Dealing with Claim Denials in Healthcare Facilities

April 22, 2022/3458 views / 1 Comment/in BLOG, Data Integrity, Denied Claims, Duplicate Medical Records, EHR, healthcare, Patient Data, Patient Identification, Patient Safety /by Matt Gibson

Healthcare providers have always been under a lot of pressure. Patient mix-ups, identity theft cases, denied claims, medical record errors, data breaches, and patient safety incidents are just a few examples of the challenges. However, all of these issues were more visible than ever with COVID-19. Claim denials were one of the most difficult challenges, as there were more patients in need of healthcare services during the pandemic’s peak. Both healthcare providers and payers were (and still be) at odds over denied claims, and the situation will only worsen as rules and regulations change. While hospitals are already suffering from massive losses, refused claims exacerbate the situation. That being said, let’s take a look at a few strategies for dealing with claim denials in healthcare facilities.

Strategies that can help reduce claim denials in healthcare

Provide training to the coding team

Coding errors are one of the most regular reasons for claim denials in healthcare facilities. For example, suppose a patient came in and requested healthcare services; the latter has a unique code. However, the coding team utilized the incorrect code, and when the payer inspects the claim, it is classified as denial because the incorrect code was used.

To avoid such errors, healthcare providers must train the coding team on topics such as common coding errors, coding do’s and don’ts, recent updates, and so on.

Ensure that physicians record information correctly

A lack of proper clinical documentation is another factor that contributes to claim denials in healthcare. The coding team is not responsible for every denied claim. When clinical documentation problems occur, wrong codes are almost always selected, resulting in denied claims.

As a result, healthcare providers must guarantee that physicians properly and timely record all paperwork in suitable medical records. RightPatient can aid in the proper identification of medical records and the reduction of denied claims.

Ensure that claims are submitted timely

Another reason contributing to denied claims is the failure to submit them on time, which can be easily rectified. Healthcare providers should set goals for their coding teams in order for them to process claims in a fast and accurate manner. They should, for example, categorize which batch of claims will be delivered and when they should be sent and check for errors.

While this does not always succeed, detecting the issues that cause late submissions can assist providers in addressing the issue and reducing future claim denials.

Ensure accurate patient identification to reduce denials in healthcare

One common cause of denials in healthcare facilities is medical record errors such as duplication and overlays, the majority of which result in mix-ups, improper treatment, and, predictably, billing and coding issues. The majority of medical record errors arise because there is no standardized patient identification in the US healthcare system.

While many healthcare providers waited for a standardized and effective patient identifier while dealing with duplication and denied claims, forward-thinking health systems already prevent them with RightPatient.

RightPatient is a touchless biometric patient identification platform used by top healthcare organizations such as Terrebonne General Medical Center, Duke Health, Community Medical Centers, and University Hospital. RightPatient uses one of the most secure, sanitary, and non-transferable properties of patients: their faces.

During registration, patients must look at the camera; RightPatient takes a snapshot and compares it to existing medical information to identify duplication. If no matches are identified, a new EHR is created with the patient’s photo attached. Whenever the patient comes to the hospital for additional healthcare services, they only need to look at the camera, And RightPatient generates the necessary medical record in seconds.

RightPatient isn’t just for registration; healthcare providers can use the platform throughout the care continuum. After scheduling sessions, remote patients can send selfie photographs as well as a photo of their ID card. RightPatient examines the photographs for a match, then searches to see if there are any existing records, and either produces new credentials for new patients or sends the proper EHR to the hospital for existing patients.

RightPatient not only makes accurate patient identification simple, but it’s also safe, secure, clean, and seamless. Healthcare providers may smoothly link RightPatient with their EHR systems, making the latter part of the EHR workflow.

Using RightPatient, some prominent healthcare providers reduce patient misidentification, eliminate duplicate medical records, minimize denied claims, and enhance patient safety and quality.

How Patient Safety and Quality in Healthcare Can be Improved With Positive Patient ID

February 14, 2022/3376 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Infection Control, Medical Record Mix-ups, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

While COVID-19 has been arguably the most talked-about issue over the past few years, it’s not the only problem that healthcare providers face. Even now, a plethora of problems continues to plague the US healthcare system. Duplicate medical records, overlays, medical identity theft, lack of proper patient identification, labor shortages, massive financial losses, and infection control issues are just some of them. While not all of these factors are solvable by the hospitals themselves, ensuring positive patient identification can help reduce many significant problems. With that being said, today, we’ll be considering how effective patient identification can improve patient safety and quality.

Five ways that patient identification improves patient safety and quality

It ensures patient data integrity

One significant issue that healthcare providers face in the US is the lack of data integrity in medical records or EHRs, which can often be traced back to patient misidentification. It’s pretty simple: if a patient has more than one EHR, their medical history, allergies, medications, vitals, etc., will be spread across several different medical records.

There are thousands of fragmented EHRs like these. As such, the patient will receive treatments based on a highly fragmented EHR; it doesn’t provide the complete collection of patient information. As a result, treatments may be inaccurate or less effective. However, there’s an even more severe scenario. In cases where there’s a lack of accurate patient identification, hospitals could use one of these EHRs to treat the wrong patient!

The presence of positive patient identification, on the other hand, ensures patient data integrity at all times since patients are treated using accurate EHRs whenever they come in. This remains true both for virtual and inpatient visits.

It ensures positive patient outcomes

Positive patient identification ensures that accurate EHRs are associated with the correct patients across the care continuum. Doing so helps the patients receive the best possible treatment plans and care without inaccuracies, helping them recover without any unwanted incidents, thereby enhancing patient safety and quality in the process.

Patients can receive the wrong treatment without accurate patient identification since they’re associated with incorrect medical records, which can lead to dangerous and adverse incidents.

It reduces medical record errors

One of the biggest problems caused by patient misidentification is that it leads to medical record errors, such as duplicates and overlays. Naturally, these can be detrimental to patient outcomes. Imagine a scenario whereby a patient has multiple EHR documents; if just one of those records is used to treat them, the treatment plan would be based on incomplete information, hence leading to ineffective treatment. On the other hand, overlays are even more dangerous; these are merged EHRs, but they often belong to different patients! Whichever patient gets treated using such an inaccurate EHR record could naturally face detrimental and wrong treatments down the line unless it’s detected and resolved quickly.

Fortunately, accurate patient identification prevents medical record errors right off the bat. Ensuring that accurate EHRs are used every time that patients come in for an appointment helps avoid the creation of duplicates and overlays, thereby saving considerable costs for the hospital and improving patient safety and quality of care overall.

It avoids mixups

Patient mix-ups can be hazardous and can even lead to the wrong patient getting the treatment or surgery intended for another. It might sound like a basic mistake that would never happen, but in reality, such an event has happened numerous times where the wrong patient received kidney transplant surgery.

One of the most common reasons for this is because patients had similar names and characteristics on their EHRs, which can easily lead to mixups, especially in high-pressure environments. In other cases, the wrong patient may have received chemotherapy that was assigned to a different patient for lifesaving treatment. Meanwhile, patients receiving the wrong medication and so on are potentially common risks due to mixups and mistakes.

Most of these mixups can be traced back to – you guessed it – patient misidentification. As such, ensuring positive patient identification is one of the most effective ways for hospitals to prevent these mixups and avoid jeopardizing patient safety overall.

It boosts infection control efforts

It might seem a little unclear as to how accurate patient identification can help boost infection control issues? Well, integrating a touchless patient identification platform such RightPatient helps with that. RightPatient doesn’t just ensure that the patients are identified correctly across the care continuum, but it also ensures that this care is provided hygienically.

Patients only need to look at the camera for registration; the platform captures a photo and attaches it to their EHRs, essentially locking them. Whenever patients come in for subsequent visits, all they need to do is look at the camera, and the platform automatically matches the current photo with the saved one.

RightPatient is already helping several healthcare providers ensure accurate patient identification, improve patient safety, and bolster infection control efforts effectively. As such, it could be a valuable tool to implement for your own healthcare facility’s management systems, too; why not give it a try?

Accurate Patient Identification Tops 2022’s Patient Safety Goals

December 7, 2021/3925 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, HIM, Patient Data, Patient Identification, Patient Safety /by Matt Gibson

There is a lot going on in the U.S. healthcare industry right now. While some might argue that the industry has always been a dynamic field, which is true, it’s safe to say that the pandemic has pushed healthcare into overdrive. While healthcare data breaches, increased hospitalizations, vaccine booster shots, and oral pills to tackle COVID-19 dominate the news, the Joint Commission has announced next year’s National Patient Safety Goals applicable beginning January 1, 2022.

Unsurprisingly, again in 2022, the number one priority for improving patient safety, as per the Joint Commission, is identifying patients accurately. This highlights the importance of positive patient identification, which we’ve been promoting for a long time. That being said, let’s take a look at the top patient safety goals for 2022, why patient identification has been a topmost priority for years, and how RightPatient can effectively help meet those goals.

What are patient safety goals?

Every year, the Joint Commission collects information on patient safety issues that plague hospitals, health systems, and other healthcare facilities. After collecting all the data via credible sources and experts, the Joint Commission releases a list of goals that healthcare facilities need to implement in order to improve patient safety.

As healthcare is quite broad, the Joint Commission has divided it into chapters such as Ambulatory Health Care Chapter, Assisted Living Community Chapter, Behavioral Health Care & Human Services Chapter, Hospital Chapter, Home Care Chapter, etc. However, in all nine chapters, the number one goal is to identify patients correctly (residents in the case of Nursing Care Centers). This shows how imperative proper patient identification is as it’s the top priority in all the chapters.

That being said, let’s look at next year’s goals for the Hospital Chapter, as that’s our primary focus.

2022’s patient safety goals for hospitals

Next year, according to the Joint Commission, healthcare providers need to focus on the following goals to improve patient safety at their facilities:

Accurate patient identification
Improving staff communication
Using medicine safely
Using alarms on medical equipment
Infection prevention
Identifying patient safety risks
Preventing errors in surgeries

Comparing them with the goals for 2021, there hasn’t been any significant change in the goals or their order. But why is patient identification always the topmost goal?

Accurate patient identification has been a priority for years

Patient misidentification isn’t anything new. Since there was a ban on creating a state-funded patient identifier around two decades ago, patient identification errors have been quite common. To this very day, a standardized and effective patient identifier doesn’t exist. Since misidentification has led to duplicate medical records, overlays, and medical record mix-ups, they have also created medication administration errors, repeated lab tests, patient data integrity failure, delays in care, transplant mix-ups, and even deaths! As a result, patient misidentification quickly became a patient safety concern.

Every year, healthcare experts come together and demand that the ban against a state-funded patient identifier is lifted. However, to this very day, the ban on the unique patient identifier is in effect.

While different healthcare providers use various methods, solutions, and strategies for accurate patient identification, a touchless biometric patient identification platform like RightPatient is the most ideal and future-proof platform for that. In fact, RightPatient also helps with a few of the other patient safety goals – let’s explore how.

RightPatient helps improve patient safety in several ways

RightPatient is helping several leading healthcare providers enhance patient safety by protecting patient medical records, ensuring accurate patient identification, and reducing infection control issues. It captures patient photos during the registration process and attaches them to EHRs.

For subsequent visits, returning patients only need to look at the camera for verification. RightPatient compares the live photo with the saved one and provides accurate EHRs, preventing mix-ups, duplicates, and other problems associated with misidentification.

RightPatient can be used for remote authentication as well – patients need to provide a selfie along with the photo of their driver’s license after scheduling appointments. RightPatient compares the images, and after a successful match, provides the patients with biometric credentials – check out the video to learn more about it.

RightPatient helps with several patient safety goals:

It ensures accurate patient identification
It prevents errors in surgeries by preventing patient mix-ups
It reduces infection control issues (it’s a touchless experience for both patients and caregivers)
It improves staff communication as redundant lab tests, mix-ups, and delays are reduced
It reduces medication administration errors

How are you planning to improve patient safety at your healthcare facilities, and does the strategy include a solution that solves several problems simultaneously as RightPatient does?

Patient Safety Improvement in Hospitals with 5 Strategies

November 11, 2021/4292 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Medical Record Mix-ups, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

Patient safety is one of the key components that is crucial for preventing patient harm, ensuring proper healthcare outcomes, and reducing redundant costs for healthcare providers. Without it, adverse events lead to patients receiving the wrong care, and according to WHO, one in ten patients is harmed while receiving healthcare services. Fortunately, half of these adverse events are preventable – let’s take a look at some patient safety improvement strategies that can help with that.

5 strategies for patient safety improvement

Nurture a patient safety-focused culture

One of the best patient safety improvement strategies is to foster a culture that focuses heavily on improving patient care. All employees, from the janitors to the decision-makers, must be a part of the culture and focus on patient safety and quality healthcare more than anything else. In fact, healthcare providers that aren’t fostering such patient-centered cultures are struggling with adverse events, medication errors, and worse. For instance, physicians must focus on patients themselves rather than their medical records and involve them in the decision-making process. This way, they can get better insights into the patient’s ailments to help them identify the problems in a more reliable manner.

Identify and work on mistakes

Rather than only acknowledging the mistakes that lead to patient safety incidents, working towards preventing future incidents is a much more sensible strategy. What’s even better is identifying the issues before they happen and preventing them. For instance, there are different solutions available that can help identify potential issues and address them effectively. In the case of mistakes that already took place, identifying why they occurred and coming up with strategies that can prevent future occurrences is the tried and tested solution.

Reduce chances for human error

While technology is evolving rapidly, most healthcare providers, unfortunately, are still stuck with ancient processes and manual methods. This leaves room for human error, something that can jeopardize patient safety in hospitals significantly. For instance, if paper is used for recording medicine administration, handwriting or common names can lead to mix-ups, leading to an adverse impact on healthcare outcomes. On the other hand, if digital solutions are used, then not only will it speed up the process, but it will also make it more reliable and safe (especially if patient photos are used for identification). This is just a simple example, but reducing chances for human error ensures patient safety improvement across the care continuum.

Ensure a clean environment and enforce hygiene rules

While many might have forgotten that we’re still going through a pandemic, hospitals and health systems must ensure that they are providing a safe environment for everyone involved. Not only must hospitals ensure that they keep their facilities clean, but they also need to ensure that everyone in the facilities is complying with safety rules such as wearing masks and maintaining distance. All of this leads towards reducing HAIs (hospital-acquired infections), improving patient safety in the process.

Ensure accurate patient identification

One of the topmost patient safety goals for many years has been improving the accuracy of patient identification, and according to the Joint Commission, it will once again be the number 1 goal for 2022. This just shows how important accurate patent identification is for patient safety improvement.

The problem is that patient misidentification leads to a number of issues – duplicate medical records, patient record mix-ups, wrong treatment, and even medical identity theft. All of these lead to adverse healthcare outcomes, hospital readmissions, and even deaths.

Fortunately, accurate patient identification IS possible – hospitals that have been using RightPatient are protecting millions of patient records and improving patient safety.

RightPatient is a touchless biometric patient identification platform that essentially locks medical records during the registration process with patient photos. Registered patients only need to look at the camera when they revisit hospitals – RightPatient compares the photos and provides the accurate medical records for use, preventing duplicates, overlays, and medical errors. Moreover, it also helps prevent HAIs as it’s entirely touchless – improving patient safety on two fronts.

How are YOU improving patient safety at your hospital(s)?

RightPatient Partners with Harris Healthcare to Secure and Maintain EMPI Data Integrity

November 8, 2021/3992 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, HIM, Partnerships, Patient Data, Patient Identification /by Michael Trader

Very recently, RightPatient and Harris Healthcare’s DIS (Data Integrity Solutions) Business Unit have announced a strategic partnership to tackle patient data integrity issues by ensuring accurate patient identification.

Harris DIS includes QuadraMed, which focuses on EMPI management and data cleanups, and Just Associates, focused on helping hospitals and health systems achieve and maintain a highly accurate and quality MPI. QuadraMed provides end-to-end patient identity management to prevent duplicate medical records and dirty patient data to improve patient data integrity. From data analysis to cleanups, Just Associates performs the critical tasks necessary for a pristine MPI. Its state-of-the-art suite of identity management solutions and services includes continuous duplicate detection (IDSentry™), ongoing MPI management (IDManage™), and customized MPI clean-up services (IDResolve™).

By using the RightPatient Integrity Platform with Harris DIS’ existing solutions, patient identity management will be much more secure, accurate, and efficient. The collaboration provides important protections against front-end contamination of the MPI and EMPI and helps eliminate patient misidentification and safety issues created by “dirty” patient identification data.

The problem of patient misidentification and dirty patient data

Several factors cause front-end contamination and dirty patient data within an MPI or EMPI, such as frequent flyers, medical identity theft, and duplicate medical records. There may even be duplicate records that have very limited or contrasting information.

RightPatient Integrity Platform incorporates patient photos into the Quadramed SmartID platform, helping identify and resolve these challenging duplicate records that were created from cases of alias or stolen identities. This helps reduce new duplicate and overlaid medical records right from the start, while Just Associates focuses on creating and maintaining a pristine MPI/EMPI environment and supporting rapid and accurate patient identification.

RightPatient advances Harris DIS’ ability to address key health information issues by reducing the volume of potential duplicate medical records, preventing patient misidentification, enhancing patient safety, and ensuring patient data integrity across the care continuum. Doing so is more important than ever as remote patient registrations have increased due to COVID-19.

RightPatient and Harris DIS’ partnership aims to improve the overall efficacy of medical data clean-ups and ongoing data integrity efforts with RightPatient’s robust de-duplication engine. It secures patient information and minimizes the ongoing cost of maintaining quality patient data.

How RightPatient and Harris DIS improve patient identity management

Typically, an EMPI contains patient information from a health system’s several facilities such as labs, hospitals, physician practices, and pharmacies. Front-end contamination is common if positive patient identification isn’t ensured during the registration process. This later leads to dirty patient data, duplicates, overlays, patient safety incidents, write-offs, and more.

RightPatient and Harris DIS can address and solve patient misidentification right off the bat using patient photos.

During the registration process, hospitals collect the patient information along with their photos. The MPI data is then sent to QuadraMed for analysis and cleaning, after which RightPatient Integrity Platform receives a copy of the patient photos along with the corresponding MRNs (medical record numbers). Using RightPatient’s powerful photo-matching engine, the patient photos are deduplicated to bolster overall system analytics.

RightPatient Integrity Platform with Harris DIS can be used for:

Existing EMPI data cleanup projects
Identifying duplicates during the registration process
Hospitals that are starting to capture patient photos

The impact of effective patient identity management

RightPatient’s leading touchless patient identification platform is being utilized by numerous healthcare providers to identify their patients safely, reliably, and effectively.

During the registration process at hospitals and healthcare facilities, patients just look at the camera and the platform takes a photo and attaches it to the medical record. During remote registrations, patients receive an SMS after which they provide a selfie and a photo of their driver’s license. The platform then searches for a match between the two photos and assigns biometric credentials to new patients.

The same expertise comes with the RightPatient Integrity Platform which can be seamlessly integrated with any EHR, including QuadraMed’s SmartID Platform. This enables healthcare providers to:

Prevent duplicate and overlaid medical records during registration
Ensure remote patient photo capture and authentication
Bolster de-duplication and EMPI data cleanup efforts
Ensure clean patient data across the care continuum
Improve patient safety and prevent medical errors
Reduce write-offs and denied claims
Prevent cases of identity theft and “frequent flyers”

Electronic Medical Record Errors Are Preventable with Positive Patient Identification

September 13, 2021/5645 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Medical Record Mix-ups, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

We’ve been talking about several topics such as medical identity theft, duplicate medical records, COVID-19, revenue cycle management, data breaches, and more. However, the one point we keep coming back to is electronic medical record errors. This has been a cause of concern among healthcare providers and patients, but it doesn’t end there. The consequences of medical record errors extend to insurance providers, healthcare staff members, physicians, and even the patients’ family members!

What many fail to grasp is that most of these errors are not caused by the EHR systems themselves, but are caused by external factors. One of the foremost reasons is that there’s no effective, standardized patient identifier present. This alone leads to medical record mix-ups, duplicates, and other errors – more on that later.

Let’s take a look at EHR error statistics, the consequences caused by them, and how positive patient identification can mitigate them.

Statistics regarding electronic medical record errors

A recent study focused on the frequency and types of EHR issues perceived by patients which shed light on a number of insightful statistics. Over 136,000 patients received the invitation to participate, and over 29,000 patients responded. 22,889 viewed 1 or more notes within one year. Out of these 22,889 patients, 21% (4,830) of them witnessed mistakes. Out of these 4,830 patients, 43% said that the mistakes were serious, 32.4% said that it was somewhat serious, and 9.9% said that it was very serious.

When asked about what kind of issues they saw within their EHRs, the most common response was diagnosis errors. For instance, many saw that a disease they didn’t have was listed in the EHR! Can you imagine the consequences of this?

Others witnessed wrong medical history, medication errors, and so on.

Most of these issues, if not all of them, can be traced back to the lack of accurate patient identification – let’s see how.

How patient misidentification creates electronic medical record errors

It’s quite simple – since there’s no effective and standardized patient identifier present in the U.S. healthcare system, EHR issues are bound to occur. An EHR system houses thousands and can even hold millions of medical records. It’s quite natural to have many patients with the same name, especially if it’s a common one.

Now, if a patient named “James Smith” turns up, the EHR user will see that there are several medical records associated with the same name. Moreover, there’s no guarantee that the patient’s record is under the same name – it might be saved as “Jim Smith”.

Also, most EHRs provide basic search functionality, and with the registration area being a high-pressure environment, the EHR user needs to select the appropriate medical record quickly. If the hospital isn’t using an effective patient identifier, the registrar either creates an entirely new medical record or chooses the wrong one – creating the potential for medical record errors.

While that’s how patient misidentification and electronic medical record errors are related, let’s take a look at some of the consequences.

Consequences of EHR errors and patient misidentification

EHR errors, bolstered by inaccurate patient identification:

Increase duplicates and overlays within the EHR system
Jeopardize patient safety
Hamper patient data integrity
Lead to patient record mix-ups
Create medication administration errors
Increase denied claims
Cause patients to go through repeated lab tests
Increase hospital readmissions
Create detrimental patient outcomes

It’s not very surprising that patient identification errors have been occurring for a long time, and only a handful of healthcare providers have been proactive regarding preventing such issues within their facilities. These responsible healthcare providers have been using RightPatient to prevent such issues by ensuring accurate patient identification.

RightPatient ensures positive patient identification

RightPatient is the number one choice of leading healthcare providers – they’ve been using our touchless biometric patient identification platform to protect millions of patient records.

RightPatient is easy to use and becomes a part of the EHR workflow. During registration, the platform requires patients to simply look at the camera – the platform takes a photo of the patient and essentially “locks” the EHR with it. Already registered patients then only need to look at the camera – RightPatient runs a search to match the live photo with the saved one – it’s that easy!

RightPatient has a vast amount of experience with several diverse hospitals, making it a clear choice to ensure accurate patient identification, prevent medical record errors, and more.

Are YOU preventing medical record errors successfully at your healthcare facility?

Patient Verification Helps Hospitals Deal with Decreasing Revenue as COVID-19 Cases Rise

August 31, 2021/6728 views / 0 Comments/in BLOG, COVID-19, Data Integrity, Duplicate Medical Records, EHR, healthcare, Medical Record Mix-ups, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

Hospitals and health systems are constantly being challenged by the pandemic. Sure, COVID-19 has affected virtually every business – many organizations have declared bankruptcy while others have shuttered their doors. However, most, if not all of these organizations, had their employees work from home. Healthcare providers, on the other hand, had to face unprecedented challenges head-on, such as frontline healthcare teams risking their lives, losing billions of dollars, patient verification issues, data breaches, and more.

Unfortunately, it looks like the battle with COVID-19 is far from over for healthcare providers. With the Delta variant once again wreaking havoc, caregivers are experiencing razor-thin margins. That being said, accurate patient verification CAN prevent many issues, helping hospitals survive this challenging period. Let’s take a look at a few stats that show how concerning the new variant is and how positive patient identification can help caregivers.

Some recent statistics that show a rise in margins and expenses

While things were definitely getting better with millions being vaccinated across the U.S. and businesses slowly opening up, the Delta variant of COVID-19 has struck back with full force. While healthcare providers have been facing lower losses and improved margins when compared to the first half of 2020, a new report sheds light on many facts. While many indicators show that things are going in the right direction, some show that the effects of COVID-19 are far from over.

The “median operating margin index” in June was 2.8%, excluding funding from the CARES (Coronavirus Aid, Relied, and Economic Security) Act. When taking funding into account, it was 4.3%.

What do these numbers mean for hospitals and health systems? Well, it’s an increase of almost 90% (excluding CARES Act Funding) or 48.7% (including the funding) when compared to the first half of 2020. All of these numbers are based on 900 hospitals that have participated monthly for the last three years.

When it comes to patient volumes, it’s a mixed bag. Patient volumes were higher when compared to 2020, but lower than they were before the pandemic. For those who want specifics, discharges between January and June of 2021 were 10.1% higher than in the first half of 2020, but when compared to the first half of 2019, patient volumes are down 4.4%. A similar trend can be seen for ER visits in hospitals, i.e. higher than in the first half of 2020 but lower than in the first half of 2019.

Fortunately, the revenue of hospitals and health systems has increased compared to both 2020 and 2019! According to the same report mentioned above, this is because of outpatient visits. “Gross operating revenue,” excluding CARES Act funding for January to June of this year, was 18.2% higher than the same period of 2020 and 7.9% higher than the same period of 2019.

But all of these statistics look good for hospitals, right?

Well, while all of these do look good, expenses have also increased – affecting margins significantly. The first half of 2021 saw an 8.5% rise in expenses when compared to the first half of last year, and an increase of almost 10% when compared to the first half of 2019.

While margins are increasing, expenses are increasing as well

Unfortunately, the COVID-19 pandemic is far from over – the Delta variant has reached the U.S. and has been in the news for the past few weeks. While healthcare providers have opened their doors to regular patients, COVID-19 cases are spiking once again, and this might be detrimental to hospital margins according to an official associated with the study mentioned above.

Hospitals need to identify ways to reduce losses, improve patient safety, and avoid unwanted incidents that hurt the bottom line. But how can patient verification help?

How patient verification helps improve hospital margins

Accurate patient identification has been a topic of discussion for several years now, and identification errors have also given rise to a number of studies.

Accurate patient identification helps

Prevent medical record errors such as duplicate medical records and overlays
Prevent medical identity theft in real-time
Protect patient data integrity
Reduce denied claims by ensuring accurate, consistent information within medical records
Prevent medical errors that might lead to patient safety incidents
Avoid dangerous patient mix-ups, including transplant mix-ups
Ensure CMS compliance by sending out proper e-notifications to appropriate caregivers
Improve patient outcomes
Reduce hospital readmissions

All of the above, when considered together, can drastically reduce losses and improve a hospital’s margin. We know this because our leading patient identification platform has been helping several healthcare providers for years.

Patient verification made easy with RightPatient

A number of healthcare providers have chosen RightPatient to manage their patients’ medical records. In a post-pandemic world, RightPatient’s touchless patient ID platform makes the most sense, as it keeps everyone safe by preventing physical contact (when compared to other methods of identification).

RightPatient reduces denied claims, improves patient safety, prevents duplicates and overlays, and prevents patient identity theft – boosting the bottom line of hospitals.

How are YOU planning to reduce losses and improve margins at your healthcare facility?

Denied Medical Claims Are Costly but Preventable with Patient Identification

August 23, 2021/6079 views / 0 Comments/in BLOG, Data Integrity, Denied Claims, Duplicate Medical Records, EHR, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

The U.S. healthcare system is no stranger to problems, unfortunately. In fact, it has been plagued by a plethora of issues for several years. While some of the problems are definitely solvable, external issues alongside other factors cause the problems to continue. Some of the many problems are astronomical prices, the lack of price transparency, interoperability issues, the abundance of data breaches, medical identity theft, and patient safety issues. While we have covered some of these topics at one point or the other, let’s take a look at another crucial problem, denied medical claims, how they are problematic for everyone, and how positive patient identification can prevent them.

Denied medical claims are costly and cumbersome for everyone involved

Denied claims are not a recent problem within U.S. healthcare – most hospitals and health systems are quite familiar with them. One can safely say that denied medical claims are quite expensive – an average hospital can lose around $3.5 million due to them. However, denied claims not only affect hospitals but also insurers and patients, albeit in different ways – let’s see how.

Claim denials in a nutshell

In the U.S., healthcare is closely related to reimbursements from Medicare, Medicaid, and commercial insurers. Patients get health insurance, go to their healthcare provider, get treated, and that’s about it. However, a lot more goes on behind the scenes regarding healthcare reimbursements.

After providing healthcare services to the patients, the hospital processes the information and sends the claims to the insurance company. While healthcare providers usually get reimbursed by the payer, some of them face expensive hiccups. Due to billing or coding issues, patient identification errors, medical record mix-ups, or other problems, the payer identifies inconsistencies after receiving claims, and they might reject or deny said claims. While some claims can be resubmitted, checking for and fixing the errors is time-consuming, costly, and requires a considerable number of resources.

All of the above leads to back-and-forth exchanges between care providers and payers. Insurers have to reject claims, caregivers lose out on a significant amount of revenue, and many patients even receive shocking, incorrect bills. However, some even lose healthcare services, especially those associated with Medicaid.

Let’s take a look at a few statistics to see how Medicaid patients suffer due to denied medical claims. However, do keep in mind that denied claims can be detrimental for any patient.

A worrying study regarding denied claims

A very recent study has shed light on denied claims and how physicians or hospitals are reluctant to see Medicaid patients due to reimbursement issues.

According to the study, at least 25% of Medicaid claims have been denied upon initial submission. On the other hand, 7.3% of Medicare claims were denied whereas commercial insurers denied 4.8%.

Moreover, the study also states that around 17% of revenue is lost due to billing problems associated with Medicaid patients, whereas the numbers are quite lower for patients covered by Medicare (5%) and other payers (3%).

While any type of denied claim is extremely costly, the statistics show that the Medicaid ones are quite problematic. Moreover, since Medicaid is associated with low-income families, reimbursements are lower as well.

All of this just leads to caregivers being reluctant to look after Medicaid patients.

Denied medical claims are preventable

One of the topmost priorities of physicians and healthcare providers is to look after the patients, Medicare or otherwise. Instead of worrying about denied claims, hospitals and health systems can work on reducing or eliminating them with the right tools and strategies.

Fortunately, RightPatient, the industry’s leading touchless biometric patient identification platform, can help reduce denied claims substantially.

Denied and rejected claims typically occur because of billing and coding errors – most of which can be traced back to medical record errors, patient mix-ups, and identification issues. RightPatient eliminates all of that, and more, as it ensures that the accurate information is fed to the correct EHR at all times. As a result, billing and coding errors are drastically reduced and so are denied claims – boosting the bottom line.

How are YOU reducing denied claims in your healthcare facility?

Hospitals that Identify Patients Correctly Enjoy Several Benefits

June 30, 2021/6426 views / 0 Comments/in BLOG, Duplicate Medical Records, EHR, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

We typically talk about grave situations – stories of patient mix-ups, healthcare data breaches, medical identity theft cases, denied claims, and more. However, this time, we will look at the more positive aspects – the additional benefits that healthcare providers who identify patients correctly enjoy. These range from preventing unwanted patient safety incidents within the premises to enhancing patient outcomes.

However, did you know that our touchless biometric patient identification platform can provide far more benefits? More on that later – let’s dive deep into the topmost benefits of ensuring proper patient identification in hospitals.

Why hospitals must identify patients correctly

Well, in order to understand that, first, one must understand why patient identification is such a big deal. For starters, patient identification is quite problematic in the U.S. healthcare system for several reasons. Since no effective standardized patient identifier has ever been implemented in the U.S., healthcare providers use different methods, solutions, or strategies to verify their patients, and most of them suffer from patient identification errors and the consequences that follow.

Fortunately, responsible healthcare providers don’t have to suffer from these issues because they have made patient safety their number one priority. These providers are utilizing effective solutions like RightPatient to eliminate errors by helping them identify patients correctly.

So, what are the benefits of accurately identifying patients?

Top benefits enjoyed by hospitals that identify patients correctly

Prevents fraudulent cases right from the start

Although wrong patient identification and medical identity theft are both crucial issues of the U.S. healthcare system, many don’t know that preventing the former can also prevent the latter.

It’s quite simple – since there’s no standardized and rigid way to identify patients accurately in most hospitals, fraudsters aren’t identified right off the bat. In fact, many medical identity theft cases remain undetected until the patient receives a shocking bill or notices anomalies with their EHRs.

Hospitals that identify patients correctly can prevent medical identity theft in real-time. When the fraudster comes in, proper patient identification will help officials flag them and catch them red-handed.

This is also applicable even in the case of data breaches. Even if healthcare data is breached, accurate identification will lead to fraudsters being caught in the act, preventing medical identity theft and reducing substantial expenses of rectifying medical record errors and litigation costs down the line.

Prevents expensive and dangerous medical record errors

One of the reasons why patient identification is such a mess has already been mentioned – the lack of an effective patient identifier. However, another reason is the overwhelming medical record errors that already exist in the systems. Duplicate medical records and overlays, namely, have been causing patient mix-ups, leading to the wrong patients getting transplants, incorrect treatments, and more. These duplicate medical record errors typically are created during the registration process, and both their creation and use can be eliminated if patients are identified accurately.

See, if the patient is accurately identified right from the start and the appropriate medical record is used throughout the patient’s medical care history, then duplicates and overlays can be avoided – eliminating the issues caused by them for both caregivers and patients, preserving authentic patient data. This leads to another benefit of proper patient identification.

Ensures patient data integrity

As mentioned, medical record errors, and patient misidentification in general, lead to patient data corruption. Unless patient data integrity is maintained, the information is useless for healthcare providers and quite dangerous for patients. Imagine if a patient has cancer but gets treated for heart disease – it would be catastrophic!

Patient data integrity failures lead to the wrong treatment plans, detrimental healthcare outcomes, readmissions, and even deaths. However, accurate patient identification ensures that the correct information is being recorded in the appropriate medical records – ensuring patient data integrity.

Enhances patient safety

By now, it should be clear that positive patient identification prevents a plethora of issues such as duplicates, patient data corruption, medical identity theft, among other things. However, identifying patients accurately also leads to better healthcare outcomes and prevents medical errors, improving patient safety in the process.

Medical errors caused by mix-ups are prevented which also reduces readmissions – improving patient outcomes. Accurate information arms healthcare providers with the relevant details about the right patient, helping them make informed decisions, something that’s not possible when patients are wrongly identified.

Reduces denied claims

Denied claims are a huge burden for any given healthcare provider, however, most of them can be prevented with accurate patient identification. Let’s look at an example of exactly how denied claims and patient misidentification are related.

Suppose a patient, A, comes in for a checkup and the physician recommends a follow-up, and a small surgical procedure is planned. During the first two visits, A has been identified properly and their medical record includes the proper information. However, prior to the surgery, A is misidentified and the wrong EHR is assigned. Moving forward, everything will be recorded in the wrong EHR.

Now, when it comes to receiving payment for the surgery, the hospital sends a claim to the patient’s insurance provider. However, when the insurance company detects inaccurate coding due to incorrect information, the insurance company “denies” the claim. These billing and coding errors need to be fixed which takes up a considerable amount of resources and time – creating inefficiencies.

Denied claims can cost north of $4 million for the average health system, making it extremely costly for even the largest provider.

Positive patient identification can prevent most denied claims as they are often caused by medical record mix-ups. Moreover, this also frees up FTEs (full-time equivalents) to do their jobs properly – improving efficiency and eliminating bottlenecks.

Improves the quality of healthcare services

Patient identification errors have been rampant for almost two decades, leading to data quality issues. As a result, this information cannot be trusted – if the data is inaccurate, then everything moving forward will also be full of issues.

Proper patient identification ensures that the right patient is connected to their accurate medical record at all times – this itself drastically improves the quality of services they receive. For instance, they won’t get redundant lab tests, incorrect medication, or the wrong treatment plans.

All in all, patient misidentification might seem trivial to many, but if accurate patient identification is ensured, then it brings several benefits for healthcare providers, patients, insurance companies, and everyone else involved.

However, did you know that our patient ID platform, RightPatient, can do even more than everything mentioned above?

RightPatient helps healthcare providers identify patients correctly

RightPatient is the leading biometric patient identification platform that has been helping several healthcare providers protect their patients. However, the factor that sets RightPatient apart from others is that it’s entirely touchless – patients only need to look at the camera during the verification process. The platform matches the saved photo with the live one and provides the accurate EHR once a match is identified.

The fact that RightPatient is contactless is why prominent healthcare providers have chosen it. The platform improves infection control and reduces HAIs (hospital-acquired infections) as there’s no physical contact required, making it ideal in a post-pandemic world.

Caregivers such as Community Medical Centers, Catholic Health Services of Long Island, and the University Health Care System have been using RightPatient and enjoying several benefits such as preventing medical identity theft, reducing duplicates and overlays, protecting patient records, and boosting their bottom lines. Be a responsible healthcare provider now and use RightPatient to see the difference it makes.

Preventing Medical Record Errors Improves Patient Safety

June 28, 2021/6552 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Patient Data, Patient Identification, Patient Safety /by Matt Gibson

Healthcare providers in the U.S. never seem to catch a break – they’ve always faced a plethora of issues even before the pandemic. For a brief refresher, the U.S. healthcare system suffers from outrageous costs, the lack of price transparency, ancient laws that hamper healthcare outcomes, the lack of proper interoperability, medical record errors, preventable medical errors, patient safety incidents, and more.

While all of that seems like a bit too much, there are actually far more issues that regularly challenge health systems and hospitals and hold them back from providing positive patient outcomes. One such crucial but overlooked issue that hampers healthcare outcomes is medical record errors. Let’s explore how they are created, what are the consequences, and how proper patient identification can enhance the quality and safety in healthcare facilities.

Medical record errors jeopardize healthcare outcomes in several ways

Patient safety incidents, detrimental healthcare outcomes, denied claims, patient mix-ups, and other adverse effects can be traced back to errors with medical records – the most common ones are duplicates and overlays. In fact, whenever an EHR error occurs, it typically goes undetected until an unfortunate event occurs such as the ones listed above. However, if one goes even further back, patient identification errors are likely to be the main culprit – let’s see how that happens.

Patient misidentification leads to most medical record errors

One of the most common causes that lead to medical record discrepancies is patient misidentification, and that’s because most healthcare providers are using obsolete means to identify their patients – more on that later. Let’s take a look at how duplicates and overlays are created within EHR systems.

Duplicate record creation

It’s quite straightforward – let’s start from the beginning. A patient comes into the hospital for a checkup, and since most hospitals suffer from patient identification problems, the EHR user is left with a difficult choice if they can’t find the accurate medical record. This happens because:

The patient has a common name
There are multiple patient records with the same characteristics
Searching for the right medical record is virtually impossible

Now, the choices the EHR user has are either diving deep and painstakingly finding the accurate medical record, assigning the medical record that seems to be the “closest match”, or, just to be safe, creating an entirely new medical record. However, the latter can be catastrophic for both the patient and the hospital. Saving a discussion about the consequences for a later part, let’s see how overlays are far more damaging.

Overlays are extremely dangerous

Duplicate records are created when a patient has multiple medical records. Overlays, however, are single medical records that contain information about multiple patients – clearly, these medical record errors can be very dangerous.

Let’s continue from the previous example – the EHR user selected a medical record that best matched the patient (X), but it actually belongs to a different patient (Y). When patient X has their medical checkup, their health information is recorded into patient Y’s medical record, rendering it corrupt, unusable, and dangerous. Next time, when either patient returns for medical treatment, they’ll be facing detrimental healthcare outcomes because the data in their medical record is unreliable.

Moreover, with the growing adoption of EHR systems, these issues are becoming far more common. In fact, according to AHIMA, smaller hospitals have around 5-10% of these duplicate medical records whereas larger health systems can have a whopping 20%. These errors can cause around $40 million in unnecessary costs in clean-ups, litigation costs, and others.

Unfortunately, the biggest issue with these duplicates and overlays is that, as previously mentioned, they remain undetected until an adverse event occurs. The best way to resolve medical record errors is by preventing them right from the start – accurate patient identification can help with that.

RightPatient prevents duplicates and overlays

RightPatient has been helping responsible healthcare providers accurately identify patients at any touchpoint with its robust biometric patient identification platform. It can be seamlessly integrated with any EHR system and it becomes a part of the EHR workflow.

Patients only need to look at the camera – the platform automatically locates the accurate medical record for the EHR user, making it a seamless, safe, and hygienic experience for everyone involved. It has been helping reputed caregivers like Grady health, TGMC, and Community Medical Centers prevent duplicate record creation, ensure patient safety, and boost the bottom line.