Reducing-denied-claims-is-possible-with-RightPatient

Hospitals Can Reduce Denied Claims By Preventing 6 Issues

The COVID-19 pandemic has caused arguably the worst financial strain the US healthcare system has ever experienced. While all healthcare systems around the world are facing similar challenges, the US is currently witnessing the highest number of cases in the world – over 10 million people! As the numbers continue to increase, so do the losses, and healthcare providers must reduce their costs to cope with these unprecedented numbers. That being said, reducing denied claims is more crucial than ever, as they cause caregivers to lose a significant portion of their revenue. Let’s take a look at denied claims, how they affect caregivers, and six errors caregivers must avoid to improve revenue cycle within their facilities, leading to improved bottom lines.

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What are denied claims?

While this is a common term heard within healthcare facilities, many still don’t understand how much loss can be incurred for any given healthcare provider. To put it into perspective, Change Healthcare stated that denied claims can cost around $4.9 million on average for any hospital. But what are claim denials?

Simply put, denied claims are those that are classified as unpayable by the payers (insurance companies) after they receive the process them. Claim denials often occur because there’s some form of error present within the claim that becomes apparent after processing. Issues such as missing information, sending the wrong information, and non-covered services are the common reasons why claims are denied. However, there’s another form known as a rejected claim.

When one or more issues are detected within a claim even before it was accepted or processed by the insurance company, it is classified as a rejected claim. Coding errors and mismatched procedures are the most likely causes that lead to such claims.

How do denied claims affect healthcare providers?

Claim denials are a massive pain point for healthcare providers as they decrease already razor-thin margins, significantly increase collection times and reimbursement, and consume valuable resources such as FTEs (full-time equivalent).

As we can see, claim denials significantly affect a hospital’s bottom line. Moreover, while 63% of claim denials can be recovered down the line, the administrative costs are a nightmare – $118 per claim. Thus, it’s better to avoid denied claims right from the beginning.

That being said, let’s take a look at the top six issues that lead to claims being denied.

6 issues to avoid that can help reduce denied claims

Absence of information

One of the most common mistakes that lead to claim denials is sending inadequate information to the insurance company. Even the smallest details such as date of surgery, date of onset, demographic information, etc., are liable to classify claims as unpayable.

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Issues with coding

Using an obsolete codebook or incorrect codes is a common mistake that leads to claim denials, as they cause revenue leakage.

Insufficient documentation occurs when there are missing elements required for the services billed, and it is extremely crucial to prevent them. Thus, immaculate documentation is critical to prevent legit claims from being converted to denied ones. If proper documentation is not present when coding and submitting claims, then insurance companies classify them as denied because they consider that the services were not performed.

Duplicate bills

Duplicate claims are quite common and are usually attributed to human errors. These occur when the revenue cycle staff forgets to remove a claim from the patient’s account after resubmitting the claim. However, as claims processing systems consist of tools that help detect duplicate ones, the systems flag and classify the anomalies as either suspect duplicates or exact duplicates. As the entire healthcare process is quite complex in nature, it might lead to original claims appearing as duplicate ones – resulting in a claim denial.

Simply preventing duplicate claims is not enough. Properly coding the billed service with required modifiers and documentation is crucial to help identify the bill as original and not as a duplicate.

Not filing claims at the right time

Various rules and regulations must be followed regarding claims and failing to do so will result in even legitimate claims being denied. For instance, the Affordable Care Act reduced the deadline window for submitting Medicare claims to 12 months from 15-27 months after the date of service.

Not verifying coverage eligibility for the services provided

Healthcare insurance is quite volatile, leading to constant changes. As a result, it is crucial to check eligibility every time services are provided to the patients. While this might seem like a tedious task, it will help save a significant amount of money down the line.

Whenever a patient comes in for healthcare services, it is essential to check whether the coverage is still in place (read: not terminated), the service provided is covered by the plan, and the cap has not yet been reached. However, a healthcare provider can cover its services using plans with a cap as long as it follows provided guidelines meticulously and provides the required documentation. 

Patient identification errors

One of the biggest problems that leads to claim denials is patient identification errors. Imagine this: if a patient is not accurately identified right from the start, the claim will be filed against the wrong medical record and the insurance company may ultimately classify it as denied. To ensure that claims are not denied and are processed smoothly, patient identification is a must. That’s where RightPatient can help.

RightPatient is a touchless biometric patient identification platform that locks patients’ records with their photos – protecting patent data. It can even remotely identify patients, making it ideal to be used across the care continuum and any touchpoint.

After scheduling an appointment, patients need to provide a personal photo and a photo of their driver’s license. RightPatient matches the photos to verify their identities, and when patients arrive at the hospital, all they need to do is look at the camera. The platform matches the saved photo with the live one, instantly eliminating any chances of the claims being denied.

Healthcare providers can reduce denied claims, optimize the revenue cycle, avoid duplicate medical records, improve healthcare outcomes, and even prevent medical identity theft with RightPatient – enhancing patient safety in the process.

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Improving Patient Safety Depends on Error-Free ADT E-Notifications

While COVID-19 has been ravaging almost the entire world, healthcare industries have been facing an unprecedented number of patients and challenges. Arguably, the US healthcare system has been hit the worst. Just look at the numbers – over 10 million cases with a record of 100,000 new cases for seven consecutive days. Unfortunately, things will get worse, as spikes are seen across the states and experts predict far more cases during the fall. Healthcare providers are facing huge challenges while they deliver care, while keeping patient and provider safety as a top priority. That being said, CMS (the Centers for Medicare and Medicaid Services) has mandated that caregivers must support sending and receiving e-notifications during ADT (admission, discharge, and transfer) events, something that many believe will help with improving patient safety and quality of care. Let’s take a closer look at the rule, how it will enhance care coordination, and why it requires accurate patient identification.

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Interoperability has always been problematic

COVID-19 has already shown the importance of sharing patient data among caregivers. Most of the patients have multiple caregivers located at different sites, and for seamless care coordination and improved healthcare outcomes, their data needs to be shared accurately and in real-time with the appropriate parties. That’s exactly what CMS aims to achieve: improved interoperability between caregivers with patients in common.

Interoperability has been a massive issue within the healthcare space as caregivers fail to share patient data accurately, mostly because of patient identification issues – more on that later. In order to bolster interoperability, enhance coordinated care, and improve patient outcomes, CMS announced a new CoP (Condition of Participation) surrounding e-notifications as a part of their Interoperability and Patient Access Final Rule.

The new Condition of Participation (CoP) in a nutshell

This CoP requires applicable healthcare providers (critical access, psychiatric, and regular hospitals) that use digital medical records to share and receive alerts that are triggered in real-time due to ADT events – both inpatient and ED (emergency department) events. Applicable parties are PCPs (primary care physicians), post-acute care providers, and primary care practitioners, among others. The notifications should at the least include patient information, such as the patient’s name, the treating practitioner’s name, as well as the sending institution’s name. Caregivers can share more information if they deem it necessary.

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The applicable healthcare providers need to support e-notifications by May 1, 2021. This means they have around half a year to comply with the requirements.

Why it is critical for improving patient safety

By sharing critical patient information with other parties across the care continuum, all of them can make informed decisions using the most recent data, leading to seamless care coordination and better healthcare outcomes – improving patient safety along the way.

Healthcare in the US has become multifaceted and complex – gone are the days when a patient would go to a single caregiver for receiving care. Now, a single patient can have multiple doctors that are located at different healthcare facilities. E-notifications enable such caregivers to quickly send and receive information that can lead to faster outcomes and better decision-making. When you compare it to previous methods – fax, phone calls, etc. – you will understand how this is going to change patient data sharing and interoperability. In time-sensitive cases, for instance, these real-time alerts will save lives.

How healthcare providers are addressing this CoP

Caregivers are brainstorming to identify the best way to address this CoP. Many will develop e-notifications solutions in-house, whereas others will use third-party solutions. While healthcare providers do that, they might overlook a crucial aspect that will make or break their e-notifications solution: patient identification.

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To improve care coordination and interoperability efforts, e-notifications won’t be effective on their own – let’s see how.

Improving patient safety requires accurate patient identification

One serious but overlooked issue faced by healthcare providers is patient identification errors. Even during the pandemic, patient identification errors have been brought up a number of times, as they lead to delayed care, repeated lab tests, and can even hamper patient safety. But how exactly is this related to e-notifications? 

It’s quite simple – imagine a hospital that does not utilize an effective patient identity verification solution. It is bound to face a number of issues, such as duplicate medical records, overlays, medical record mix-ups, and so on. Now, imagine that a patient is misidentified during registration; the entire caregiving process will be dangerous and inaccurate as it will use the wrong medical record. This will also hamper interoperability – false alerts will be sent out, raising credibility concerns. It will wreak havoc in the facilities that are associated with the wrong medical record. Thus, accurate patient identification is crucial for improving patient safety as well as making e-notifications work. Fortunately, RightPatient can help with that.

RightPatient has been improving patient safety

Used by several caregivers, RightPatient is the leading biometric patient identification platform for a number of reasons. First, it ensures hygiene as it is a touchless solution, eliminating risks of hospital-acquired infections. Second, it has a vast amount of experience over the years, making it a trusted name within the healthcare space.

By using patients’ photos, RightPatient locks the medical records. Patients are asked for a personal photo and a driver’s license after they schedule appointments. The platform matches the photos to verify the identities remotely.

When patients arrive at the hospitals, all they need to do is look at the camera – the platform identifies them using the saved photo and provides the appropriate medical record within seconds. 

Use RightPatient now and eliminate misidentification, ensuring that you send out proper alerts to the correct caregivers, enhancing patient safety and care coordination in the process.

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4 Strategies to Optimize Revenue Cycle in Healthcare and Mitigate Losses

The US healthcare system has been going through a rough patch for a number of years now. When one problem is solved, other critical issues arise. However, with all these preexisting issues, it is now facing its biggest challenge in decades: COVID-19. With patients postponing regular visits and elective procedures, COVID-19 has created a severe financial strain and plunged hospitals and health systems into unprecedented losses. While hospitals are having to cope with these losses by closing down emergency departments, laying off employees, and so on, they can significantly reduce costs by focusing on their revenue cycles. Let’s explore why revenue cycle in healthcare is crucial, some strategies to optimize it, and how positive patient identification can help significantly.

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Why is revenue cycle in healthcare important?

Revenue cycle management is one of the most crucial aspects of any given healthcare provider. In a nutshell, it is the series of events that starts when a patient schedules an appointment and ends when the provider receives payment and is reimbursed. Since it’s related to patient service revenue, it has a direct effect on any hospital’s bottom line. 

If a hospital’s revenue cycle is optimized, then it will face higher margins, and if not, it will face significant losses. Complications such as billing and coding errors, patient misidentification at the front-end, and miscommunication lead to denied claims and delayed payments. In the end, patient volume won’t matter if a hospital takes a long time to capture the revenue or faces denied claims. Thus, optimized revenue cycle in healthcare facilities is extremely important if hospitals want to continue to operate in the foreseeable future.

4 Strategies to optimize revenue cycle management

Improve front-end and back-end collaboration

The front-end consists of activities where the hospital’s staff members interact with the patient directly: patient information collection, appointment scheduling, eligibility, verifying insurance coverage, upfront patient collections, and registration of new patients are just a few examples.

The back-end, on the other hand, consists of medical billing, claims management, denials management, as well as the collection of final “patient financial responsibility”.

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Usually, when it comes to revenue cycle management, most healthcare providers have their front-end and back-end tasks separated. However, collaboration between the two can significantly improve revenue cycle management. Effective and seamless communication is the key, and if that can be facilitated between the front-end and back-end teams, then it will result in faster, more accurate, and improved collections.

Improve front-end activities

According to a recent webinar, half of denied claims incurred by hospitals can be traced back to front-end activities, with the top contributors being registration and eligibility issues. These ultimately cause issues at the back-end of the revenue cycle in healthcare facilities, and the caregivers are forced to allocate significant resources such as FTEs (full-time equivalents) to fix billing and coding errors. If the front-end issues are not addressed, then this will lead to an endless cycle of lower productivity and an unoptimized revenue cycle.

If the front-end processes can be improved by preventing common errors such as patient misidentification or missing patient information, then issues like claim denials, underpayments, and lower productivity of the FTEs can be vastly reduced. Automating the front-end workflow is just one step towards improvement – but more on that later.

Adopt revenue cycle automation 

Revenue cycle automation is becoming more popular within the healthcare space, and for good reason. It leads to a significant reduction in the pressure that is put on healthcare professionals, reduces avoidable errors, and streamlines the entire process. However, organizations have to be cautious in their search for an effective automation tool.

Identify patients accurately

The most prominent issues that cause revenue cycle inefficiencies are patient identification errors, duplicate medical records, and medical record mix-ups at the front-end. If the accurate medical record isn’t identified, then the subsequent processes will be riddled with errors, leading to denied claims. Hospitals lose a huge amount of money – around $4.9 million – due to denied claims, many of which can be traced back to patient identification errors. Thus, revenue cycle in healthcare can be optimized if patient misidentification, duplicates, and mix-ups can be eliminated. This is exactly what RightPatient does.

RightPatient is a touchless patient identification platform that is used by several healthcare providers. It uses the patients’ photos to verify their identities, eliminating misidentification, avoiding duplicates, and preventing mix-ups at the front-end.

New patients need to take a photo during registration, locking their medical records with it. Enrolled patients only need to look at the camera – the platform identifies the patients accurately by matching the photos and provides the appropriate medical records within seconds. 

By eliminating misidentification, mix-ups, and duplicates at the front-end, RightPatient ensures that the accurate medical record is used across the care continuum, eliminating denied claims, boosting bottom lines, and enhancing patient safety in the process.

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Wrong Patient Identification Errors Lead to Several Issues – Are You Preventing Them?

Patient identification has always been hit or miss within the US healthcare system. Wrong patient identification errors cause a plethora of serious issues for not only healthcare providers but also patients. Patient mix-ups, patient safety issues, medical identity theft, duplicate medical records, and overlays are just some of the many issues that can be traced back to patient identification errors. These issues have been popping up even more during the pandemic, leading many experts to demand a patient identifier. While we’ve talked about all of that in previous articles, let’s take a look at a very recent patient mix-up, its consequences, and how positive patient identification can prevent such cases.

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Another one added to the list of wrong patient identification

The mix-up took place back in August at Washington-based Sacred Heart hospital. Interestingly, the person with whom the hospital mixed up the information was a former patient of the healthcare provider. 

For simplicity’s sake let’s call the actual patient Samantha and the former patient (who got the call) Rebecca.

Back in August, Rebecca’s daughter was called and she was informed that her mother was hospitalized due to a critical injury. However, the daughter responded that Rebecca was right in front of her and fine, but the staff at the hospital was adamant and said that her mother was injured and admitted. Understandably, Rebecca was quite worried about the real patient, Samantha.

Rebecca and her daughter reportedly informed the healthcare provider that they had a case of mix-up on their hands – she said that she didn’t know who was being treated under her name or why. In response, she was told that the hospital would rectify the issue. However, that was only the start.

What happened down the road?

Since Rebecca was a former patient of Sacred Heart, she checked her records to see if it was fixed or not. Unfortunately, the wrong information was still present, and to make things worse, other irrelevant materials were added, such as $3,000 worth of bills. Moreover, the provider also tried to bill her old insurer, which naturally didn’t work. Subsequently, the provider attempted to help her get insurance.

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The actual patient was safe

Rebecca heaved a sigh of relief when she found out that Samantha was out of danger – she kept in contact with the hospital over the phone. When this was over, Rebecca was also relieved that she didn’t receive the wrong bills as a result of the mix-up.

Wrong patient identification errors are quite common

While this case didn’t have any adverse consequences, not everyone is as lucky. Wrong patient identification errors occur every day and most are not identified until it’s too late. Not only are they problematic for patients, but they create issues for caregivers as well.

Patients face delays in treatment, incorrect procedures, and repeated lab tests – ultimately hampering patient outcomes as well as jeopardizing patient safety in the process. Moreover, they receive shocking bills for medical procedures or treatments they never received. The lucky ones can have them written off as denied claims, but this is still a huge cost for the providers. 

On the other hand, healthcare providers face unwanted attention, loss of goodwill, denied claims, lower scores, and might even risk losing CMS reimbursements (as they are tied to patient safety). 

All of this is leading to healthcare experts and leaders rallying for a state-funded patient identifier. While this appeal has been denied for over two decades, forward-thinking hospitals and health systems are not waiting for it, and have taken the initiative themselves to eliminate issues related to wrong patient identification errors.

Leading providers are using RightPatient

RightPatient is the industry’s leading touchless patient identification platform trusted by providers such as Grady Health, Catholic Health of Long Island, Terrebonne General Medical Center, and University Health Care System. Using the photos of patients, it prevents patient identification issues like mix-ups, duplicates, medical identity theft, denied claims, and more.

After successfully scheduling an appointment, patients receive an SMS or email, after which patients are required to provide a personal photo and a photo of their driver’s license. RightPatient matches the photos automatically and verifies the identity of the patients remotely. 

Be a responsible healthcare provider and prevent mix-ups and the issues associated with patient misidentification by deploying RightPatient.

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Patient Matching and Interoperability Are Ineffective Without Positive Patient Identification

The U.S. healthcare system has been inundated with several issues even before the pandemic. The lack of price transparency, medical identity theft, duplicate medical records, high costs, medical errors, and patient safety issues are just some of the issues plaguing providers. However, today’s focus is on another problem – the lack of interoperability. Many providers are thinking that interoperability will get a significant boost due to changes such as the 21st Century Cures Act and the CMS Interoperability and Patient Access Final Rule. While that might be true, many are overlooking the fact that it needs a particular component to work immaculately – patient matching. While some might believe that it is just a cog in the wheel, everything in healthcare heavily relies on accurate patient identification – without it, everything will go wrong.

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Let’s take a closer look at the rules, how they will boost interoperability, and why patient identification is crucial for interoperability to work.

The 21st Century Cures Act and Patient Matching

What it means

Several healthcare experts are quite content with the Cures Act, believing that it will usher in the era of true interoperability. In a nutshell, the implementation of certain provisions within the act will enhance interoperability and also support accessing, exchanging, and using electronic health information. What all this means is that patient data can be easily shared among caregivers, leading to better, more personalized care, as well as enhanced healthcare outcomes – but that’s only one side of the coin.

Interoperability requires more than the Cures Act

While the Act is a step in the right direction, interoperability won’t be successful solely because of it – other factors need to be considered. The most important factor is patient matching.

Imagine a scenario where a healthcare provider is abiding with the Act and has taken all the necessary measures to do so. However, due to issues like patient misidentification or duplicate medical records, matching patients to their proper EHRs will become nearly impossible. As a result, the wrong medical record will be sent to the wrong caregiver – jeopardizing patient safety and adversely affecting coordinated care efforts along the way. Thus, proper patient matching is an absolute must to make sure that the patient data exchanges are successful and error-free. Healthcare providers can do so by ensuring accurate patient identification across the care continuum by using solutions like RightPatient – more on that later.

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The Interoperability & Patient Access Final Rule

We’ve already talked at length about this rule and how it will enhance interoperability as well. In a nutshell, healthcare providers using EHR or EMR systems need to enable e-notifications support so that they can receive and send out real-time notifications during ADT (admission, discharge, and transfer) events with the patients’ other caregivers. While this rule has been established to boost interoperability and coordinated care efforts, this also requires proper patient matching. If a patient is misidentified, the caregiver will send out false alerts, jeopardizing the care coordination efforts. It will also put the provider’s CMS reimbursements at risk.

Thus, patient identity matching must be accurate at all times, if the providers want to ensure CMS compliance and abide by the 21st Century Cures Act. This is where RightPatient can help caregivers ensure accurate patient identification – and more.

RightPatient can improve patient matching 

RightPatient has years of experience with reputed healthcare providers such as Terrebonne General Medical Center, Community Medical Centers, and University Medical Center. It is a touchless patient identification platform that identifies patients with the element that cannot be copied or stolen – their face. Right from appointment scheduling, the platform ensures remote patient authentication – patients are asked for a selfie and a photo of their driver’s license. RightPatient matches the photos and ensures that patients are identified accurately – ensuring positive patient identification.

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Revenue Cycle Optimization Efforts Are Hampered by Duplicate Medical Records

Medical record errors such as duplicate medical records and overlays are issues that keep resurfacing time and again, especially when they lead to patient identification errors. We’ve already taken a closer look at duplicate medical records, how they are created, and how they impact patient safety. However, these are not the only problems medical record errors create. Another prominent issue is that duplicates jeopardize your revenue cycle optimization efforts by creating denied claims. Let’s take a look at exactly how that happens, how denied claims can take up your valuable resources, and how RightPatient can help combat duplicates and overlays, and in turn, optimize revenue cycle management.

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How duplicates get created

To understand how duplicate medical records affect the revenue cycle, let’s take a brief look at how duplicates and overlays get created. These usually originate during the registration process, especially if the healthcare providers don’t have any effective patient identity verification system in place.

For instance, patients keep coming in and they need to be identified immediately so that they can be treated. This clearly shows that hospital registration desks are environments that are always hectic and staff is under pressure, more so for busy or larger hospitals. If you factor in outdated or ineffective patient identification platforms, duplicates are bound to occur, along with problems such as infection control issues that are associated with touch-based patient identification platforms.

Coming back to duplicates, the registrars have a very small window to identify the accurate medical records from an EHR system that might house thousands of records. Name changes, common names, misspellings, and nicknames only make matters worse. For instance, the medical record is saved under the name “Richard Grayson”, but the patient uses his nickname “Rick Grayson”. These are bound to create identification issues, and when the registrar can’t find the accurate record, they might end up creating a new one – leading to a duplicate record. Furthermore, existing duplicates will create more confusion for the registrars – AHIMA (The American Health Information Management Association) has stated that larger healthcare facilities have around 20% duplicates.

That’s how medical record errors usually begin, and while we’ve already talked about how it impacts patient safety, how exactly does it affect revenue cycle optimization and a hospital’s financial performance? Let’s analyze the issue.

How revenue cycle optimization is hampered by duplicates

According to a Black Book report, 33% of denied claims were caused by patient identification errors in 2017, costing the average healthcare provider $1.5 million and the entire U.S. healthcare system a whopping $6 billion per year. Let’s see how duplicates lead to denied claims that hamper the revenue cycle.

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It’s quite straightforward – as duplicate medical records consist of incorrect, obsolete, fragmented, or incomplete information, these lead to coding and billing errors. Moreover, as duplicates hamper patient care, litigation costs regarding such cases are not unheard of. Not only do healthcare providers lose money, but they also lose their goodwill – these stories spread like wildfire, whenever they occur.

Coming back to duplicate records and revenue cycle, let’s take a look at how they are related. One of the more common places where denied claims occur due to duplicates is during surgical procedures, according to an article from HIM Briefings. Let’s use the example provided by Letha Stewart from QuadraMed within the article.

During the presurgery phase, the patient comes in and is registered as “Richard Grayson” and has the medical record number 111. As previously mentioned, common names lead to confusion among the registrars, and thus, without an effective patient identifier, the registrar couldn’t find the accurate medical record on the day of the surgery. As a result, a new record gets created under “Rick Grayson” with a different number, for instance, 222. When the insurance provider verifies the claims regarding this surgical procedure, it will notice the glaring discrepancy – there are different medical records involved for a single procedure. Moreover, the insurer most likely will use the patient record available at their end, and seeing that the records don’t match, the claim will be denied. While this is a simple but illuminating scenario, this is how most of the claim denials that stem from duplicate medical records occur. To sum it up, incorrect, fragmented, or incomplete patient data and discrepancies lead to denied claims that impact revenue cycle optimization efforts.

Providers dedicate FTEs for fixing medical record errors

Duplicate records and overlays need to be identified and fixed to prevent impediments to revenue cycle optimization. Most providers do that by dedicating their full-time employees (FTEs) from their HIM departments. While these activities are necessary, they also consume a significant amount of resources and time. According to Stewart, many providers dedicate around five FTEs to solve these issues. However, if providers don’t have an effective patient identifier in place, they cannot take the load off their FTEs and they’ll need to continue fixing these errors for quite some time, leading to lower productivity and higher costs. Given the current pandemic, providers need to mitigate costs as much as possible. That’s where RightPatient can help them.

RightPatient enhances revenue cycle optimization

As we’ve mentioned several times, going to the root of the issue, patient identification, is the best strategy. If you avoid duplicates and overlays at the frontend, you won’t have to deal with them later and face consequences like denied claims, allocating FTEs for fixing the issues, and higher costs. But how can RightPatient help with that?

RightPatient is the leading touchless biometric patient identification platform used by many providers to prevent duplicates. With its photo-based search engine, RightPatient identifies patients from appointment scheduling and beyond. Be it remote patient validation or identification within the healthcare facility, RightPatient ensures that the correct medical record is provided every time within seconds. Reduce denied claims, prevent duplicates, and enhance patient safety with RightPatient now.

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CMS Interoperability and Patient Access Final Rule Requires a Robust Patient Identification Software

This has been quite a year for the U.S. healthcare system – nobody could’ve predicted all the series of events. While the novel coronavirus is still raging on, telehealth is experiencing unprecedented growth. On the other hand, hospitals are facing immense financial strain due to the pandemic’s consequences such as the cancellation of elective procedures and lower inpatient visits. However, despite all the recent developments healthcare providers need to work on something else as well – supporting e-notifications. CMS has made some additional changes to the Medicare Conditions of Participation (CoPs), and while providers will be busy brainstorming about how to best approach the requirements, many will overlook one critical factor that will either make or break their e-notifications – patient identification. Let’s take a look at what the rule specifically says about e-notifications, who is eligible, how it helps caregivers, and how a robust patient identification software like RightPatient is a must for ensuring proper e-notifications.

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The Interoperability and Patient Access Final Rule – in a Nutshell

While the rule itself is quite vast and detailed, we’ll cover the e-notifications part briefly. The basic meaning of the rule is clear from its name. For years, the U.S. healthcare system has been suffering from the lack of proper interoperability for a number of issues – patient misidentification being a major reason. However, with the “companion final rule”, as per CMS, things are about to change for the better, as it will introduce a certain level of interoperability that will ultimately boost coordinated healthcare efforts.

The “companion final rule” states that healthcare providers such as critical access providers, acute care, or psychiatric hospitals must send out real-time e-notifications during ADT (admission, discharge, or transfer) events to a patient’s caregivers such as established primary care practitioners, post-acute providers & suppliers,  primary care practice groups & entities, as well as any other practitioners, groups, or entities primarily responsible for the patient’s care. The information sent must contain the patient’s name, the treating practitioner’s name, and the sending institution’s name, at the very least. Finally, these are applicable during inpatient ADT events and ED admissions or discharges.

Any caregiver that uses digital medical records such as EHRs or EMRs must support e-notifications by May 1, 2021, to ensure CMS compliance.

With that out of the way, let’s look at how the rule requires accurate patient identification and how a robust patient identification software is critical for its success.

Why patient identification will make or break your CMS compliance

Healthcare providers are already busy working on e-notifications support, and while there are a lot of great solutions out there, providers shouldn’t forget the foundation upon which e-notifications depend on – proper patient identification.

The Interoperability and Patient Access Final Rule requires hospitals to identify their patients accurately across the care continuum, especially if they want to send out e-notifications to the proper caregivers. Sadly, patient identification has always been problematic – it is an overlooked but significant concern for the U.S. healthcare system. One might ask how are patient identification and e-notifications related – let’s learn more.

Imagine this – a hospital already has patient misidentification cases because they don’t use an effective patient identification software. If a patient comes in and is misidentified, not only will the treatment be affected, but the hospital will be sending out false alerts to the wrong caregivers. This will wreak havoc for all the caregivers involved with the patient. 

If such cases become common, then the patients, as well as the care coordination teams, will start questioning the credibility of the caregiver sending out false alerts. As a result, the hospital will lose goodwill and risk its CMS reimbursements. After COVID-19, not a single hospital can afford to make such mistakes – the pandemic has already caused the worst financial strain on hospitals and health systems in recent times. Thus, patient identification is a crucial component for the e-notifications to work. If caregivers don’t have a robust patient identity matching system in place, they need to upgrade it before the e-notifications support deadline.

RightPatient is the most robust patient identification software

RightPatient has been accurately identifying patients for years. With its touchless patient identification platform, RightPatient ensures that patients are identified accurately and safely right from the start.

After a patient schedules an appointment, they are sent an SMS or email and are required to provide a selfie and a photo of their driver’s license. The platform automatically matches the photos and remotely ensures patient identification. If it’s a new patient, the platform will automatically assign new biometric credentials for them. 

During hospital visits, patients only need to look at the camera – RightPatient matches the saved photo with the photo taken by the camera – ensuring accurate patient identification. Best of all, it’s an entirely touchless process, something that is mandatory in a post-pandemic world.

RightPatient is the leading patient identification software in the healthcare industry and is used by prominent caregivers such as Terrebonne General Medical Center, Community Medical Centers, and Catholic Health Services of Long Island. Be a responsible healthcare provider and upgrade your patient identification system now to prevent misidentification cases, medical identity theft, and ensure compliance with the Interoperability and Patient Access Final Rule.

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CMS Compliance Requires Identifying Patients Correctly – Are you Ensuring it? 

From the title, it is quite clear what this is about. The changes made to the Medicare CoPs (conditions of participation) have attracted attention within the US healthcare system, especially after the introduction of mandatory e-notifications during every ADT (admission, discharge, or transfer) of a patient. While providers are more focused on e-notifications, most of them forget about one very important prerequisite: identifying patients correctly. While we have already touched upon the topic regarding CMS (Centers for Medicare and Medicaid Services) Interoperability & Patient Access Final Rule, this time, we will focus more on the practical aspects and how patient identification is a crucial component that is absolutely necessary for e-notifications to work properly as well as CMS compliance. Without further ado, let’s dive deeper into the topic at hand.

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A brief refresher

A few changes have been made regarding the CMS Interoperability & Patient Access Final Rule. As the name suggests, it has been done to boost interoperability efforts within the caregivers of the patients. Let us look at why it is required within the healthcare system.

There are many cases where a patient is not restricted to a single healthcare provider;  especially if they have complications, multiple ailments and so on. Such patients need to visit and consult with multiple healthcare providers in order to receive the best patient care. For this to be effective, caregivers need to have access to the patient’s medical record, history, medications, vitals and other necessary information. In order to make the caregiving process seamless and boost interoperability, the Final Rule was introduced.

The “companion final rule” states that e-notifications must be sent out by healthcare providers (such as acute care, psychiatric, critical access providers, etc.) during every ADT to the appropriate recipients, i.e., the other caregivers (post-acute providers & suppliers, established primary care practitioners, or any other entity primarily responsible for the patient’s care). This rule applies to inpatient admissions as well as ED admissions. 

Who needs to ensure it?

Applicable healthcare providers are those who use digital medical records like EMR or EHR systems. They need to ensure compliance and have proper systems set up by May 1, 2021 so that they can send out e-notifications during ADTs. 

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While that’s a succinct summary of the most recent change in the CoPs, every healthcare provider needs to ensure that they are sending out e-notifications. Otherwise, they can face undesirable consequences such as receiving penalties for non-compliance, or worse, jeopardizing their CMS provider agreements. But how is identifying patients correctly related to CMS compliance regarding e-notifications?

Identifying patients correctly is required for CMS compliance

As previously mentioned, the CMS rule requires healthcare providers to send out notifications during ADTs. But there’s a catch.

Identifying patients correctly is quite important for e-notifications to work. Think about it: if a patient is not accurately recognized or is misidentified as a different patient, the healthcare provider risks sending alerts to the wrong caregivers. Worst of all, the provider risks that they won’t be able to answer alerts other caregivers are requesting.

Without a reliable way to identify patients, things can escalate quickly. If a provider cannot fulfill alert requests or sends too many incorrect alerts, care coordination teams will start to lose faith and miss opportunities to improve patient outcomes. Noncompliance will also incur CMS penalties, which can result in hefty fines. After COVID-19, nobody can afford such costs.

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While healthcare providers are busying themselves by deciding how to best implement e-notifications, they should also assess the effectiveness of their patient identity matching systems. Clearly, the former is dependent on the latter. Those who are struggling with patient identification need to upgrade their systems to futureproof, easy-to-use and hygienic ones. 

RightPatient helps identify patients correctly

We ensure that patients are always identified correctly with our industry-leading touchless biometric patient identification platform.

How it works

After making an appointment, patients receive an SMS or email to validate their identity. During this process, the patient takes a photo of their driver’s license and a selfie. RightPatient automatically matches the selfie photo with the photo on the driver’s license to ensure a proper identity match. If the patient is not already in the system, RightPatient assigns biometric credentials to the new patient.

This is how we prevent patients from registering under a different identity or medical record mix-ups. There’s no need to worry about name changes, mistakes when entering a patient’s name or other common issues. Patients are recognized with their selfies.

We have been helping prominent health systems like TGMC, CMC and CHSLI fight the battle against patient misidentification for years. With RightPatient, responsible healthcare providers can send e-notifications and comply with CMS without worrying about faulty alerts.

If we haven’t convinced you by now, why don’t you try our free trial? No gimmicks – it’s really free!

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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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Patient Identification in Hospitals is in Dire Need of an Upgrade After COVID-19

COVID-19 has changed the world around us in unprecedented ways. In fact, it is still shaping how we will interact with each other in the future for years to come. Social distancing, ensuring proper hygiene at all times, and wearing PPE whenever we step outside have become the norms and it will be so for quite some time. Naturally, hospitals have been the most affected parties due to the coronavirus, since they are the ones treating the patients. As different parts of the US are opening up gradually, it is quite natural that healthcare providers would open their doors too. However, changes are advised to ensure that patient safety is improved while hospitals are reopening. One of the most important changes required is the overhaul of patient identification in hospitals since that is usually the first point of contact for both patients and caregivers. Let’s look at why most of the current patient identifiers can pose threats now, and how a touchless solution like RightPatient is the only choice going forward.

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Why is patient identification in hospitals important?

Patient identification errors have been haunting the US healthcare system for a long time now. The consequences of patient misidentifications can be quite severe for both providers and patients. Patients can suffer from shocking bills, the wrong treatment, repeated care or lab test results, and even death. Providers, on the other hand, may experience denied claims, unwanted attention, the costs associated with fixing duplicate records and overlays, and loss of goodwill. As can be clearly understood, patient identification errors can cause irreparable damage to all those who are associated with them. But how is the US healthcare system identifying its patients?

What patient identification was before COVID-19

Patient identification in hospitals has, admittedly, been quite fragmented. Different providers use different strategies to identify their patients. Let’s look at some of the common means of patient identification along with their pros and cons, as well as why RightPatient is the perfect choice for accurate patient identification.

Even though there are a variety of patient identification solutions available, some hospitals still prefer to use the decades-old method of identifying patients by asking them questions to find their respective EHRs. The EHR user may ask the patients to state their names, addresses, DOB, ID numbers (if appropriate), and so on. The only good thing about this is it is mostly touchless. However, the costs outweigh the only benefit of this archaic method. It is slow, tedious, time-consuming, and cannot detect if someone else is pretending to be the patient, leading to medical identity theft.

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Another popular method is using patient ID wristbands. While this is more accurate than just asking questions, it has its drawbacks as well. It can be transferred or stolen, leading to others using healthcare services assigned for a different patient, committing medical identity theft. More importantly, it is also contact based, something which everyone is quite reluctant to do nowadays, but more on that later.

One of the most accurate ways to identify patients is by utilizing features patients do not share with anyone else, that is, the features that are unique to them. This is where biometrics comes into play. For instance, modalities like fingerprint and palm-vein scanning drastically improve accurate patient identification. However, these would require the patients to touch the devices for identity verification, which was off-putting for leading healthcare providers. These would cause infection control issues. For instance, a patient with a contagious disease could come in, touch the device, and effectively contaminate it, unless it is cleaned after every usage. It would be a nightmare for all those involved in the process.

What COVID-19 taught us

Prior to the pandemic, not many patients would have thought about it. After COVID-19, however, the majority of patients would be extremely reluctant to use touch-based solutions for patient identification, as they have a fear of contracting the highly contagious virus now. Thus, acceptance rates for touch-based solutions would be quite low now. Thus, patient identification in hospitals needs to be upgraded to enhance patient safety as well as accuracy. 

So, what are the leading healthcare providers using for accurate patient identification?

What patient identification should be after COVID-19

The leading touchless biometric patient identification platform, RightPatient, is being used by providers like Grady Health, Duke Health, and University Health Care System. So, what makes RightPatient so different yet effective? 

It locks the medical records of the patients with a photo of them upon registration. When registered patients return, all they need to do is look at the camera; the platform recognizes them and produces the correct medical record within seconds. All of this can be done easily and without a single touch from the patient!

RightPatient ticks all the right boxes – it ensures accurate patient identification, successfully prevents medical identity theft, reduces denied claims, prevents new duplicate records, and enhances patient safety by providing them a touchless solution. All of these benefits lead to boosting the bottom line of healthcare providers – something that they really need right now. 

RightPatient has been protecting over ten million patient records already, and with the COVID-19 pandemic, it has become the only viable solution. Are you still using outdated platforms? It is high time to make the change and upgrade to RightPatient.