4 Practices Regarding Telemedicine That Enhance Patient Protection

January 7, 2021/11487 views / 0 Comments/in BLOG, Cybersecurity, Data Integrity, healthcare, Medical Identity Theft, Patient Data, Patient Identification, Patient Outcomes, Patient Safety, Telehealth /by Matt Gibson

COVID-19 is a phenomenon that will impact us for years to come, if not decades. It has shaken the entire world to its core and has changed everything we know. COVID-19 affected our daily lives, changed the way we interact with others, and made masks as well as sanitizers crucial necessities. Since many of the COVID-19 patients required urgent care, the US healthcare system had to come up with other ways for hospitals to serve non-COVID-19 patients without exposing them to the virus. Fortunately, tailor-made solutions already existed – telehealth and telemedicine being the biggest players. As a result, hospitals have been diverting a significant portion of their non-critical patients to virtual sessions – changing healthcare and the patient experience forever. That being said, let’s explore what the patients think about telehealth, what experts are saying about it, and how to ensure patient protection while improving quality and safety in healthcare facilities.

How telemedicine came into play

Since the novel coronavirus hit the US, it has been overwhelming healthcare providers, their frontline teams, and virtually everyone who is involved in the caregiving process. Due to capacity restrictions and patient safety concerns, caregivers had to redirect at least one-third of their less critical patients to telemedicine. Naturally, its usage shot up significantly in the beginning, and while it has been declining for some time, it is expected to increase as COVID-19 cases are once again rising. The bottom line is that telemedicine and telehealth are here to stay, although some issues need to be addressed.

Let’s take a look at what over a million end users, i.e. patients, think of telemedicine, according to a recent survey by Press Ganey.

Patients’ perceptions regarding telemedicine

The first thing to highlight is that while most patients do appreciate the convenience telemedicine offers, it has a lot of wrinkles to iron out to make it seamless and more effective.

The good things

While many patients were being exposed to virtual visits for the first time, they did find it satisfactory. Many even said that they were likely to give good ratings to their caregivers after virtual visits, just as much as they would during inpatient ones. Telemedicine could successfully lead to a bond between the patient and the physician, and many patients felt that their physicians were more attentive during these virtual sessions. A patient even noted that during inpatient visits doctors would be looking at their computer screens anyway, which felt like they were distracted. During the virtual visits, however, the doctor had direct eye contact with her.

What needs improvement

While telemedicine itself is good, the process and ease of getting to virtual visits are not – these need significant improvements, especially with scheduling sessions and making audio or video connections.

However, there are a few more issues that require attention which, according to experts, might hamper patient protection – let’s dive in.

Experts are worried about patient protection

Healthcare data breaches have been increasing significantly, and are occurring even now. Moreover, the risk of a breach is higher during virtual sessions, ultimately endangering patient data. Healthcare providers need to strengthen their security measures and ensure patient protection during virtual visits. With restrictions eased regarding communication tools like Zoom, Skype, and similar utilities, as well as hackers turning their attention to virtual sessions, patient data security is at more risk than ever.

Practices that improve patient protection during virtual visits

Provide training and ensure awareness

There is nothing more effective than raising awareness among your employees, and the best way to do this is by providing them with training. Clearly explain to them the consequences of data breaches, and also provide them with sessions where they can learn about the do’s and don’ts regarding emails, opening links, accessing patient data, etc.

Follow practices that safeguard patient information

Encrypting data might be the oldest trick in the book, but it can make it difficult for hackers to use the information.

A few practices must be followed to ensure patient protection during both virtual and inpatient visits:

Ensure that patient data is encrypted during rest and transmission.
Use reputed antivirus and firewall applications.
Use only verified and licensed software and keep them updated.
Restrict access to any unauthorized parties.

Use enterprise-level video conferencing platforms

While hospitals initially got the chance to use tools such as Zoom, Skype, Meet, etc., these have added cybersecurity risks. Telemedicine has grown significantly now, with many enterprise-grade platforms available that have enhanced security out of the box. While deploying them might be costly, they can be critical for ensuring patient protection during virtual sessions, eliminating the chance of hackers gaining access during these sessions.

Use solutions to mitigate risks and ensure patient protection

While there are many practices and strategies available that might strengthen cybersecurity efforts, hackers always come up with plans that ultimately could result in data breaches. Moreover, not all caregivers can upgrade their security measures due to several factors, especially budgetary constraints. As a result, having a response plan to mitigate the risks and consequences is crucial. Also, while it might seem like data breaches are unstoppable, medical identity theft is not – it can be prevented with RightPatient.

RightPatient is a touchless biometric patient identification platform that uses patients’ faces to identify their records. Moreover, it is versatile enough to be used at any touchpoint across the facility – making it perfect for virtual visits.

After scheduling appointments, patients need to provide a personal photo and a photo of their driver’s license; RightPatient automatically extracts the data and compares the photos for a positive match, verifying identities remotely. New patients are provided with unique biometric credentials. If a fraudster attempts to assume the identity of the patient, the platform will red-flag them, preventing medical identity theft in real-time.

During inpatient visits, enrolled patients only need to look at the camera – the platform runs a search to identify the patient and provides the correct medical record within seconds.

By doing so, RightPatient can prevent medical identity theft even after data breaches, protecting patient information, eliminating litigation costs, and mitigating the consequences.

Improving Remote Patient Outcomes by Addressing 5 Elements

January 6, 2021/10236 views / 0 Comments/in BLOG, healthcare, Medical Identity Theft, Patient Data, Patient Experience, Patient Identification, Patient Outcomes, Patient Safety, Telehealth /by Matt Gibson

The pandemic has been an unprecedented event that has taken much away from us since it started. However, hospitals in the affected countries felt its heat the most, and arguably the worst affected one is the US healthcare system. COVID-19 forced hospitals to divert regular patients to telehealth, leading to the explosive growth that it very much needed. Since telehealth is here to stay, more and more caregivers are adopting it and allocating resources for their online patients. While doing so, healthcare providers need to ensure that patient outcomes are optimal and immaculate.

Let’s take a look at five elements healthcare providers need to consider and address to improve the patient outcomes of their remote patients.

5 addressable elements that can improve online patient outcomes

Catering to patients’ expectations

While telehealth has been around for quite some time in the US healthcare system, healthcare providers and patients did not pay much attention to it. Experts kept arguing about its merits and drawbacks, whereas patients were reluctant to try it.

Telehealth achieved mainstream popularity only after the pandemic hit the US, and after almost a year, both patients and caregivers still might need some adjustments. For starters, caregivers need to identify patients’ expectations and work on addressing them.

A seamless check-in process and reduced wait times are good starting points, as these are some common requests. Moreover, if there are any temporary issues with the service, patients need to be notified immediately to avoid dissatisfaction. Conducting small and engaging surveys is another good strategy to determine what patients expect during the virtual sessions.

Training telehealth staff members

One of the best ways to improve online healthcare outcomes is by ensuring that patients have the best possible experience, and that can be done only if the telehealth team works effectively.

As already mentioned, telehealth is quite new to virtually everyone, and providing training sessions to the telehealth teams is a must to ensure that they use this solution to its maximum potential.

Not only can training help improve efficiency, but it can also help caregivers provide patients with a seamless, intuitive, and engaging experience, improving patient outcomes in the process.

Ensuring ample security

Patient safety and confidentiality are necessities that any and all healthcare providers must ensure, and virtual sessions are no different. Something that is often brought up in regard to telehealth is security – data breaches are at an all-time high. Experts have been predicting that there will be fraudulent cases during telehealth sessions, as hackers and fraudsters may try to disrupt the entire session.

Hospitals and health systems must ensure that ample safeguards are used to protect patient information, prevent data breaches, and identity medical theft. Caregivers must go the extra mile and ensure that patient outcomes are error-free, safe, and optimal.

However, while data breaches have so far been inevitable, medical identity theft is not. It can be prevented, but more on that later.

Ensuring reliability

A solution is as good as its reliability, and the same goes for telehealth options. Healthcare providers have a variety of options – they can either choose from the vast number of third-party solutions, or they can develop their own in-house. Whichever option they choose, healthcare providers must ensure that the solution is reliable and doesn’t break down unexpectedly or under pressure. If it fails, it can result in detrimental patient outcomes. For instance, equipment or technology breaking down in the middle of a telehealth session can be potentially dangerous for the patients, especially those who need urgent care.

While choosing third-party telehealth solutions, reading reviews can be quite helpful to determine their reliability. Also, pilot testing them provides a first-hand experience as to how reliable they are in real-time.

Ensure accurate patient identification for improved patient outcomes

Patient identification errors have been a prevalent but overlooked issue within the US healthcare system, and while many caregivers are still struggling with it during the pandemic, it will very likely be an issue during telehealth sessions as well. Imagine this: if the patient is misidentified right from the start and the wrong EHR (Electronic Health Record) is used, then the entire process will be full of errors. Moreover, as previously mentioned, medical identity theft during telehealth services is a growing concern. However, all of this can be mitigated with RightPatient.

RightPatient is a touchless biometric patient identification platform that is used by responsible caregivers to accurately identify their patients. It locks patients’ medical records with their photos and their biometric data during registration. Moreover, it is versatile enough to be used at any touchpoint across the healthcare facility, making it ideal for virtual sessions like telehealth and telemedicine.

Patients receive an SMS or email after scheduling their appointments, after which they have to provide a personal photo and a photo of their driver’s license. RightPatient automatically compares the photos for a match, ensuring correct patient identification.

Within healthcare facilities, the patient only needs to look at the camera – RightPatient performs a biometric search and provides the correct medical record after finding a positive match.

Not only does RightPatient prevent medical record mix-ups, but it also red-flags fraudsters, preventing medical identity theft even after a data breach and improving patient outcomes in the process.

Four Ways to Improve Protection of Patient Information Within Hospitals

December 21, 2020/11092 views / 0 Comments/in BLOG, Cybersecurity, Duplicate Medical Records, healthcare, Medical Identity Theft, Patient Data, Patient Experience, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

Healthcare in the US has been facing considerable challenges for the past few years. Data breaches, medical errors, patient safety issues, patient mix-ups, medical identity theft, the lack of interoperability, and detrimental patient outcomes are just some of the many problems that plague healthcare providers. However, one of the more crucial issues for healthcare providers is data breaches as they lead to a number of problems, especially compromising patient information. Unfortunately, these are becoming more common, even during the pandemic. Let’s take a look at why protection of patient information is crucial and four ways to improve its protection – leading to better quality and safety in healthcare facilities.

Why the protection of patient information is crucial

The importance of patient information cannot be overstated – it is one of the most sensitive pieces of information for any given individual. Since it contains data such as names, medical history, medications, vitals, diagnoses, allergies, test results, demographics, etc., it should be protected at all times. Otherwise, external and internal data breaches can lead to the exposure of patient information to unauthorized individuals who might use it for nefarious purposes.

Medical identity theft is one of the most common outcomes of data breaches, and the former leads to patient data corruption. Patient data becomes unreliable, fragmented, and dangerous, causing detrimental healthcare outcomes down the line. This is exactly why HIPAA focuses on protecting sensitive information, known as PHI (protected health information).

After seeing why the protection of patient information is important, let’s take a look at how to improve it.

Four ways to improve the protection of patient information

Monitor access rights

Another way to enhance patient data protection is by monitoring access rights periodically, at the very least. This can be done by conducting internal audits to detect whether any unauthorized individuals have access to patient records. It’s crucial to remember that patient data protection requires preventing both internal and external breaches as well, and monitoring access rights prevents internal ones. After detecting the issues, simply revoking the access given to unauthorized users enhances protection.

Conduct risk assessments regularly

The best way to protect patient information is by taking the proactive approach – identifying issues within the system before the hackers do. Thus, healthcare providers need to conduct internal audits in order to detect existing security gaps, come up with effective solutions, and implement corrective actions.

Utilize blockchain

Blockchain is something that has been trending in the past few years, and using it can significantly improve patient data protection. But how exactly can it help healthcare providers do so?

Well, hackers usually attack a single point. Since patient information is grouped in a single location, it’s easier to attack it and tamper with it however they please. Fortunately, blockchain enhances the protection of patient information. As the stored data is distributed over the network, hackers no longer can attack a single point – they need to access the data at all the blocks repeatedly. Moreover, any changes will be picked up by the officials and such changes require the approval of the majority of those in charge, making it virtually impossible for conventional hackers to hamper patient information.

Use solutions that focus on patient data protection

There are many solutions available for protecting patient data, but responsible caregivers need to think beyond data breaches as well. Data breaches have been far too common, and that’s because most healthcare providers have budgetary constraints leading to poor cybersecurity measures. While data breaches might be inevitable, providers can prevent medical identity theft in real-time with RightPatient.

RightPatient is a touchless biometric patient identification solution that locks EHRs with patients’ photos. Moreover, it’s versatile enough to be used at any touchpoint across the hospital, making it ideal for remote sessions such as telehealth and telemedicine.

After scheduling an appointment, the patients receive an SMS or email. They need to provide a selfie along with a photo of their driver’s license, after which the platform compares the photos for a positive match, ensuring remote authentication.

Patients coming to hospitals only need to look at the camera. The platform compares the photos – red-flagging fraudsters and preventing medical identity theft in real-time. This ensures the protection of patient information as it prevents incorporating the fraudsters’ medical information within the EHR. In many cases, medical identity theft can be life-threatening for the patients if it remains undetected and unaddressed, something that RightPatient prevents.

Protect Patient Information During Telehealth Visits by Addressing 7 Issues

December 14, 2020/11143 views / 0 Comments/in BLOG, Data Integrity, healthcare, Medical Identity Theft, Patient Data, Patient Identification, Patient Matching, Patient Outcomes, Patient Safety, Telehealth /by Matt Gibson

The pandemic has been spreading like wildfire, and its effects on the US have been devastating – over 12 million people have been affected by it. Hospitals barely kept up with the pandemic’s effects when it first hit the country. Now that the winter has arrived, COVID-19 cases are increasing rapidly. One of the previously overlooked aspects of healthcare, known as telehealth, has gained much attention during this period. As it ensures that non-critical patients could receive healthcare services without the risk of contracting the virus, officials were quick to redirect such patients to telehealth. As a result, telehealth usage surged and it finally got the attention it deserved. However, like everything else, it also has pros and cons, and healthcare providers must address the risks associated with telehealth to protect patient information, improve healthcare outcomes, and enhance patient safety – let’s explore.

7 issues healthcare providers must consider regarding telehealth

Cybersecurity risks

Since telehealth requires the internet, hackers are always working on new and innovative ways to steal patient data and sell it to unethical individuals, who will later assume the identities of the victims to use the healthcare services fraudulently.

Phishing attacks

One of the most common tools used by hackers is phishing, and while simple, it is quite effective. Hackers pose as officials and lead the unassuming healthcare employees to click on the links they provide. As a result, hackers gain access to the targets’ accounts and can access or steal information.

While these attacks happened prior to the pandemic, telehealth is at huge risk as well now. Phishing tactics that are currently used rely on social networking, and it might lead to users being victims down the line. Moreover, there are many instances where hackers posed as credible organizations like Microsoft.

Hackers

Hackers have been constantly trying to access patient information to steal or use it for themselves, and the sudden growth of telehealth makes it much easier for them. If telehealth sessions are done using unsecured networks, hackers can just add themselves to the session and steal patient information. They are now targeting providers using obsolete systems that have security issues and vulnerabilities, as that will be much easier to gain access to.

Uncertainty regarding rapidly changing rules

As the situation surrounding COVID-19 is evolving, the rules are being constantly updated. Thus, it is quite crucial to ensure that providers are up to date regarding the changes surrounding telehealth usage in order to ensure telehealth services are delivered in a manner that can protect patient information.

Fraudulent activities

There’s a much broader scope for fraud in telehealth than inpatient visits – such as kickbacks, charging for services that weren’t actually provided, misrepresentation, and so on. Even CMS is closely monitoring in order to reduce such risks. Providers must ensure that they are not being charged falsely by having all the required documentation on hand at all times.

Patient misidentification

An issue that can be commonly seen during inpatient visits, patient identification errors may very well bleed over to virtual sessions as well. The premise is just the same – misidentification at the front-end due to issues such as duplicate medical records, overlays, or human errors leading to medical record mix-ups. All of this ultimately leads to delayed care, detrimental outcomes, and compromised patient safety. Thus, accurate and secure patient identification is crucial.

Medical identity theft

One can safely assume that medical identity theft is the end result of most of the concerns listed above. Let’s explore why it is so prevalent and how it takes place.

Well, the hackers aim to steal patient information from healthcare providers, and the ones who are high-risk are the ones that have vulnerabilities such as keeping patient data unencrypted or using unsecured means to transmit or receive it. After stealing the information, they sell it to hackers for steep prices – up to $1000!

This information is available on the black market, and fraudsters buy it to pose as the victims. Armed with the credentials of the victims, they can easily pass themselves off as the patients and have access to healthcare services, expensive medical equipment, prescription drugs, and more. That’s not all – the victims will be fraudulently billed for the services used by the impostors.

Experts are predicting that such cases will transpire with telehealth visits too, and with the issues listed above, it won’t be that hard. Fortunately, RightPatient can prevent medical identity theft and protect patient information.

RightPatient can protect patients during telehealth visits

RightPatient is a touchless biometric patient identification platform that uses patients’ faces to verify their identities. While data breaches might seem inevitable, RightPatient can mitigate its losses by preventing medical identity theft in real-time.

Patients are required to take a selfie and submit a photo of their driver’s license after registration. The platform automatically compares the photos for a match and verifies patients’ identities remotely, making it ideal for telehealth sessions as well. Fraudsters are red-flagged whenever they try to use the platform and pass themselves off as the patient. RightPatient helps protect patient information, enhance patient safety, and accurately identify patients across the care continuum.

Infection Control in Hospitals is Imperative as COVID-19 Cases Increase

November 27, 2020/12108 views / 0 Comments/in BLOG, COVID-19, healthcare, Infection Control, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

COVID-19 is a phenomenon that has crippled almost the entire world. Even in those very rare countries where it didn’t infect many people, it did hurt their economies. The majority of developing countries are severely affected by the novel virus, leading to disruption in international businesses and global transactions. However, one can safely say that COVID-19 has affected America the worst – it is currently seeing huge spikes across the states, where officials are introducing new safety measures. Let’s take a look at the most recent record-breaking statistics of US COVID cases, some measures officials are implementing to mitigate its spread, and practices that will help ensure infection control in hospitals – improving patient safety and quality of care.

US COVID-19 cases keep breaking records

Unfortunately, the US has the highest number of COVID-19 cases in the world – over 11.3 million! Moreover, it keeps on making new records: November 13 saw 184,514 new cases, according to John Hopkins University. This is in line with experts’ predictions – many stated that things will get worse during the fall. Ultimately, all of this will add to the huge amount of pressure healthcare providers are already facing – the COVID Tracking Project saw over 68,000 hospitalizations on November 13 where 6% of the patients were on ventilators and 19% in ICUs.

Needless to say, these numbers are frightening, with officials introducing measures to mitigate further spread. Let’s review some of the emergency measures introduced within some states.

Some recent measures to mitigate COVID-19’s spread

Oregon will see restrictions on gyms, restaurants, and retail stores. Virginia issued a mask mandate for anyone older than five starting on the 15th of November. New Mexico will be facing a two-week shutdown that consists of nonessential activities starting from 16th November. Many other locations are seeing similar restrictions to ensure social distancing practices as a result of ever-increasing cases.

While these measures are in place to lower potential COVID-19 cases, infection control in hospitals must be ensured so that cases don’t spread within healthcare facilities. Let’s explore why this is important.

Why is infection control in hospitals important?

Of healthcare providers’ many responsibilities, preventing hospital-acquired infections (HAIs) has been a topmost priority for many of them. Hospitals are constantly looking to improve practices that enhance infection control and prevent HAIs. It is a crucial role of any hospital because, if not ensured, it will lead to compromised patient safety, undesirable healthcare outcomes, and create a chain of events that will jeopardize the entire healthcare facility. However, prior to the pandemic, HAIs used to be a headache of healthcare providers only; but now, contracting diseases is the concern of virtually everyone, especially those in hospitals.

COVID-19 has shown how effective communication can be in this day and age – any new update regarding the novel virus can be shared and seen by anyone, thanks to the internet. Almost everyone has extensive knowledge about the do’s and don’ts, and they are quite reluctant to visit hospitals since they know that’s where the COVID-19 patients are going. Thus, healthcare providers need to ensure infection control in hospitals and enhance patient safety as well as the safety of the frontline staff members. Let’s take a look at how hospitals can reduce HAIs, some of which are according to WHO, and improve healthcare outcomes as a result.

Practices to ensure infection control in hospitals

Create an effective infection control policy

The foundation of having zero to minimal HAIs is to have an effective infection control policy at hand. Healthcare providers wanting strict infection control must plan for it in advance, and this plan should contain guidelines for dealing with HAIs, identifying affected patients, locations to place the patients in isolation, and the duration of such events.

Washing hands thoroughly and regularly

While this might seem obvious at this point, it is still one of the most important practices to ensure infection control in hospitals and save lives in the process. Washing hands regularly with liquids containing antimicrobial agents for twenty seconds is a must, especially after interacting with extractions, contaminated items, blood, secretions, etc. Keep sanitizers within a short distance of each other so that patients and caregivers both have access to them. If possible, use automatic dispensers to make it a touchless and safer experience for everyone involved.

Enforce PPE usage

PPE is a term that has been tossed around since the beginning of the pandemic, and for good reason. While healthcare professionals have been using it for decades to prevent HAIs, virtually everyone uses some form of PPE nowadays to protect themselves. Unfortunately, not everyone follows best practices, which will ultimately put others at risk.

Enforcing PPE usage for everyone within a healthcare facility is a good practice, regardless of their designation. Simply putting up signs saying “No PPE, No Service” will be quite effective for patients. For the healthcare staff members, surgical masks, face shields, gloves, gowns, etc., must always be present whenever they are within the facilities.

Keeping surfaces clean

Viruses linger on surfaces for days, and keeping them clean is the best solution to prevent HAIs. We can significantly reduce HAIs by monitoring the materials and environmental surfaces that are touched frequently and disinfecting them regularly and thoroughly, such as beds, handles, etc.

Using touchless solutions that ensure infection control

While many touchless solutions will be popping up within the next few years, there is one that is already being used by many healthcare providers to prevent infection control issues – RightPatient. It is a touchless patient identification platform that uses patients’ photos to lock medical records and verify their identities. Enrolled patients only need to look at the camera – the platform matches the live photo with the saved one, providing the appropriate medical record within seconds without requiring any physical contact, and ensuring patient safety and hygiene.

Hospitals Can Reduce Denied Claims By Preventing 6 Issues

November 26, 2020/11949 views / 0 Comments/in BLOG, Denied Claims, healthcare, Medical Record Mix-ups, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety, Revenue Cycle Management /by Matt Gibson

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.

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.

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.

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

November 25, 2020/10894 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, healthcare, Medical Record Mix-ups, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

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.

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.

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.

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.

4 Strategies Hospitals Use to Prevent Medical Identity Theft Cases

November 20, 2020/10584 views / 0 Comments/in BLOG, Data Breach, healthcare, Medical Identity Theft, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

The US healthcare system has been plagued with several issues over the years. The lack of price transparency, interoperability issues, sky-high prices, and the lack of a standardized patient identifier are just some of them. One of the more concerning, and increasingly common, issues is medical identity, affecting more and more healthcare providers and patients. While providers are already facing huge losses due to the pandemic, they need to mitigate them by reducing preventable costs. One viable solution can be to reduce medical identity theft cases, and doing so will bring several benefits.

Let’s take a look at how medical identity theft happens, how common it is, and some strategies that can prevent it and mitigate losses.

How do medical identity theft cases happen?

Medical identity theft can occur in many ways, but it can usually be traced back to stolen patient information or records – a consequence of healthcare data breaches. There’s a reason why medical identity theft cases are so common: hackers are focusing more on healthcare data breaches because stealing and selling patient information is quite lucrative.

After a hospital suffers a data breach, the hacker(s) then tries to sell the stolen patient information on the black market. Unfortunately, there are many buyers available for many reasons, and they are also willing to pay high prices – up to $1000 per record!

After buying the stolen patient data, the fraudster assumes the identity of the patient. This can happen within healthcare facilities as well as during telehealth sessions (which are surging in popularity right now).

The majority of hospitals have no effective patient identifier and therefore they fail to red flag the individual, leading to medical identity theft. The scammer then illegally uses the victim’s credentials to obtain prescription drugs, medical equipment, and healthcare services, charging the victim for the services. Not only that, but since the fraudster uses the medical record, their information will be recorded within the EHR (Electronic Health Record) and can lead to patient safety issues down the line.

While that was a simple example, many complex medical identity theft cases are occurring almost daily.

Is medical identity theft common?

The numbers don’t lie –more patient records were breached in 2019 compared to the prior three years combined! Moreover, 9.7 million patient records were affected by data breaches this September. There’s no doubt that the majority of these patient records will be used for medical identity theft, as experts are also predicting a sharp increase in the near future.

Hospitals must ensure that they are preventing medical identity theft cases to guarantee patient safety and reduce associated litigation costs. Let’s take a look at some strategies that can help prevent medical identity theft and all of its consequences.

4 strategies hospitals can use to prevent medical identity theft cases

Follow the rules and regulations

First and foremost, the healthcare facility must ensure that they are properly following the rules. For instance, HIPAA mandates that there should be some technical, administrative, and physical safeguards present to protect patient information, known as PHI (Protected Health Information).

While this might seem like a straightforward strategy, a lot of healthcare providers fail to ensure HIPAA compliance. This not only leads to data breaches and medical identity theft down the line, but also incurs HIPAA penalties. HIPAA itself is a multi-layered and complex law that requires continuous effort to ensure compliance.

Fortunately, healthcare organizations can use HIPAA Ready, a robust HIPAA compliance software, to reduce the administrative burden. It streamlines HIPAA compliance, ensures training management, keeps all the HIPAA-related information in a centralized location, and also helps conduct internal audits.

By ensuring HIPAA compliance, healthcare organizations can detect security gaps and address the vulnerabilities, mitigating data breaches and, in turn, medical identity theft.

Devise a policy to enhance security

As previously mentioned, HIPAA has several requirements and requires that networks and devices are secure at all times. To do that, hospitals must come up with and follow a strict device policy so that sensitive patient information is not leaked inadvertently. While a BYOD (bring your own device) practice might be more flexible, it will inevitably lead to data breaches and leakage of sensitive information.

Thus, the following tips will help enhance security:

Only allow official devices for storing sensitive information
Only allow logging into secure networks
Encourage usage of VPN
Ensure data encryption at all times
Keep logs of access requests to track any suspicious activity

Train employees regularly

Staff members such as registrars and nurses are the ones who regularly access patient data. Training them will provide them with the knowledge to avoid suspicious emails, as that is the primary weapon of hackers. Moreover, providing regular training – especially if it includes information on recent data breaches – can be beneficial. As previously mentioned, HIPAA Ready can help with training management.

Ensure accurate patient identification

Even if a data breach occurs, medical identity theft can be prevented if healthcare providers can red flag the fraudster during identity verification. That is exactly what RightPatient does.

RightPatient is the leading touchless patient identification platform used by several caregivers. It verifies identities by using patients’ photos. After scheduling appointments, patients need to provide a personal photo and a photo of their driver’s license. The platform matches them and verifies their identity remotely, red-flagging fraudsters. This system is ideal for telehealth sessions.

During inpatient visits, the scammer is red-flagged when the platform identifies that their face does not match the saved photo attached to the medical record, preventing medical identity theft in real-time.

How to Improve Patient Safety and Add Millions to Hospitals’ Bottom Lines

November 16, 2020/10173 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, healthcare, Medical Identity Theft, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

The US healthcare system has been having a tough time for many years due to several issues, but the pandemic arguably tops all of them. It has damaged everything, leading to the cancellation of regular healthcare services in order to aid COVID-19 patients. While COVID-19 cases had decreased over time, cases rose across many states in the US. The American Hospital Association (AHA) also predicted that healthcare providers will face losses of at least $323 billion in 2020 due to the novel virus. As caregivers are still facing some of these challenges, as well as lower reimbursements, they can save significant costs and add millions to their bottom lines if they improve patient safety. Let’s take a closer look at the losses, what caused them in the first place, and how patient safety can be improved.

What contributed to the losses?

In short, a variety of factors contributed to the unfathomable losses. However, the key factors were elective procedures being canceled or postponed, drastically lower patient volumes, and high costs due to the surge in demand for crucial materials such as PPE (personal protective equipment). All of these were necessary so that caregivers could treat COVID-19 patients.

The losses didn’t stop there, which forced many healthcare providers to resort to cost-cutting strategies. Furloughing, laying off employees, restructuring the organization, introducing pay cuts, and even shutting down departments or entire healthcare facilities were just some common strategies seen during the pandemic. Unfortunately, there’s more bad news.

Hospitals reportedly received lower reimbursements for treating uninsured COVID-19 patients. It was estimated that the reimbursements might total from $13.9 billion to $41.8 billion. However, around $881 million has been provided at this point. Moreover, CMS fined half of the hospitals in 2021 as these hospitals readmitted patients too frequently. From every angle, hospitals are facing the worst financial strain in decades. Thankfully, these losses can be mitigated significantly if healthcare providers improve patient safety within their facilities with RightPatient.

How can RightPatient improve patient safety?

Ensures a hygienic environment

One aspect that makes RightPatient different from other patient identifiers is that it is touchless. The platform uses the faces of patients to verify their identities. In healthcare facilities, all a patient needs to do is look at the camera – the platform matches the saved photo and the live one for verification, making it a hygienic and safe experience for everyone involved.

Prevents medical identity theft

By identifying patients accurately across the care continuum, starting from appointment scheduling, RightPatient ensures that patients are who they claim to be and not some fraudster. After scheduling an appointment online, patients receive an SMS/email instructing them to provide a personal photo and a photo of their driver’s license – RightPatient does the rest. It red-flags any anomalies when it sees that someone else is assuming the patient’s identity, preventing medical identity theft in real-time.

When a scammer uses the victim’s medical record, it is contaminated with their data, rendering it dangerous, fragmented, and inconsistent. If such cases are undetected, they severely hamper patient safety and impact healthcare outcomes. Thankfully, RightPatient can prevent such cases and improve patient safety along the way.

Prevents duplicate medical records

Duplicate medical records are quite dangerous, as they lead to treatment based on incomplete and inaccurate medical data, creating incidents that hamper patient safety. RightPatient identifies patients right from the start, avoiding duplicates and overlays.

Protects patient data integrity

Patient data is useless and dangerous if it is corrupt, and such cases increase when patient misidentification is common. RightPatient eliminates patient misidentification and helps improve patient safety by using the most appropriate characteristic to identify them – their faces.

Reduces medical errors

Medical errors occur on a regular basis. In fact, a John Hopkins study claimed that each year, over 250,000 American patients lose their lives due to medical errors, whereas others claim the number to be above 440,000. This would make medical errors the third leading cause of death in the US, and as most of these errors stem from something as simple as patient identification issues, those deaths are preventable.

Imagine this – when a patient walks into the hospital, the registrar needs to identify their accurate medical record. However, if the wrong medical record is chosen, even if it is a duplicate medical record of the same patient, the treatment will be based on obsolete or incomplete information – even a single medication can severely hamper the patient’s outcome. RightPatient prevents these cases and eliminates preventable medical errors associated with misidentifications.

RightPatient can improve patient safety and mitigate losses simultaneously

RightPatient does all of the above and more – it reduces denied claims, litigation costs, and eliminates the costs associated with preventable medical errors. Leading caregivers have already experienced how useful RightPatient is and reduced losses significantly. Use RightPatient now to be a responsible caregiver and enhance patient safety, all while boosting your bottom line.

Hospital Readmission Prevention is a Must as CMS Fines Half of Hospitals

November 13, 2020/10078 views / 0 Comments/in BLOG, healthcare, Patient Data, Patient Errors, Patient Identification, Patient Matching, Patient Outcomes, Patient Safety, value-based care /by Matt Gibson

The US healthcare system is in an unfortunate state – it just can’t seem to catch a break. While it was already coping with a number of issues – such as medical identity theft, the lack of price transparency, interoperability issues, and healthcare data breaches, among others – COVID-19 hit it hard. As a result, healthcare providers across the US are facing huge losses. With increasing COVID-19 cases across the States and with experts predicting even more during the fall, healthcare providers received yet another blow. CMS (Centers for Medicare & Medicaid Services) will fine about half of hospitals due to readmissions of Medicare patients, although this is for the pre-pandemic period and therefore COVID-19 cannot be held accountable for the lower payments. Let’s take a look at the numbers, how this will affect the hospitals further, and how hospital readmission prevention can be achieved with a proper patient identity verification platform.

CMS will lower payments

While it’s already been quite a harsh year for healthcare providers, it’s about to get worse. Many caregivers are resorting to cost-cutting strategies by laying off employees, furloughing them, or even shutting down; however, the lowered payments will only add to the unprecedented costs.

Some numbers surrounding the penalties

During the fiscal year 2021, CMS will fine 2,545 hospitals due to increased Medicare patient readmissions that occurred within 30 days. The penalties were based on patient data ranging from July 2016 through June 2019. A staggering 83% of the hospitals received penalties, and they will be facing payment cuts as high as 3% per Medicare case during 2021. 39 caregivers will face the maximum penalty next year, which is an improvement over this year, when the number of hospitals hit with the maximum penalty was 56. However, with the pandemic disrupting everything, hospitals will lose more than ever. As a result, hospital readmission prevention becomes a topmost priority.

Why is the program important?

This is the ninth year of the Hospital Readmissions Reductions Program, and it has been created to improve patient care quality while lowering overall costs. As previously mentioned, it takes into account the readmissions of Medicare patients that occur within 30 days. While CMS is considering a suspension of the penalty program due to COVID-19, the penalties are still in effect this year.

Some exceptions

Congress has exempted 2,176 hospitals out of the 5,267 from penalties due to a number of reasons. The hospitals exempted are either:

Critical access hospitals,
The only inpatient facility in the area,
Hospitals specializing in long-term care, children, veterans, or psychiatric patients.

What the industry thinks about hospital readmission prevention

While many participants within the US healthcare system have voiced disapproval regarding the penalty program, others have said that, while not perfect, the Hospital Readmissions Reductions Program is useful – it pushes caregivers to find innovative solutions to provide better quality care.

The penalties will further increase hospital losses

Moreover, as healthcare providers are already facing huge losses due to the pandemic, they need to ensure hospital readmission prevention if they want to survive in the long run. Several hospitals are heavily relying on CMS reimbursements, and if they can reduce readmissions, it might help them survive the pandemic’s financial strain. By improving patient safety and quality of care, hospitals can significantly lower readmissions. Fortunately, RightPatient can help with that.

RightPatient enhances hospital readmission prevention

RightPatient has been helping leading healthcare providers with its touchless patient identification platform for years. It ensures improved healthcare outcomes by eliminating one of the most overlooked problems within hospitals: patient misidentification.

Patient misidentification leads to duplicate medical records and overlays, jeopardizing patient safety. Moreover, it provides the wrong medical records to caregivers, resulting in negative healthcare outcomes. Naturally, these are the patients who are readmitted within hospitals frequently. So, how does RightPatient help?

It locks the medical records of the patients using their photos during registration. Patients receive an SMS/email after they schedule appointments, and they are required to provide a personal photo and a photo of their driver’s license. RightPatient compares the photos for a proper match, eliminating any chance of misidentifications. All of this is done without requiring the patients to touch any foreign objects, eliminating infection control issues – something that is crucial during and after the pandemic.

Reduce patient readmissions, improve healthcare outcomes, and ensure patient safety with RightPatient – contact us now to learn how we can help you.