it. However, what did it cause this time? Where did it happen? Who was affected? Was it fatal? Let’s dive deep.

The patient misidentification took place in Lourdes Hospital Transplant Center, located in New Jersey. This time, it was the case of a kidney transplant- the patient who had the surgery and got another patient’s required kidney. However, nobody at the hospital noticed that such a mix-up took place.

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Why did this mix-up happen?

Once again, it is because of the similar characteristics of the patients. This time, the patients had a similar name as well as age. Both of them needed kidneys, that’s why they were on the same list. However, the one who was supposed to get a kidney later got it first- this was found out by a hospital official while checking the organ donor list. It was quite lucky for the patient that the kidney was a perfect match, as the other scenario could have had dire consequences.

The good thing is that the hospital reported the incident on their own, according to Virtua Health (which owns the Lourdes Health System). Thus, it is quite transparent about the issue. Had this been some other hospital, it might have denied it or kept the matter under wraps.

Virtua Health’s Executive Vice President and Chief Clinical Officer said that this is a rare case occurring in its forty-years-old program and that they are ensuring they take the steps necessary to ensure that this unwanted incident does not happen again.

Later on, the patient who was supposed to get the kidney first got the surgery a week later, and both the patients are doing fine now.

Wrong Patient Identification Causes Kidney Transplant Fiasco at a Hospital
Wrong Patient Identification Causes Kidney Transplant Fiasco at a Hospital

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This is not an isolated incident. It might be one of the very few cases where the patients were unscathed due to wrong patient identification, which did not cause any significant harm to them. Several patients get misidentified every day, almost due to medical record mix-ups, duplicate medical records, data overlays, and so on. This affects patients as they receive the wrong bills, medication, and even surgeries, like in this case. Hospitals are also affected- denied claims, lower ratings, data overlays, and medical identity theft all lead to huge losses.

How can hospitals avoid wrong patient identification?

The problem here is medical record mix-up and wrong patient identification. That is eliminated by using RightPatient- several progressive health systems and hospitals are using this biometric patient identification platform. It seamlessly integrates with existing EHR systems and keeps the biometric data of the patients. Once a patient registers with it, the biometric data such as irises or fingerprints are used to identify the accurate medical record within seconds and pulls it from the EHR system for use. RightPatient also locks the medical record with the patient’s biometric data so that unauthorized access is prevented- eliminating medical identity theft in the process. Had RightPatient been used in this case, this mix-up could have been prevented, just how health systems like Novant Health and Terrebonne General Medical Center are avoiding it. 

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Can Revenue Cycle Improvement Prevent Hospital Closures?

So many hospitals are closing their doors that it is hard to keep count nowadays. These closures happen for several reasons which we will discuss later. One of the latest ones to join this unfortunate group is Nix Medical Center, located in San Antonio, Texas. 

The 208-bed hospital once owned by Prospect Medical Holdings was acquired in 2012 and operated by Nix Health as the Nix Medical Center for 89 years.  

In addition to closing its hospital’s doors, Nix Health also had to close its home health division as well as Nix Specialty Health Center & Nix Behavioral Health Center, generating an estimated layoff of over 970 employees. 

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But why are these hospitals being closed?

Hospitals are supposed to offer health care and save lives. Thus the most important institutions in any society. So why are they being closing down? 

Well, the largest and most common reason is the lack of revenue. 

In this instance, with fewer people visiting Nix Medical Center the hospital simply couldn’t generate enough revenue to sustain it’s operational costs thus resulting in its inability to provide effective health care and subsequently closing its doors.

What to take away from this example?

Hospitals need to learn from this scenario and focus their efforts on better financial management via reducing denied claims via revenue cycle improvement. 

Known to cost any health system an average of more than $5 million each year, denied claims often occur due to mistaken billing of patients. For example, a patient visiting the hospital for a routine checkup is billed the cost for a surgical procedure and vice-versa. While this may sound peculiar you would be surprised to know just how common it is. Although 63% of initially denied claims are recoverable, they can cost as much as $8.6 billion in appeals-related administrative costs and why hospitals must find ways to mitigate such losses.

Can Revenue Cycle Improvement Prevent Hospital Closures?
Can Revenue Cycle Improvement Prevent Hospital Closures?

#1 Biometric Patient ID Platform

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How can hospitals achieve revenue cycle improvement?

One way health systems can achieve revenue cycle improvement and lessen denied claims is by ensuring patients are correctly billed for the healthcare provided. 

To achieve this many progressive health systems are using RightPatient – a biometric patient identification platform. By implementing RightPatient, medical records are locked to each patient’s biometric data thus preventing unauthorized identity theft. 

Health systems such as Terrebonne General Medical Center and University Health Care System are already using RightPatient and are preventing medical identity theft, patient mix-ups as well as denied claims. RightPatient effectively reduces loss in revenue by ensuring each patient is billed correctly for the healthcare provided. Using biometric data, patient misidentification is also prevented. Each patient is required to register only once after a health system deploys the platform- attaching the biometric data with the EHR of the patient. Afterward, whenever that patient visits the hospital, RightPatient uses their biometric data to access their respective medical records for the previous diagnosis and prescribe the necessary treatment.

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2583 hospitals hit with penalties due to readmission reduction program

Medicare hit 2583 health systems with penalties by cutting payments to them. This has been happening for the last eight years and thanks to the ACA, it is an effort to reduce the readmission rates of hospitals. This specifically focuses on the patients who return within the same month after they are primarily discharged which helps the readmission reduction program.

This is not something new, as it is a recurrent theme for the last few years, where Medicare predicts that it’ll cost the hospitals a whopping $563 million per year. This effort to reduce readmissions is known as the Hospital Readmission Reduction Program and has about 3129 hospitals attached to it. Out of them, a staggering 83% could not reduce the readmission rate and thus, were slapped with the penalties. This penalty to each of these hospitals will be in the form of deductions from the payments Medicare will pay them for future patients over the next year, starting this October 1st.

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One thing has been repeatedly said that these efforts have been going on for quite some time, since 2012, to be precise. However, many are still unclear whether these fines are helping to reduce readmission rates and thus generating better patient safety. On the other hand, these efforts have been reinforcing hospitals and health systems to reimagine how the patients are receiving care and focus on their health after discharging them so that minimal readmissions occur. Conversely, many industry pundits have chimed in that a few healthcare providers may intentionally avoid readmitting patients who require critical post-discharge healthcare services solely because of these penalties, which is severely detrimental for the patient’s health as well the hospitals’ reputations. Others are saying the program itself is not that effective, although it has brought in small benefits. 

Some studies were conducted, and it was revealed that this HRRP caused an increase in fatal incidents regarding patients. However, it was refuted by a study conducted by the Medicare Payment Advisory Commission (MedPAC).

Sometime last month, MedPAC’s study was released to the public, and it showed that the number of readmissions of Medicare patients within a timeframe of 30 days decreased to 15.7% in 2017 from 16.7% in 2010. 

2583 hospitals hit with penalties due to readmission reduction program
2583 hospitals hit with penalties due to readmission reduction program

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Going into specifics, the hospitals are penalized for these readmissions when the patients are provided with healthcare services for heart failure, pneumonia, heart attack, hip and knee replacement, chronic coronary artery bypass graft surgery, or lung disease. One good thing regarding HRRP is that inevitable readmissions, for instance, scheduled ones, are exempted from penalties. Delving deeper, HRRP dictates that if patients return within the 30 days timeframe, the hospital will be penalized. Also, if the Medicare-funded patients go to a different hospital, the primary hospital which provided the care will be penalized. 

According to KHN, about 1177 hospitals were penalized higher than they were compared to last year, whereas 1148 received lower penalties compared to the previous period. 64 providers were stable since they received the same amount of penalty compared to last year. 194 new hospitals were added to the list of penalized hospitals, whereas 372 exemplary hospitals received no penalties for two consecutive years. However, one thing must be noted- 2142 health systems and hospitals were exempted due to the lower number of cases, veterans, or children’s hospitals. 

So, the readmission reduction program is one of the biggest headaches of hospitals and health systems. How can they be reduced? Well, a lot of health systems are using RightPatient to address it. It is a biometric patient identification platform that locks the medical records of the patents with their biometric data and the records cannot be accessed without biometrics. Other than ensuring positive patient identification, it also ensures that the hospitals receive a notification when a patient enters their premises within the 30-day period so that they can be provided with better care and thus ensuring better patient experience, reducing the penalties as well as better patient outcomes and thus, minimizing losses while creating a win-win situation for all.