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Patient Identification Errors in Hospitals Should be Eliminated Now Instead of Waiting for a UPI

Patient identification errors have been haunting the US healthcare system for decades now. In fact, the lack of effective patient identity management within the majority of hospitals and health systems is quite well-known as it is prevalent. Otherwise, groups would not have formed every year to appeal to Congress to finally approve a state-funded unique patient identifier (UPI). However, the coronavirus pandemic has been wreaking havoc across the US, which is why accurate patient identification is needed more than ever. But should they still wait for Congress for a UPI, or is there a way to eliminate patient identification errors in hospitals now? The short answer to the latter is yes – RightPatient. Let’s dive deep into the issues caused by patient misidentification, what the healthcare industry is doing about it, and how leading providers are solving it.

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Issues caused by patient misidentification

Patient misidentification has always caused a plethora of problems – for patients, healthcare providers, insurance companies – basically anyone involved with patient care. However, the pandemic has deemed the elimination of patient identification errors in hospitals more necessary than ever, so that patients can get faster, more accurate care, leading to improved health outcomes. So, what are the issues caused by patient identification errors?

The lack of accurate patient identification can create duplicate records or overlays (merged medical records of the same or different patients), causing a ripple effect and hampering patient safety by generating inaccurate patient information. For example, a patient with a common name comes into a provider’s facility, and without a robust patient identification platform, it will be quite difficult for the EHR user to determine the correct medical record for the patient. Thus, the healthcare official will either painstakingly search for the correct record, which is quite time-consuming, or else an entirely new record will be created, leading to just another duplicate record among the several existing ones. Duplicate records create patient safety issues – patients will be treated based on an incomplete or inaccurate medical history. For providers, the financial cost of duplicates can be up to $40 million, according to AHIMA.

Patient misidentification can also cause denied claims, which have a severe impact on the financials of hospitals and health systems. Suppose a patient is misidentified by the provider using an obsolete patient identification system. While the patient at the facility will be receiving the care, someone else will be charged inadvertently for the services as a result of patient identification errors. However, the medical record holder can simply let the authorities know that someone else had used the healthcare services, and thus, he/she will not be charged – leading to a case of claim denial. Denied claims can cost up to $4.9 million on average for any given healthcare provider.

Even during this ongoing and unprecedented health crisis, patient misidentification is quite common. It occurs because there is no proper way to match patients to their electronic health records (EHRs) within those providers’ facilities, and it leads to patient safety issues as well as reduced quality of care. Other issues patient misidentification causes are incorrect treatments, medications, and lab test results – hampering patient outcomes significantly. Given the current scenario of the healthcare system, these issues should be minimized as much as possible – something that RightPatient can help hospitals with.

What is the healthcare industry doing about it?

During a virtual briefing, the CEO of AHIMA, Wylecia Wiggs Harris, stated that COVID-19 shows how important accurate data is and why patient misidentification issues must be solved as soon as possible. 

Leading-healthcare-providers-use-RightPatient-for-positive-patient-identificationLikewise, other experts have been making similar statements. For instance, even COVID-19 test results were affected by patient identification errors. After the results came in, it was quite difficult to identify and search for the patients, as no accurate patient identity management system existed within the facilities.

Thus, healthcare leaders across the states are coming together to once again to ask Congress to lift the archaic ban on a state-funded UPI. However, if the past has anything to teach, it is the fact that the ban has been in effect for decades now. Lawmakers and officials placed the ban citing privacy concerns regarding a UPI, and it is quite unlikely that they will budge now.

Instead, many leading providers have taken it upon themselves to eliminate patient identification issues within their premises themselves. How are they doing that?  

Eliminate patient identification errors in hospitals now

Forward-thinking providers did not rely on Congress to remove the ban, which might not happen anytime soon, admittedly. Instead, they deployed RightPatient – the leading photo-based biometric patient identification platform.

It locks the medical records of the patients with their photos – a returning patient looks at the camera, allowing the platform to identify the correct medical record within seconds. It is completely hygienic and ideal for the current crisis. 

Our platform has been successfully reducing patient identification errors in hospitals and health systems. RightPatient ensures accurate patient identification, reduces claim denials, avoids duplicate medical records, and even prevents medical identity theft – improving patient safety and quality of care in the process.

Contact us now and ensure accurate patient identification at your facilities to stay ahead of the curve.

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How Can Medical Identity Theft Occur During Telehealth Visits?

Telehealth has been around for years, but it has only been growing exponentially for the past few months. One of the biggest propellers that caused the surge in telehealth usage is the coronavirus pandemic, while the other reason is its benefit of taking healthcare out of the regular setting and setting up safe and remote environments for the patients and caregivers. While many predict that telehealth is here to stay after seeing how it can benefit caregivers and patients, health systems and hospitals need to focus on another important aspect – how can medical identity theft occur during telehealth visits, and is it preventable? Fortunately, it can be – with RightPatient. Let’s dive deep.

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Telehealth skyrocketed due to COVID-19

Since telehealth was introduced, experts in the US healthcare system have been busy debating its pros and cons, affecting its growth and questioning its capabilities. However, as the pandemic has shown, telehealth has been extremely crucial for the US healthcare system during its ongoing battle against the pandemic. It has helped reduce the risk of more COVID-19 cases as non-COVID-19 patients were recommended to use telehealth instead of inpatient visits.

As previously mentioned, the biggest benefit of telehealth is that it enables patients and caregivers to engage in healthcare remotely. All they need is a good internet connection and devices to communicate with each other – eliminating any chances of contracting the virus as opposed to inpatient visits during the pandemic. Thus, it is no surprise that telehealth demand has been sky-high, with experts predicting over one billion visits during 2020 alone. While providers are quickly adapting to the changes and using telehealth, hospitals and health systems must also think about a serious problem – how can medical identity theft occur during telehealth usage?

Medical identity theft is all over the place

Medical identity theft is nothing new. Hackers steal valuable patient information through healthcare data breaches. They sell it for up to $1000 per record on the black market to fraudsters. Since healthcare is quite expensive, these fraudsters prefer buying patient information from hackers for a much cheaper price, shifting the healthcare costs onto the shoulders of the victims.

Medical identity theft is becoming quite prevalent. In 2019 alone, more patient records were breached in comparison to the previous three years combined. Medical identity theft leads to lawsuits, patient safety issues, settlement costs up to $250,000, unwanted attention, and loss of goodwill. Thus, it becomes increasingly necessary to ensure that medical identity theft is prevented, even during telehealth visits.Medical-identity-theft's-effects-can-be-mitigated-with-RightPatient

But how can medical identity theft occur during telehealth? Well, the stolen information can be easily used by the fraudster to bypass the obsolete patient identification systems most hospitals have – just like inpatient visits. Moreover, many patients sometimes even give their credentials to their family members or friends willingly – aiding them in medical identity theft. 

Such cases lead to added costs like medical record clean-ups, lack of patient data integrity, and patient safety issues, among other problems. Hospitals are facing huge losses already due to the pandemic, and they need to recover their losses if they want to survive in the future. One of the best ways to do all of that is by ensuring positive patient identification.

Accurate patient identification with RightPatient

RightPatient is the healthcare industry’s leading touchless patient identification platform. It locks the medical records of the patients with their photos upon enrollment. Whenever the patient comes, all he/she needs to do is look at the camera and the platform matches the photos and provides the correct medical record within seconds. RightPatient seamlessly integrates with the major EHR systems, enhancing the experience for providers as well. It is hygienic too, enhancing patient safety and reducing infection control issues.

While it has been ensuring accurate patient identification for providers for years, RightPatient brings the same expertise to telehealth. It can also be used to remotely validate a patient’s identity. Patients receive an SMS or email after scheduling an appointment, after which they need to take a selfie and photos of their driver’s license. RightPatient automatically matches the photos of the driver’s license and the selfie to validate patient identity – preventing medical identity theft in the process.

RightPatient has been successfully protecting over 10 million patient records and preventing fraudsters from harming patients while reducing healthcare costs, denied claims, lawsuits, and boosting the bottom lines in the process. Protect your patients – even during telehealth visits – with RightPatient. 

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Identifying Patients Accurately is Critical for Ensuring CMS Compliance

The US healthcare system has been going through a very challenging phase due to the coronavirus pandemic. However, it looks like healthcare providers are going to have their hands full – they have another rule to comply with and must plan accordingly to ensure compliance by May 1, 2021. The fact that there have been additional changes to the Medicare Conditions of Participation (CoPs) is already well known among healthcare leaders. However, while many providers are already thinking about how they can ensure compliance, they might leave out one significant factor that can make or break the entire effort – are they identifying patients accurately? Why is this important? How does patient identification fit in with the new changes? How can providers ensure accurate patient identification? Let’s explore in detail.

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CMS Interoperability & Patient Access Final Rule

While the entire healthcare system has been suffering from the lack of interoperability, the Centers for Medicare and Medicaid Services (CMS) have made some changes to the CoPs to ensure that there is some degree of interoperability, believing that it will have positive effects on care coordination as well.

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The “companion final rule”, as per CMS, mandates that healthcare providers like acute care, psychiatric, and critical access hospitals send out e-notifications during every patient admission, discharge, or transfer (ADT) to the designated recipients (read: providers and other entities primarily responsible for patient’s care). This is applicable for both inpatient admissions and patients registered in the emergency departments (EDs).

Moreover, the providers obligated to follow the ADT requirements must make enough effort to ensure that they have sent out the notifications to the applicable parties (suppliers, entities, practitioners, etc.) in real-time.

Any given healthcare provider that uses digital medical records like EMRs or EHRs needs to ensure compliance with the updated CoPs for e-notifications. COVID-19 has extended the deadline – healthcare providers now have until May 1, 2021 to ensure compliance with the recent changes. 

Why are the CoPs important?

What is the biggest reason to ensure CMS compliance? Financial factors like CMS reimbursements and avoiding non-compliance penalties are more than ample motivators. Healthcare providers need to be compliant in order to safeguard their CMS provider agreement – it determines whether the providers are able to receive reimbursements or not, which can be quite significant in some cases. If providers do not ensure compliance, not only will their agreements be in jeopardy, restricting them from receiving reimbursements, but they might also face penalties. Given the current healthcare crisis that has crippled almost every caregiver, more financial woes are something any provider would want to avoid. 

What the healthcare providers are doing

Since the deadline has been extended to May 1, 2021, leading figures of healthcare providers are brainstorming about how to comply with the change – should they build an in-house e-notification system themselves, or should they buy from experienced vendors? Whatever option providers go with, they are not addressing the elephant in the room – are they identifying patients accurately?

How identifying patients accurately is related to e-notifications

Think of it this way – patient identification in hospitals is already inaccurate. In fact, many healthcare providers face patient identification errors due to duplicate medical records, medical record overlays, and patient mix-ups, among other problems. These lead to issues like compromised patient safety, unwanted patient outcomes, avoidable medical errors, and even deaths.

So, it has already been established that if a hospital does not have an accurate patient identity management system, then it causes a lot of problems for the facility. Can you imagine what will happen if the hospital goes for an e-notification platform without identifying patients correctly first?

Issues like common names and characteristics shared by patients are already quite prevalent and cause patient mix-ups. If such a case occurs while sending out e-notifications, then the wrong patient’s data will be provided to the subsequent caregiver. Thus, patient mix-ups and incorrect patient identification cases during ADT notifications will wreak havoc – delays in treatments, medical errors, and lawsuits are just some of the consequences of such scenarios. It will be a nightmare for any given provider. Hospitals and health systems that are not identifying patients accurately at their facilities need to eliminate these errors to ensure CMS compliance and avoid any unwanted consequences. They need to ensure patient data integrity by ensuring positive patient identification every time a patient comes in. That’s where we can help.

Identifying patients accurately with RightPatient

CMS-compliance-requires-proper-patient-identification-for-e-notificationsRightPatient is the healthcare industry’s leading photo-based biometric patient identification platform. It seamlessly integrates with the major EHR systems and becomes part of the workflow. Patients are registered by locking their medical records with their photos. After enrollment, incoming patients only need to look at the camera and the platform matches the photos and provides accurate medical records within seconds. This ensures a safe, easy, touchless, and hygienic patient identification experience for everyone.

RightPatient ensures that the correct patient is identified every time across the care continuum, helping you maintain patient data integrity. With RightPatient, you can send out the correct patient’s notification every time, ensuring CMS compliance and safeguarding your patients and, in turn, your business.

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5 Tips for Preventing Medical Identity Theft in Healthcare

Hospitals, medical centers, and physicians’ offices are not only places where patients should feel safe about getting the right medications, but it should be a place where they also feel safe with their sensitive information. Unfortunately, with the rise in the number of healthcare data breaches, the market is even riper for medical identity theft. Over 41 million patient records were breached in 2019 alone and the majority of them were associated with hacking or cyber attack-related incidents. 

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Preventing medical identity theft has been one of the top priorities, yet many organizations still rely on antiquated patient identity management solutions. Many leading hospitals, namely, Terrebonne General Medical Center and The University Healthcare System have been successful in preventing medical identity theft and benefitted in many other ways since using RightPatient. Other benefits include eliminating duplication of medical records, improving patient identity matching rates, clinical efficiency, and boosting the overall revenue cycle. But what about medical identity theft? How are patients affected by it? What are the ways for preventing medical identity theft? Let’s find out.

What is Medical Identity Theft?

Medical identity theft occurs when a fraudster uses someone else’s personally identifiable information (e.g. name, DOB, Social Security Number, health insurance number) to fraudulently receive medications or services, including attempts to falsify medical billings. The healthcare industry would have billions of dollars in surplus if all healthcare providers could prevent medical identity theft. This crime involves the fraudulent use of someone’s health insurance information to obtain reimbursement for healthcare-related services provided to a person not covered by the policy. This is one of the most common reasons for the rise in the numbers of claim denials. It affects revenue integrity and requires organizations to put in more strenuous efforts and resources to identify and resolve the problem throughout the revenue cycle management.

How are patients affected by medical identity theft?

Patients may not be able to afford the cost: Financial consequences for the victims of medical identity theft can exceed the cost of credit card fraud. According to a study conducted by the Ponemon Institute, medical identity theft can cost an average American $13,500 to resolve.

Victims may not be aware of their information being stolen: In most cases, insurers or healthcare providers rarely inform the patients about the crime. In general, victims are completely unaware of when they became a victim and learn about the theft of their credentials about three months after the crime has occurred.

Reputations can be on the line: Found in many studies, victims said that their reputation was affected because of medical identity theft due to disclosure of personal sensitive health information. Many respondents believe they missed out on good career opportunities due to identity theft. Some said it resulted in the loss of their job.

5 Tips for Preventing Medical Identity Theft

Invest in modern patient identity management technology and software

With the transition of paper-based patient’s records to electronic-based record-keeping systems, it is necessary to invest in modern technology and software for preventing medical identity theft. For better security and matching rates, many healthcare providers have adopted RightPatient – a leader in touchless biometric patient identity management solutions. With RightPatient, healthcare providers can verify patients’ identities and protect access to medical records. RightPatient does not only help in preventing medical identity theft but it also drastically improves patient matching rates and eliminates the creation of duplicate records.

Just as facial recognition or iris scanning techniques are used in smartphone devices today, this platform uses similar biometric techniques in a healthcare setting for authenticating and verifying an individual’s identity. RightPatient uses an individual’s iris pattern or photos of their face to lock their medical records. Each time a patient arrives at the continuum of care, the platform will scan their iris pattern or photos of their face to authenticate their identity and retrieve their correct medical records. With secure-log-in monitoring, fraudsters will be instantly denied when they try to gain access to medical records by assuming someone’s identity. 

Automating the patient registration and enrollment process

Automating the patient registration and enrollment process can eliminate the hassle of a long, complicated registration process, save valuable time and resources, and reduce errors at the same time. Criminals can easily obtain or use someone else’s common identifiers, such as names, SSNs, and DOB for fraudulent use. Many times common identifiers have also been the main cause of the creation of duplicate identities or record mismatching. Paper-based records are also vulnerable to how easily they can end up in the wrong hands. With RightPatient, transitioning to an automated patient enrollment system will be seamless. 

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Streamline workflow and maintain compliance

Protected health information (PHI) is like a treasure box for cybercriminals and thieves. PHI contains valuable sensitive information and can easily be worth more than credit card numbers on the black market. This is why the Health Insurance Portability and Accountability Act (HIPAA) was established to ensure confidentiality, integrity, and availability of PHI. HIPAA requires healthcare organizations to implement appropriate safeguards to better protect patients’ information so it doesn’t end up in the wrong hands. Maintaining compliance with HIPAA can be quite strenuous, but organizations can use HIPAA compliance software to streamline their compliance efforts and reduce administrative burden. Adopting the best security practices to limit unauthorized access or disclosure of patient information is crucial for preventing medical identity theft.

Robust bring your own device (BYOD) and network access policy

Personal devices should be secured before accessing a patient’s information across the network. A proper BYOD policy must be developed and maintained. For instance, is it safe for employees to bring company-issued devices back home? Many times, thieves get access to sensitive information when devices such as laptops, tablets, or smartphones get stolen from the office, home, or even from a car. Hospitals should also install a separate internet wi-fi network for visitors and patients to restrict access to the organization’s internal network. 

Educate your employees and patients and instill a culture of best privacy practice

Not all data breaches are malicious – human error is inevitable. From emailing sensitive data to the wrong person to accidentally posting on social media or leaving a laptop open, information can be disclosed in many ways. It is essential for healthcare providers to conduct proper training and educate their staff members, working in any capacity with medical information on how to handle and access PHI in an appropriate manner and identify suspicious behaviors for preventing medical identity theft. Training can be easily streamlined using applications.

Many hospitals always strive to do their best when it comes to securing patient information. The occurrence of medical identity theft is unfortunate but isn’t rare at all. Hospitals should also advise patients and encourage them to keep their sensitive information safe and be cautious when sharing sensitive information. 

Preventing Medical Identity Theft with RightPatient

Even during this COVID-19 national emergency crisis, medical identity theft is continuously becoming a great threat to the safety of patients and healthcare providers. Besides being the leader in patient identity management, RightPatient offers completely touchless biometric modules for patient identification. With RightPatient, healthcare providers can easily prevent medical identity theft and improve patient safety along with hygiene in a facility by removing physical contact, thus, limiting the spread of contagious diseases. 

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Verifying Patient Identity – Top 3 Benefits

The failure to accurately identify patients throughout the healthcare industry continues to result in medication and diagnosis errors, procedures on the wrong person, duplicate medical records, and health insurance fraud. Therefore, healthcare providers should properly collect and manage information for verifying patient identity to prevent medical identity theft, improve medical record accuracy, and comply with HIPAA.

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The amount of information flow in healthcare is greater than any other industry, but it all means nothing if a patient’s identity is compromised, or cannot be matched with their records. Verifying patient identity before starting a medical treatment or service is vital for ensuring a positive patient experience. The inability of healthcare providers to accurately identify their patients during the COVID-19 pandemic has resulted in slow procedures, incorrect treatments, and even encouraged insurance fraudsters to take advantage of this chaotic situation. 

That being said, RightPatient has been helping healthcare providers keep accurate records connected with the correct identity for years now, ensuring effective health treatment and recovery. The coronavirus pandemic has also been a prime catalyst for the consideration of futureproof biometric identity management solutions, such as RightPatient, for verifying patient identity. The reason for this is that our solution helps providers maintain a hygienic environment and limit the spread of contagious diseases. Here’s what else RightPatient can do for your organization:

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Verifying patient identity to prevent medical identity theft

Even during this pandemic, security experts warn that the threat of medical identity theft is far from over, because attackers know they can take advantage of this situation. Healthcare providers, as well as patients, suffer from medical identity theft: the illegal access of a patient’s personally identifiable information and using this information to fraudulently obtain medical treatment, goods, or services. 

The cost of proper medical treatment is exorbitant, especially if not covered by health insurance. It results in claim denials and negatively affects a health system’s bottom line. That is why verifying an individual identity is crucial before providing any kind of service. Health care providers, such as Terrebonne General Medical Center (TGMC) and the University Health Care System have successfully prevented many potential medical identity theft occurrences since using RightPatient. 

Reduces information discrepancies in medical records

Arguably, the most damaging concern for healthcare providers is incorrect and potentially life-altering information being put on someone’s medical record. Inaccurate records have been the root cause of incorrect treatments, delays in procedures, and even the creation of duplicate records and overlays. Medical records are very difficult to change as they are meant to be a permanent and comprehensive account of an individual’s healthcare history. Thus, verifying a patient’s identity and accurately matching their information with their medical records can help providers to avoid financial losses due to fraudulent claims and improve data integrity.

Verifying patient identity for compliance

In the U.S., various state, federal, and industry-specific compliance regulations such as HIPAA and HITECH have been established for verifying patient identity. Not complying with these Acts can lead to hefty financial penalties being issued, and in worst-case scenarios, criminal charges being filed. 

HIPAA, which stands for the Health Insurance Portability and Accountability Act of 1996, is a federal law that provides security provisions and data privacy, to protect a patient’s medical information. It enables smooth transitions of electronic records and requires appropriate controls over the use and disclosure of medical records.

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Any organization that deals with protected health information (PHI) is required to comply with HIPAA’s rules and regulations. The law consists of several standard verification requirements for the disclosure of PHI. Under this subpart:

(i) Except with respect to disclosures under §164.510, verify the identity of a person requesting protected health information and the authority of any such person to have access to protected health information under this subpart, if the identity of any such authority of such person is not known to the covered entity;

Numerous stipulations suggest that it is lawful for organizations to take reasonable steps, such as using HIPAA compliance software and using platforms like RightPatient for verifying patient identity, to ensure compliance. HIPAA compliance also ensures that there are appropriate safeguards in place to protect PHI from unauthorized disclosure or breaches. 

RightPatient – touchless biometric patient identity management platform

RightPatient is the healthcare industry leader in biometric patient identification. RightPatient also offers remote identity validation and appointment scheduling solutions for telehealth practitioners to ensure positive clinical outcomes during this pandemic. The platform verifies patient identities by comparing their selfie photos and ID (e.g. driver’s license). It helps healthcare providers save money on more costly identity-proofing solutions through credit agencies.

Even without this pandemic, exercising due diligence is vital. With the threat of medical identity theft looming even greater than before, healthcare providers need to have the most risk-conscious and thorough procedures in place to mitigate fraud. With RightPatient, healthcare providers can confidently stand under the near-perpetual spotlight of public scrutiny.

How to Get Prescription Drug Coverage

How to Get Prescription Drug Coverage

Did you know that your health insurance might cover your prescriptions too? Many people are unaware of this added benefit when they visit the pharmacy for a course of antibiotics or other prescription drugs. 

Behind the scenes of your health insurance plan is usually a list of approved medications that your insurer will cover in part or in full. This is known as a formulary. Some insurers may offer prescription coverage only as an add-on to your current plan. It’s always best practice to fully understand every inch of your insurance. 

Why spend money when you don’t need to? Health insurance premiums don’t come cheap. Take advantage of your entire plan or what your insurer has to offer and cut down your medication costs.  

Below we will cover everything you need to know about getting prescription drug coverage. Read on to learn more. 

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Prescription Drug Coverage Options

There are a myriad of ways in which you can gain prescription coverage. You may already be entitled to it through your employment or union without even knowing. TRICARE, Medigap, and Veterans Affairs also offer prescription coverage policies. It’s worth taking the time to delve deeper into any existing insurances you already hold. 

Alternatively, Medicare offers two different routes to obtaining drug coverage. The Medicare Prescription Drug Plan is often referred to as Part D is a drug-specific add-on to your existing Medicare plan. 

You can also opt for a Medicare Advantage Plan (Part C), which is similar to an HMO or PPO plan. With this option, you’ll receive the benefits of parts A, B, and D. These include hospital insurance, medical insurance, and drug coverage. Specific in-network pharmacies may need to be used to ensure your insurer will cover the cost if you opt for this route. 

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How to Join a Drugs Plan

Joining a drug plan is simple. If you’re searching for a new insurance policy, all you need to do is select it as an option (if available) during the selection process. Many independent and federal insurance companies will provide this choice.  

Alternatively, if you’re eligible for Medicare and want to enroll in Medicare prescription drug coverage, you’ll need to enroll in the Medicare Plan Finder. You can also call the Medicare agents to set up your drugs plan. If you want to add the cover later, you will need your Medicare number and the correct date your part A and B insurance began.

How to Find Out What Prescription Drugs Are Covered in Your Plan

If you want to find out what prescription drugs are covered in your current plan, you can head to your insurer’s website. Here you’ll be able to find the list of included medications in the provider’s policies. If the information isn’t transparent, then you should call your insurer directly for more details.

Drugs covered in your prescription policy should also be detailed in any materials mailed to you after setting up the insurance. If you have lost these, you can often request a new set to be sent to you.  

How to Get Prescription Drug Coverage

Other Important Factors to Be Aware of With Prescription Cover

What type of insurance you take out (HMO, PPO, or private) and what plan you purchase will determine how your drug policy works. 

Some may only allow you to use certain pharmacies. Others may not cover your current prescription. In the latter instance, you may be offered a one-time refill until your doctor prescribes a new drug that is eligible under your cover. Alternatively, you can apply for an exception. 

An exception will make the specific drug you use eligible for cover. However, you will often be charged copayment. The fee is usually the same rate as the most expensive drug already on the policies approved list. The amount may count towards your deductibles and out-of-pocket limits. 

If your request for an exception is denied, you can appeal this decision and seek a third-party review. 

You may also find that some policies cover shipping costs for delivering your prescription by mail. On the other hand, others may not offer this service within the plan and charge you an additional fee for it.

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To Conclude

Don’t be afraid to pick up the phone and ask your medical insurer if prescription drug cover is part of your policy. You may be surprised by the number of medicines that are already covered in your plan. 

If a drug policy needs to be added on, it’s more than worth investigating further. You may incur a slight increase in premiums, so you would need to factor this into your budget. 

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Optimizing Revenue Cycle Management in Healthcare is More Important Than Ever

While the US is still suffering from the effects of the highly contagious COVID-19, it has arguably hit its healthcare system worse than anything else. Around 1.4 million people working in healthcare have lost their jobs. The number itself is quite shocking, however, what makes it worse is that the pandemic has changed everything. For instance, the US healthcare system used to be unaffected by any recessions, but COVID-19 has shown otherwise. This is because numerous hospitals have declared layoffs, furloughs, or are even shutting down due to unimaginable financial pressure. With that in mind, as hospitals are opening up, they need to reduce their losses right off the bat, otherwise, it will be hard for anyone to survive. Thus, revenue cycle management in healthcare is more crucial than ever now.

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The numbers are drastic

It has already been mentioned that over 1.4 million healthcare professionals lost their jobs. That’s not where it stops, though. Since hospitals made the difficult but necessary choice to prepare for the overwhelming amount of COVID-19 patients by shutting down non-emergency care at their premises, they became financially crippled. The American Hospital Association stated that hospitals are losing a mindboggling $50 billion a month, due to the fact that they are seeing an extremely low number of patients – as low as 70%. Revenue cycle management in healthcare has always been a much-discussed topic, however, as the numbers show, it is of utmost importance now to optimize revenue cycles by reducing costs and mitigating losses – something that RightPatient can help healthcare providers with. But how does optimized revenue cycle management help hospitals deal with the financial crisis?

Benefits of optimized revenue cycle management in healthcare

Reduced denied claims

A streamlined revenue cycle depends on the level of accurate data present within the system. If there is a high level of accuracy, it reduces the chances of denied claims. Usually, denied claims occur when there are mistakes in payment claims. One example is when patients are mistakenly charged for services they have not used. RightPatient ensures that the patient is accurately identified from the beginning to the end of the process – substantially reducing denied claims. 

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Enhanced patient experience

An optimized revenue cycle means that the FTEs will spend less time on redundant tasks such as rechecking coding and billing for errors and focus more on providing better care to the patients – enhancing the patient experience. 

Higher and faster collections 

It is quite simple – if the revenue cycle is optimized, there will be higher collections with a lower number of errors. FTEs, thus, do not have their hands full of coding and billing errors – giving them the time to focus on the remaining collections, improving efficiency in the process. 

Accurate patient information 

An optimized revenue cycle means that you are ensuring patient data integrity; that is, from the beginning of caregiving to collections, the correct patient has been identified. This can be easily achieved using an accurate patient identification platform like RightPatient.

Better financial returns

One of the most vital parts of a healthcare provider that everyone scrutinizes, other than treating patients, is its financial performance. After all, these are the indicators as to how well a provider is doing. An optimized revenue cycle means that there are increased clean claims, faster collections, lower lost claims, and accurate patient data – all leading to improved revenue of the provider.

Since COVID-19 is still affecting the financial performance of providers, they need to ensure that their revenue cycle is as optimized as possible. 

Optimize revenue cycle with RightPatient

Optimized revenue cycle management in healthcare means that you need to have the correct data for the patient and you are ensuring that he/she is being billed accurately throughout the whole process. Thus, for a better revenue cycle, you need to ensure accurate patient identification. This is where RightPatient can help you.

It is a touchless biometric patient identification platform and is used by leading healthcare providers for a number of reasons. It prevents medical identity theft, optimizes the revenue cycle, reduces denied claims, prevents duplicate record creation, enhances patient safety, and more – leading to improved financials, boosting the bottom lines in the process. 

Upon registration, RightPatient locks the medical records of the patients with their photos. Whenever an enrolled patient comes in, all he/she needs to do is look at the camera and it identifies them within seconds, providing the correct patient record to the EHR user and ensuring accurate patient identification. This ensures that the correct patient is identified right from the start – reducing billing errors and denied claims and optimizing revenue cycle in the process. This is something that every provider needs to ensure to survive during this unprecedented situation.

RightPatient has years of experience and has been helping protect over 10 million patient records. Duke Health and Community Medical Centers, among others, are using RightPatient to ensure safe, hygienic, and accurate patient identification. Are you optimizing your revenue cycle sensibly? 

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How to Prevent Medical Identity Theft During COVID-19 as Experts Predict Rising Cases 

The world has been drastically changed due to COVID-19 – it seems as if the whole thing was adapted from a sci-fi horror story. While many parts of the world have been opened up with precautions, it looks like the coronavirus pandemic has yet to complete its significant mark on humanity. For instance, new cases are surfacing in the US – over 2.6 million Americans have been infected as of June 29th, 2020. However, that will not stop hackers from attempting to steal patient data, which ultimately leads to medical identity theft. In fact, experts have warned that such cases will rise due to the pandemic. That being said, everyone within the US healthcare system is working hard to survive, serve patients, and open up. With all these overwhelming odds, one might even not have time for the answer to the question, “How to prevent medical identity theft even during the pandemic?” Fortunately, there is an answer – RightPatient, but more on that later.

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Rising medical identity theft 

Medical identity theft is nothing new – it has been around for quite some time now. In fact, more than 2.3 million Americans are victims of medical identity theft each year, whereas healthcare providers might be forced to pay settlement costs of around $250,000. However, a security expert like Randy Pargman, an ex-senior computer scientist of the FBI, has stated that there will be more cases of medical identity theft during the pandemic as there is a lucrative window of opportunity for hackers.

But why is that so? Mr. Pargman has stated that since the patient information contains valuable and sensitive data like Social Security numbers, insurance information, DOB, names, and addresses, these can easily be used by actors. They can simply pretend to be the patients and obtain medical services while the victims are billed fraudulently. Cases like this will be quite common unless healthcare providers know how to prevent medical identity theft. Thankfully, RightPatient does that effectively. It also helps to improve quality and safety with its platform.

Why are such cases so common?

The answer is quite simple – medical records are the most profitable forms of stolen information. To put it into perspective, stolen credit card information sells for up to $110 on the dark web, whereas stolen patient records sell for up to a whopping $1,000!

Thus, it is quite natural that hackers would target healthcare providers more, as they can sell the records for far more money. Fraudsters can also obtain expensive medical services, unobtainable drugs, and medical equipment for a mere $1,000. They are saving thousands of dollars – healthcare can get quite expensive. It is simple economics – wherever there is demand, there will be supply.

While providers are required to protect patient data due to laws like HIPAA, they usually implement inadequate security, ultimately leading to healthcare data breaches and medical identity theft. As previously mentioned, not everyone is facing such cases. Healthcare leaders have taken it upon themselves to protect their patients from medical identity theft and saving themselves from unnecessary costs due to HIPAA violations. Saving costs is even more necessary during the pandemic. So, how are the leaders answering the question, “How to prevent medical identity theft?”

How to prevent medical identity theft with RightPatient

RightPatient has years of experience with leading providers. A touchless biometric patient identification platform, RightPatient solves a number of issues. But before that, how does it work exactly?

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It locks the medical records of the patients with their photos during registration. After enrollment, the platform simply takes a photo of the returning patients, matches it to the one saved within the record, and provides the appropriate EHR within seconds. The best part is that it does so without requiring a single touch from the patient, making it the most hygienic patient identification platform.

Thus, if a fraudster comes in assuming the identity of someone else, RightPatient will immediately red flag the person – preventing medical identity theft in real-time. RightPatient also prevents duplicate record creation, reduces denied claims, and enhances patient safety. All these lead to boosting the bottom lines of hospitals – something which is very much needed for providers currently to survive. 

So, how can you prevent medical identity theft during and after the pandemic? The answer is RightPatient. 

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Patient Identity Management is More Important Than Ever – Are you Doing it Right?

Patient identity management, to put it very simply, refers to how patients are being identified in hospitals. However, anyone who knows the US healthcare system is familiar with the fact that it is quite a significant problem for the majority of healthcare providers. Lack of proper patient identity management is a problem not only for healthcare providers but for everyone involved in healthcare, including patients and insurance companies. While healthcare providers incur financial costs as well as the loss of goodwill, patients face financial costs as well as the wrong treatment and medications, hampering patient safety. Even though there are effective solutions, the coronavirus pandemic has rendered most of them ineffective. Let’s dive deep into why patient identification errors occur, how they have been solved until now, and why the future of patient identity management will be different (read touchless) due to COVID-19.

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Reasons for patient identification errors

Patient identification errors have always been present. Earlier, patient record mix-ups were the main reason when paper medical records were used. To put it simply, patient records were mixed up when the patients had common names and characteristics such as age, address, etc. Fast forward to the age of EHR (electronic health record) systems, where things have become quite complicated. Human errors, negligence, and relevant external factors have caused EHR systems to house duplicate medical records as well as overlays, causing patient identification errors to be more prevalent than ever. 

Duplicate medical records can be created for the same patient. For instance, if a patient goes to avail of healthcare services, the first thing the provider would do is identify the patient’s medical record. For various reasons, the EHR user cannot identify the correct medical record (say, the EHR user sees that there are multiple records for the same name). Either the hospital staff spends more time painstakingly searching for the right medical record, or else creates a new record, the latter leading to a duplicate being created. This duplicate will lead to fragmented data and patient care – neither the correct record will house the most recent data of the patient nor the new one will contain the entire medical history of the patient. All in all, this will hamper patient safety, and increase costs. 

Medical record overlays are created when multiple records are merged, and this can be for the same patient having duplicate records as well as a different patient having the same characteristics as another patient. As can be understood, overlays are quite dangerous as it mixes information from different patients.

On top of all that, the classic cases of patient mix-ups still exist. A few months ago, two patients got mixed up regarding a kidney transplant – the wrong patient got the kidney. Fortunately, nobody was hurt as the kidney was compatible with the wrong patient. This mix-up occurred due to the patients having similar names, age, as well as being lined up for kidney transplants, albeit on different dates. While both the patients surviving without major issues was a huge stroke of luck, not everyone is as fortunate. There have been many cases where mistaken patient identities caused deaths

All in all, patient identification errors cause a plethora of problems for everyone involved, which makes an effective patient identity management solution like RightPatient all the more crucial, especially in a post-COVID-19 world.

Common patient identity management solutions

By far, the most common and obsolete way of patient identification is asking patients questions. Even in this day and age, many hospitals are still using this simply ineffective method. Patients are asked to state their names, addresses, and other relevant data to crosscheck against present medical records. This is slow, tedious, and also dangerous – someone can just assume the identity of another patient and commit medical identity theft. Healthcare data breaches are quite common, and hackers steal patient data, only to sell it later on the black market. An impostor can just buy the data and assume the identity of the patient, and if this outdated way of identifying patients with questions is used, the actor cannot be detected easily.

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Another way healthcare providers identify patients is by using patient ID wristbands. While this might seem like a better patient identity management solution, it also has its flaws. To begin with, patient ID wristbands can be transferred, stolen, or lost. This can lead to medical identity theft as well. On top of that, it requires contact – something hospitals are quite wary of and now patients are too, given the coronavirus pandemic. Infection control issues have always been a headache for providers, but COVID-19 has made it a concern for the general public as well. For the next several years, people will be quite reluctant to touch anything, especially within hospitals. 

That brings us to touch-based biometric patient identification solutions like fingerprint and palm-vein scanning. While these are far more effective patient identity management platforms, as there is no way for anyone to fool biometrics, these too pose threats to patient safety. Even before COVID-19, one of the main factors healthcare providers considered before choosing a patient identification platform was how safe it was and whether any infection control issues would arise from using the platform. For both fingerprint and palm-vein scanning, patients had to touch the devices, leading to potential infection control issues. On top of that, cleaning the devices after every use would be a nightmare, to say the least.

The futureproof patient identity management solution

RightPatient is the most apt patient identification platform, moving forward. Why? Because RightPatient is a touchless biometric patient identification platform. It locks the medical records of the patients with their photos upon registration. Whenever a patient comes to the healthcare provider, all the patient needs to do is look at the camera and the platform identifies the correct medical record within seconds, making it the easiest, most seamless, and completely touchless experience.

Leading healthcare providers like Terrebonne General Medical Center, University Health Care System, and Community Medical Centers, among others, have chosen RightPatient because it creates no infection control issues – one of the benefits of being a touchless solution.

Moving forward, the majority of healthcare providers are opening up in phases, and they would need to ensure patient safety. Hospitals have already lost a lot of money due to the pandemic, and they need to start mitigating losses. RightPatient can help providers with that – by both ensuring accurate patient identification and eliminating any touch-based interactions required during the process. This helps reduce denied claims, improves the revenue cycle, and prevents medical identity theft. Mitigate losses now with RightPatient.

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Patient Identity Verification Must be Touchless After COVID-19

The coronavirus pandemic has been the biggest changemaker in recent decades. After months of lockdown, social distancing, and gradual reopening of society, new cases are being seen in the US again. While everything may seem uncertain for now, one thing is for sure – COVID-19 has changed reality for everyone. Going to restaurants and hanging out with friends are things of the past now and there is no telling when all this will be normal again. The coronavirus has highlighted one thing in particular that will stay for us with a long time to come – how to reduce physical contact with others. Healthcare providers have had headaches of infection control issues for years now, but it is the headache of the average patient after the pandemic shook the world. While there will be a rise in usage and demand in touchless technology in the future, such as facial/voice recognition attendance systems, printing board passes via gestures, etc., one area where it is crucially needed is during the patient identity verification process. Let’s analyze the current condition of patient identification processes used, why a uniform identifier is not used by providers, and how leading healthcare providers are ensuring accurate patient identification.

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Patient identity verification – the current scenario

Patient identification errors have been a much-discussed topic in this space, and for good reason. It is still one of the biggest problems healthcare providers are facing – leading to denied claims, medical identity theft, increased losses, and patient safety issues. While ineffective patient identity verification is a prevalent issue, different providers are implementing different solutions to solve them. But shouldn’t there be a uniform method of patient identification present? That is where the UPI comes in.

The mythical UPI

UPIs, or unique patient identifiers, have been the talk for years now. UPIs can be anything that is, as the name suggests, unique to a single patient. Its absence has led to quite a few problems within the US healthcare system, including duplicate medical records, waste, and preventable medical errors. In fact, John Hopkins has said that over 250,000 people in the US die due to medical errors, many of which are due to incorrect patient records and data. These unfortunate deaths could have been avoided with accurate patient identification. But why, then, is UPI still not a thing? Why do healthcare providers still struggle with patient identification? 

Healthcare providers, as well as respected leaders in the healthcare system, have been clamoring for a UPI for years now. In fact, HIPAA (Health Insurance Portability and Accountability Act) mandates that a UPI be created for patients. However, there have been concerns since the beginning of talks regarding a UPI – how it might be stolen, misused, or worse, just like Social Security numbers. Basically, lawmakers were concerned as to how UPI could be kept private and confidential so that third parties cannot gain unauthorized access to it. Thus, back in 1998, Congress banned the authorization of a state-funded UPI. The stance has not changed after all these years. Even in 2019, the House of Representatives voted to revoke the ban, but the Senate let it stay. The lack of an effective patient identifier has been haunting the US healthcare industry ever since the UPI was banned in 1998.

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How is the US healthcare system verifying patient identity?

Different healthcare providers are using different methods for patient identity verification. However, most of them are rendered ineffective now due to the coronavirus pandemic. Earlier, only healthcare providers used to think about infection control issues. Now, it is a headache for the patients as well.

While some are waiting around for the government to approve a state-funded UPI, they are facing a constant struggle with the usage of an obsolete means to identify patients – asking them questions. This has a lot of loopholes – it is slow, tedious, and anyone can assume the identity of the patient as long as they have the patient’s data with them, leading to medical identity theft.

Others are using patient ID wristbands. While more effective than asking questions, this, too, can be stolen, transferred, and used to commit medical identity theft. Not to mention, these require physical contact as well, something that patients will very much be reluctant to do nowadays – a result of the pandemic.

An effective patient identity verification system is biometric patient identification. Once again, not all modalities are effective, safe, and practical. As mentioned earlier, the pandemic has changed reality for all of us – patient identification is no exception.

While biometric modalities like fingerprint and palm-vein scanning are effective, they require the one thing patients will not be ready to do for a long time – touch the device to verify their identities. Hospitals are the epicenter of infection control issues, and while every provider has been dealing with COVID-19 patients, regular patients will be quite hesitant to touch anything. This is especially applicable during patient identification, as they know all patients pass through this location, and contact-based devices might lead to infections.

Touchless patient identity verification is the future

This is where RightPatient comes in. We have been providing hospitals with a touchless biometric patient identification platform for years now. Since the beginning, our focus was to ensure patient safety, which is why we always suggested healthcare providers consider our touchless solution that eliminates any infection control headaches related to patient identification. Unlike touch-based solutions, our devices do not require cleaning after every use.

The medical records of the patients are locked with their photos upon registration. Whenever the patient returns, RightPatient identifies the right medical record within seconds after the patient looks at the camera. 

RightPatient has been serving leading healthcare providers like Community Medical Centers, University Medical Center, and Duke Health. It has helped with eliminating the creation of duplicate medical records, preventing medical identity theft, and enhancing patient safety through accurate patient identification in a hygienic manner.

We shared the same concerns healthcare providers have – how to ensure accurate patient identity verification while eliminating infection control issues. After the pandemic, patients have the same concern too. Are you addressing it correctly? If not, contact us right away.