Posts

Healthcare Revenue Cycle Management Optimization is Crucial as In-Person Visits Increase

July 25, 2021/7418 views / 0 Comments/in BLOG, Denied Claims, HIM, Medical Record Mix-ups, Patient Identification, Patient Outcomes, Revenue Cycle Management /by Matt Gibson

Believe it or not, while COVID-19 was arguably one of the worst problems faced by the U.S. healthcare system, it was just ONE of many. That’s right, there are a plethora of issues that have been hampering healthcare for years, causing patient safety incidents, lost revenue, and more. Unfortunately, these losses went through the roof due to COVID-19 – they were estimated to be around $323 billion in 2020. While the pandemic is slowly waning, things are going in the right direction as providers are opening their doors for in-person visits. To recover from the pandemic’s financial losses, healthcare revenue cycle management optimization must be one of the topmost priorities for health systems – let’s take a closer look at why it’s important and some strategies that can help with revenue cycle optimization.

Revenue cycle management in healthcare facilities

Healthcare revenue cycle management might be quite complex, as it contains many intricate processes, but it is simple enough to understand.

Revenue cycle management, in a nutshell, is used by hospitals and health systems to keep track of the “revenue” they receive by treating patients. It has many steps, but RCM starts from the first interaction with the patient, for instance, appointment scheduling, and continues until caregivers receive the final payment.

If broken down, revenue cycle of healthcare facilities usually contains 7 components:

Preregistration
Registration
Charge capture
Claim submission
Remittance processing
Insurance followup
Patient collections

As this list shows, the revenue cycle starts from the first interaction with the patient and ends with receiving the full amount for providing healthcare services to the patient.

While it might seem simple, healthcare revenue cycle management is quite complicated and difficult, especially when it comes to collecting claims from the payers (insurance providers).

Why optimizing RCM has never been more crucial

While it was always important for healthcare providers to improve RCM within their facilities, doing so now might ensure their survival and get them through this trying time. COVID-19 has drastically affected healthcare providers, and while some received bailouts in billions, others had to close their doors permanently. The rest of them are simply struggling through the financial losses, but as in-person visits are increasing, things look brighter for the caregivers, as long as they are implementing strategies that optimize RCM right from the start.

That being said, let’s take a look at some of the strategies that can be employed to optimize healthcare revenue cycle management.

Strategies that enhance healthcare revenue cycle management

Examine the entire RCM process to identify gaps

While the age-old saying is “If it isn’t broke, don’t fix it”, rapidly evolving environments beg to differ. How do you know that it’s working out fine for you? Unless your denied claims are reduced to virtually zero, there’s always room for improvement.

Analyze the entire RCM process to see if there are addressable gaps that require improvement – even the smallest ones matter. Talk to patients, survey your RCM team, take a look at the current numbers, and determine where you want the numbers to be. If issues are not found, then great – the problem might not lie in RCM, but if issues exist, work on them. RCM is evolving rapidly, and with the changes brought about by COVID-19, introducing technology in almost every aspect of the service to improve efficiency and collaboration has become the new normal. And speaking of collaboration, let’s move to the next point.

Improve collaboration between your front-end and back-end RCM teams

The traditional practice is that the front-end and back-end teams work towards the same goals, but separately. However, if they work more collaboratively then the entire process will become seamless and it will help optimize RCM as information is never lost or misinterpreted – helping to receive payments much faster and in greater numbers, improving the bottom line.

Using solutions that guarantee accurate patient information

When it comes to RCM, one of the biggest impediments to its optimization is denied or rejected claims – most of which can be traced back to billing and coding errors. On the front-end, if the patients are misidentified or if inaccurate medical records are used, then there are bound to be inconsistencies that are picked up by the payers. These errors lead not only to billing errors and denied claims, but can also be detrimental to positive patient outcomes – affecting the bottom line and the goodwill towards the hospital. As a result, ensuring patient data integrity and accurate patient identification is a must – both of which can be done with RightPatient.

RightPatient is a tried and tested biometric patient ID platform that safely and accurately identifies patients using their faces. The patient only needs to look at the camera – the platform does the rest, making it an entirely contactless process, something that is crucial in the post-pandemic world.

Not only does RightPatient make identification faster and accurate, but it also ensures that accurate information is fed to the registered patients’ EHRs every time they opt for healthcare visits, reducing billing and coding inconsistencies and denied claims in the process.

Ensuring Healthcare Data Quality Boosts Hospitals’ Digital Transformation Efforts

July 23, 2021/6690 views / 0 Comments/in BLOG, Data Integrity, EHR, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

The U.S. healthcare system has always had a complex relationship with technology, to say the least. While it has always been open to ideas that can transform healthcare, there have been certain impediments. For instance, the concept of a unique patient identifier is around two decades old, but due to many concerns, one doesn’t exist yet. As a result, healthcare providers are either struggling with patient identification errors or are using a robust patient identification platform to resolve the issues. Moreover, new research demonstrates the complex relationship between healthcare and technology – healthcare is lagging behind other industries in terms of digital transformation. Let’s take a closer look at the study, why some are reluctant to pursue digital transformation, and how ensuring healthcare data quality can boost digital transformation, among other things.

Some stats regarding digital transformation

The study was conducted with over 300 C-level executives, and while it includes a variety of industries, it also compares healthcare with the others, providing a different perspective.

Overall, a whopping 82% of the respondents from all industries stated that data quality is a barrier to data integration. This falls in line with the problems faced in U.S. hospitals and health systems – healthcare data quality can be inconsistent and problematic.

Healthcare was found to be comparable to financial services and the telecommunications industry in digital transformation – most of the respondents from these organizations stated that they were witnessing success rates of around 60%. While this number might be encouraging to some, healthcare lags behind organizations such as software and tech companies, who naturally are advanced in digital transformation, as well as transportation and logistics firms.

While different industries were surveyed, some commonalities show digital transformation exists as a common problem between them. For instance, around 80% of respondents stated that they found “enriching” existing data quite difficult, impeding the quest to find new insights or meaningful patterns. This is also an issue seen in hospitals and health systems, as ensuring healthcare data quality can be a considerable challenge for many – something which is preventable with proper patient identity management – more on that later.

Healthcare data quality issues also lead to losing time and resources as data needs to be rectified for usage. The survey also reflected this issue – around 40% of the respondents stated that their data teams have to spend time to clean the data, time which they could’ve spent doing something more productive, as data quality issues should not exist in the first place.

Healthcare data quality issues have a long history

It’s no secret that patient misidentification is a crucial issue in health systems and hospitals, and it leads to patient data integrity failure. Just imagine that a patient named Sam Jackson comes to the hospital and is assigned the medical record with the name “Sam Jackson”. However, the EHR actually belongs to a different Sam Jackson! The modified EHR will be full of errors and will be unusable and dangerous for both the Sams.

Such problems have been going on for a long, long time, leading to patient data quality issues, medication errors, wrong treatments, detrimental healthcare outcomes, readmissions, and more.

High-quality patient data is a must

Hospitals and health systems have been investing considerable money and resources in population health management, big data, analytics, and other projects that can transform healthcare for their patients in a variety of ways. However, the only way these efforts can work is if they have access to patient data that is complete, accurate, timely, and relevant. Unfortunately, when patient data is corrupted because of duplicate and overlay records from identification issues, these investments are diluted and affect ROI, patient safety, and healthcare outcomes.

Digital transformation in healthcare, as a result, requires high-quality patient data, and everything depends on identifying the accurate patient record right from the start – something which RightPatient is built for.

RightPatient ensures patient data integrity

RightPatient has been ensuring patient data integrity for several hospitals with its touchless patient identification platform. Registered patients are identified accurately right from the start – all they need to do is look at the camera and the platform provides the right medical record. By ensuring that accurate patient information is fed into EHRs every time, RightPatient ensures that high-quality data is present within the facilities to boost digital transformation efforts and investments – improving patient outcomes and reducing unwanted incidents in the process.

To Enjoy Advantages of Telemedicine in Healthcare, Providers Must Protect Patients Online

July 16, 2021/6868 views / 0 Comments/in BLOG, healthcare, Medical Identity Theft, Patient Data, Patient Identification, Patient Outcomes, Patient Safety, Telehealth /by Matt Gibson

Telemedicine, many times used interchangeably with the word telehealth, has grown tremendously during last year because of COVID-19. Whilst it’s been available for a long time (decades, really), its future was uncertain before now. Healthcare experts mainly debated about the possible advantages of telemedicine in healthcare, while patients were wary regarding online doctor appointments.

Still, because of COVID-19, practically everything is different, and desperate times required drastic measures. Rules enveloping virtual visits got relaxed, so, more providers and their patients got exposed to this new phenomenon called telehealth.

Online appointments currently have numerous supporters

The user base for telehealth has soared, with numerous healthcare professionals and their patients supporting it and saying they want it to be a permanent part of healthcare after the emergency is over. It was also extremely helpful and convenient throughout the pandemic. That being said, let’s look closer and examine the advantages of telemedicine in healthcare plus the way providers can safeguard their patients throughout these appointments.

A few advantages of telemedicine in healthcare

Telemedicine is cost-efficient for all

The universal understanding regarding virtual healthcare is that it is less expensive than in-person visits. Plus, it saves time, no need to travel to use it, etc. Whilst that’s correct, online healthcare is also less expensive for healthcare providers. Think about it – for most online appointments, all the provider requires is an online platform, the proper devices to connect with their patients, plus a steady, secure online connection. These types of appointments get rid of a lot of the costs linked with traditional healthcare – i.e. registration desks, using paper products, fewer staff members required, etc.

The AHA (American Hospital Association) even agrees with the aforementioned – online healthcare saved over 11% of costs for many hospitals.

Online appointments provide access to many more patients

Even the toughest critics can’t refute the fact that telehealth offers top-notch care to many more patients than in-person appointments. Consider how it worked before COVID-19 – the majority of patients in rural areas were unable to get to a suitable hospital for several reasons.

An example of one of the top advantages of telemedicine in healthcare is that one can use it from any place – so it’s quite convenient for those who live in rural areas. Whilst a tiny amount of providers offered online appointments prior to the pandemic for rural patients, the pandemic showed how helpful telehealth can be for routine patients too. Online appointments assisted in providing top-notch care to a huge number of patients who had various problems – a lot still use this and the experts want it to become a permanent option for healthcare.

Telemedicine fits more people’s needs

Preventive medicine, improved quality, superior scheduling experiences – online appointments can meet all those things and even more!

Numerous experts say because patients are more involved with telehealth appointments than with in-person appointments, the former could encourage more preventive medicine usage. Patients, likewise, feel that they are getting more personalized care with telehealth appointments since they report during in-person appointments that their physicians do not even look at them – only at their computer screens. These cases, along with other factors, might cause a surge of usage that helps to improve healthcare outcomes in the future.

Online appointments offer a superior quality of care for a lot of patients, particularly rural ones, as described earlier. With online appointments, patients can pick which provider they want, and they can even be miles away and still get one that meets their precise healthcare needs.

Finally, with online appointments, patients can merely pick the timeframe that works best for them, so, scheduling is easy. Whilst that also can happen with regular in-person appointments, the patient now doesn’t have to wait hours or longer to see their doctor, all they have to do is log in at their appointment time and see their doctor.

Still, whilst telehealth has a huge possibility, it remains pretty new, so several challenges have to be solved – one is protecting patient information online.

Providers have to safeguard their patients online to enjoy the advantages of telemedicine

Patient records and data are very sensitive information, which is one of the dominant reasons most data breaches occur in the healthcare industry. Hackers can sell a medical record for thousands of dollars on the black market, and the scammers then buy them and use them to get healthcare and the actual patient is charged with the bills. While this normally happens in traditional in-person appointments, a lot of experts believe it can also occur in online appointments, so, the healthcare providers have to safeguard their patients’ information while they are in an online appointment too.

Luckily, RightPatient comes with lots of great experience in protecting patient data as well as avoiding medical identity theft in real-time.

One of the top touchless patient ID platforms utilized by many healthcare providers, RightPatient detects patients via facial recognition and averts scammers from trying to pass as the real patient during the registration process and beyond.

RightPatient can be used during telehealth appointments – so it is perfect for protecting your patient’s information as well as stopping identity theft during virtual visits. Patients only need to take a picture of themselves and a picture ID like their driver’s license – RightPatient takes it from there.

Is your facility ready to safeguard your patients’ info and stop medical identity theft in real-time?

Improving Patient Outcomes Has to Be the Main Concern since In-Person Visits Are Back

July 15, 2021/6719 views / 0 Comments/in BLOG, COVID-19, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

Luckily, it looks like the COVID-19 pandemic may be ending at last. Whilst COVID-19 cases 19 are still occurring, the overall rate has slowed down, thanks to over 326 million Americans getting vaccinated. As restrictions that used to be in place since the beginning of the pandemic start to ease in most states, businesses are gradually opening back up. However, healthcare, which did not close is finally receiving great news – in-person appointments, as well as margins, are going up gradually. Rising patient appointments are not sufficient for caregivers – guaranteeing quality and safety in healthcare facilities is also necessary for improving patient outcomes.

Having said that, let’s look closer at the present condition concerning patient volumes as well as margins, some statistics regarding them, and the reason hospitals must find solutions that can assist them in lowering significant costs, eliminating current issues, and surviving this difficult environment.

Healthcare providers may, at last, be getting a break

After several months of financial losses, along with suffering caused by COVID-19, healthcare providers, finally are opening facilities for in-person visits. Whilst the reaction is sluggish, it is rising steadily regarding patient volumes along with margins, based on research by KaufmanHall – let’s look closer at a few of the stats.

These stats reveal that whilst patient volumes went up, particularly outpatient visits, providers are still ending up with extremely low margins. In May, the median hospital operating margin index was only 2.6 percent, and if you include the federal CARES funding, that was still only 3.5 percent.

Nevertheless, the operating margin climbed 95.2 percent YTD (year-to-date) when compared to Jan to May 2021, and operating EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization) margin improved close to double – 102.4 percent YTD in May, the latter is excluding the CARES aid.

Conversely, when in comparison to pre-COVID-19 periods (Jan to May 2019), the operating margin was down to 20.5 percent YTD without CARES.

Therefore, what do all these numbers really show regarding healthcare providers?

Actually, it is very simple – when health systems and hospitals were able to open up, and when the restrictions eased, that led to rises in their margins in comparison to the shutdown timeframes. Though the figures were lower in comparison to the pre-pandemic time due to patient numbers being quite high then, a few cases were nearer to pre-pandemic levels, said that same report.

Based on these numbers, it is very clear healthcare is improving its numbers, yet hospitals and health systems can’t stop worrying too soon – they must work towards improving patient outcomes.

Providers must deliver their patients a safer atmosphere, carry out telehealth services for people who don’t want to do in-person appointments and decrease issues that may harm patient care. Overall, they must make sure they’re striving to improve healthcare outcomes.

Improving patient outcomes is necessary to mitigate losses

Even while COVID-19 was rampaging, there were a lot of times when it was obvious hospitals needed to work hard towards improving patient outcomes. Incorrect patient information led to repeated lab tests, inappropriate data sharing, sending results to incorrect patients, etc. Regrettably, that is not new, since healthcare providers have always faced these issues, with one of the dominant causes being the wrong identification of patients.

Misidentifying patients impedes patient outcomes

It is very simple – whenever patients get misidentified, they’re assigned an incorrect EHR, and their treatment process is completely wrong from the start. Patients may get asked to do an unneeded or repetitive lab test, and then will most certainly receive incorrect treatment – all of this gets recorded in an incorrect EHR. This all causes detrimental healthcare outcomes, as well as hospital readmissions, plus in some cases, people even die.

Healthcare providers were facing litigation costs already as well as loss of income because of such cases. However, the COVID-19 issue, along with these losses, might be sufficient to make them permanently close their doors. They simply can’t afford to make medical mistakes and jeopardize patient safety.

Luckily, they do not have to – RightPatient can help with that.

RightPatient improves patient outcomes

RightPatient identifies patients correctly from the beginning, and because it is touchless, it offers a hygienic and safe experience for all. Our biometric patient ID platform is used by many reputed healthcare providers like Terrebonne General Medical Center as well as Grady Health, and it protects millions of patients from adverse effects.

Due to COVID-19, hospitals have to do what they can to lower their losses. RightPatient can do this since it improves healthcare outcomes, as well as averts misidentification problems, and improves the facility’s bottom line.

How Identity Management in Healthcare Helps With the Interoperability & Patient Access Rule

July 14, 2021/7155 views / 0 Comments/in BLOG, Data Integrity, EHR, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

With COVID-19, telehealth, data breaches, and other challenges, healthcare providers have had their hands full. Because COVID-19 is a national health crisis, CMS pushed back compliance with its Interoperability and Patient Access rule until July 1, 2021, though it’s been effective since the start of 2021. Nevertheless, with mass vaccinations across the country, as well as hospitals slowly opening, CMS (Centers for Medicare and Medicaid Services) will require healthcare providers to comply from July 1. So, let’s examine a few of these requirements, the way it mandates correct information of patients, and the way proper identity management in healthcare facilities can ensure patient data integrity.

The reason CMS is gambling hugely on this rule

Like all the rules out there, the CMS Interoperability and Patient Access rule is comprehensive – the majority of it requires healthcare facilities to remove any restrictions which normally prevent patient information exchanges all across the healthcare gamut.

Under this rule, CMS plans to improve interoperability along with patient access – assisting the providers as well as patients to ensure proper healthcare outcomes.

Concerning interoperability, CMS wants the rule to aid in assisting healthcare providers to share and access patient information securely and effectively. That will assist in improving collaboration and improving healthcare outcomes as it will help make informed decisions more accurately.

On the other hand, patients, when they’ll get access to their health information, will be more involved with care decisions, increasing patient engagement.

Improving patient data access across the care continuum has several benefits such as improving healthcare outcomes, cutting costs, reducing redundant lab tests, reducing inefficiencies, and boosting collaboration among the caregivers – improving healthcare results as well. Though, all that will happen only if patient data integrity is rigorously maintained, and this requires immaculate identity management in healthcare facilities.

Healthcare providers must support e-notifications

As a segment of this rule, CMS necessitates healthcare givers (which utilize EHR systems) like critical access, acute care facilities, and psychiatric hospitals must deliver e-notifications to the patient’s other caregivers like primary care doctors, post-acute providers and suppliers, amongst other entities during ADT (admission, discharge, or transfer) events – appropriate for ED as well as inpatient admissions. This data has to consist of the patient’s basic information, the name of the sending organization, and if needed, the diagnosis of the patient.

But how does identity management in healthcare facilities play a part here?

So, patient identification in the majority of hospitals as well as health systems is yet a substantial dilemma for several causes. The outcomes can be distressing – patient misidentification can lead to making errors with medical records, mixing up patients, medical identity theft, damaging healthcare results, getting readmitted to a hospital or it could end up killing someone!

Think about it. What if an incorrect alert gets delivered to the incorrect caregiver because of a patient identification error – it would end up a disaster for everyone, if unnoticed. Not just would it impede the outcome for the patient, it would additionally compromise CMS compliance – affecting reimbursements, something that is very important for the majority of healthcare suppliers.

Whilst incorrect patient identification is quite common in the majority of healthcare facilities, reliable caregivers are utilizing RightPatient to guarantee immaculate identity management in healthcare facilities.

The Way RightPatient guarantees accurate identity management in healthcare facilities

RightPatient is the leading patient ID platform that identifies patients accurately at any touchpoint in the care continuum. By accurately identifying patient records right from registration and beyond, RightPatient prevents false alerts and ensures that the appropriate healthcare organization receives e-notifications. Since RightPatient also ensures patient data integrity by protecting patient information, it also leads to lower readmissions, boosting CMS compliance down the line. RightPatient also enhances patient safety, prevents medical errors, red-flags fraudsters in real-time – improving the bottom line in the process.

How are YOU planning to ensure CMS compliance at your healthcare facility?

Curbing Healthcare Identity Theft During Telehealth as it Gains the Biden Administration’s Support

July 13, 2021/7279 views / 0 Comments/in BLOG, Data Integrity, healthcare, Medical Identity Theft, Patient Identification, Patient Outcomes, Patient Safety, Telehealth /by Matt Gibson

So, this topic shouldn’t surprise you, but many folks are happy about the announcement. You can’t help but have seen that the use of telehealth soared after the COVID-19 pandemic occurred in the United States along with the easing of any of the surrounding restrictions. Telehealth is here to stay now, but there are concerns regarding healthcare identity theft. Ok, its usage has fallen slightly currently, although there is an ever-expanding amount of healthcare specialists, patients, and providers who wish to institute these virtual visits into a permanent healthcare option. Luckily, that appears to be a good possibility since the Biden administration supports this, so long as it meets precise conditions. Nevertheless, there are additional problems to solve – the most important one is medical identity theft occurring during a session.

Therefore, let’s look closer at the role of telehealth in healthcare, the reason lots of folks now support it, the way the Biden administration supports it, as well as the way RightPatient can avert medical ID theft cases during a remote session.

Telehealth is getting more popular amongst providers and users

Telehealth has existed for many years, however, it only revealed its full potential when the COVID-19 pandemic occurred. Since people weren’t able to see their providers in person and many elective procedures got postponed indefinitely, healthcare givers, as well as the government, rushed to provide another method of treating non-critical patients. Telehealth proved to be the answer.

Since another method of treating patients was urgently needed, telehealth got elected, and many of its previous restrictions got lessened. Telehealth got very popular amongst caregivers and patients. A lot of younger patients even decided they prefer telehealth sessions and will use them after the COVID-19 pandemic ends.

Though, a lot are concerned that whenever the pandemic ends, the restrictions on telehealth will return and it will again be hard to use.

The future of Telehealth seems great – Yet there’s a need for the correct framework

Luckily, that is not going to occur, as the Biden administration has said it is going to support expanded telehealth access when the COVID-19 problem ends. Because it assisted in providing virtual care as well as has also ensured patients were safe during this unprecedented timeframe, it has earned a substantial amount of backers who profited from telehealth, so wish to carry it on.

Congress is looking at the present scenario, contemplating which of the regulations on virtual care ought to change whenever the Covid emergency is done. Currently, there are about forty-three bills that have provisions regarding telehealth that have been generated since the start of the pandemic, according to the Alliance for Connected Care.

Still, HHS Secretary, Mr. Becerra, asserted that everyone must be able to access telehealth, and care quality must be ensured. The Biden administration aims to ensure U.S. citizens get top-notch healthcare through virtual appointments – he said they do not wish folks to get billed for items that do not improve the services.

Healthcare identity theft can happen during a virtual visit as well

So, whilst telehealth’s future seems bright, a few issues must be ironed out. The healthcare providers additionally have to work to ensure patients get the top care and stay safe from medical identity theft.

One of the concerns some have overlooked regarding telehealth visits is medical identity theft cases that may happen in a session. Exactly like the way healthcare frauds as well as healthcare identity theft occurs in an in-person appointment, experts predict these will happen in virtual visits too. Healthcare suppliers must make sure that is averted – something they can accomplish via better identification of patients during the telehealth visits. Thankfully, RightPatient assists with doing that, and even more!

RightPatient averts healthcare identity theft in real-time

For years RightPatient has prevented medical ID theft as well as healthcare fraud, thus, safeguarding millions of patient records throughout several top hospitals and many health systems. RightPatient leads the way in touchless biometric patient ID platforms which makes sure patients get identified correctly throughout the care field. Consequently, when a bad actor attempts to pass themselves off as a patient, RightPatient red flags them, avoiding medical identity theft instantly, even during virtual visits.

RightPatient does not just assist in preventing healthcare identity theft, but it additionally safeguards patient information, ensures patient safety, and decreases litigation costs related to identity theft incidents.

Since the Biden administration backs telehealth, the future of using it looks great. Yet, caregivers must avert problems connecting to virtual appointments, and serious issues such as medical ID theft can be avoided with RightPatient.

What is the way you prevent these cases of identity theft in your medical facility?

Claim Denials are Damaging More Than 30 Percent of Hospitals – Are You Stopping Them?

July 12, 2021/6836 views / 0 Comments/in BLOG, Data Integrity, Denied Claims, EHR, healthcare, Patient Identification, Patient Safety, Revenue Cycle Management /by Matt Gibson

Claim denials have always been a problem – it is a fact that they have occurred in all kinds of health issues for many years. Nevertheless, it got pushed to the back of the line due to the COVID-19 as well as problems with IT in the healthcare field, efforts to get people vaccinated, etc.

Sadly, claim denials have gone up – they are happening much more often now. In fact, it’s reported they have gone up 20 percent in the last 5 years! That, along with other gloomy statistics, was announced in a recent study from Harmony Healthcare. With that out of the way, it’s time to look more closely at this situation and how revenue cycle management in healthcare operations can be improved by identifying patients correctly.

A short update on claim denials

Claim denials, additionally called denied claims, are simply claims normally sent in by a healthcare supplier to the authorized payer, except for particular reasons, they were deemed “unpayable.” That occurs because of issues with coding and billing, mixing up medical records, missing filing deadlines, inadequate medical needs, or additional pertinent explanations.

So, here is what’s going on currently regarding denied claims.

Several disturbing statistics concerning denied claims

The COVID-19 pandemic triggered nearly everything to become worse, including denied claims. In fact, the earlier stated study showed a massive one-third of hospitals stated their denial rates were 10% or over. The study included more than 130 healthcare providers all over the United States and this rate of denial ranged between 6 and 13%. The accepted “danger zone” for denied claims is touted as 10%.

This study likewise explained why hospital administrators think denied claims happen. Thirty-two percent said it was caused due to coding errors while twenty percent said the reason was front-end concerns. Nonetheless, both these issues may be based on mix-ups with medical records, which comes from patients being misidentified – we will speak more on that topic later.

Whilst these revealed denied claim frequency, what’re the real issues denied claims cause?

The massive effect of denied claims

Denied claims are exceedingly expensive if faced – and may amount to around $4.9 million for the healthcare supplier. No matter how big or small a provider is, that is a huge portion of cash, and could even cause some hospitals to close.

Understand, denied claims are not merely expensive on their own, FTEs or full-time equivalents must do their best to fix any coding errors so the successive claims won’t be refused or refuted. This means the FTEs aren’t doing their normal job, which slows down other work and causes the whole process to be ineffective. Altogether, these facts cause a major blow to the bottom line of these hospitals.

As earlier stated, numerous denied claims are generated because of issues at the front end as well as coding mistakes, which happen a lot due to misidentifying patients.

The way denied claims and misidentifying patients are linked

This is very easy to figure out – it begins at the registration desk. The incorrect EHR gets noted with the patient, so, incorrect info is placed in the medical record. That may occur because of an error like an overlay or duplicate. If no one discovers the error before the treatment is concluded, the patient’s provider ends up sending the wrong claim info to the authorized payer.

As the claim is being processed, the authorized payer closely inspects it and sees there are errors, thus the claim gets denied. Misidentifying patients causes coding errors and front-end problems. These issues can be averted if the patient is identified properly.

RightPatient decreases claim denials, and goes beyond!

RightPatient helps many healthcare facilities protect millions of their patients’ records. It’s the industry’s top touchless biometric patient identification platform. It works by identifying patients via facial recognition, thus averting overlays, duplicates, and mix-ups with medical records from the beginning. Therefore, this averts the claim from being denied, thus saving hospitals lots of money. It just may be the answer you need to reducing denied claims.

The benefits of RightPatient do not end there. Besides reducing denied claims, RightPatient improves patient safety, enhances healthcare outcomes, and ensures positive patient outcomes.

Does your healthcare facility prevent denied claims efficiently?

How to Protect Patient Data at Your Hospital

July 2, 2021/7731 views / 0 Comments/in BLOG, Data Integrity, healthcare, HIM, Medical Identity Theft, Patient Data, Patient Errors, Patient Identification, Patient Safety /by Matt Gibson

The U.S. healthcare system has never had a shortage of problems – it has always dealt with several issues simultaneously. The exorbitant prices, the lack of price transparency, medical identity theft cases, lack of patient identification in hospitals, preventable medical errors, and archaic laws are just some issues that plague healthcare. Healthcare data breaches have unfortunately been growing at an exponential rate. With no signs of them stopping anytime soon, it becomes crucial that healthcare providers, professionals, and everyone involved with patient information be vigilant regarding protecting the data. With that out of the way, let’s take a look at how to protect patient data within hospitals and health systems with 5 practices.

Why protecting patient data is becoming so important

Those who are familiar with the U.S. healthcare system know that data breaches are occurring left, right, and center. These data breaches have several grave consequences such as patient information being stolen, being sold in the black market, being used for medical identity theft, patient data integrity failure, litigation costs, loss of goodwill – the list just goes on. And all of this might occur simply because a healthcare staff member opened an external email without being wary of the possible risks.

As a result, healthcare professionals and facilities need to be on guard at all times against such cyberattacks so that they don’t lead to data breaches, disruption of operations, or the most common endgame – medical identity theft.

With the “why” out of the way, let’s dive into the “how”, to be more precise, how to protect patient data.

How to protect patient data with 5 practices

Work on HIPAA compliance

HIPAA, or the Health Insurance Portability and Accountability Act, mandates that healthcare providers along with anyone else dealing with patient information protect patient information effectively at all times. It provides many rules and regulations that cover a lot of aspects, and if applicable organizations aren’t ensuring compliance, then they’ll be heavily penalized.

However, working on HIPAA compliance just for the sake of avoiding penalties won’t help. HIPAA provides several guidelines on how to protect patient data at rest and during transmission. If these guidelines are taken as starting points, not only will HIPAA compliance be ensured, but patient data will also be protected – reducing chances of data breaches. There are even solutions such as HIPAA compliance software that can also aid in compliance – helping identify security gaps and reducing the administrative burden in the process.

Improve user authentication practices

Patient data can be breached from anywhere, and with many healthcare staff working remotely, the risks are just increasing. Putting safeguards in place that enforce limited access to everyone that deals with patient information can slow down breaches. This way, even if the hacker has access to the employee’s account, they will only have restricted access to sensitive information.

Always encrypt sensitive information

Encrypting sensitive information makes it useless for hackers – it makes the information unreadable by outsiders or unauthorized users. Enforce employees’ use of encryption whenever transmitting sensitive patient information.

Provide training on patient data security whenever required

Too many training sessions on patient information security can be ineffective and counterproductive, and too few can reduce its importance. Instead, find the sweet spot for your organization to provide training sessions regarding patient information security.

For instance, whenever there’s news about another data breach that can provide meaningful information, conducting a training session and disseminating the information to the employees can help – learning from others’ mistakes might just be the thing that will prevent a data breach. Also, regularly provide updates on how to handle external emails and requests – the safest bet is treating each email as a suspicious one.

Implement solutions that protect patient data

Several constraints prohibit healthcare providers from fully being protected against data breaches – cybersecurity budgets and hackers coming up with innovative ways to attack being the most common ones. However, while data breaches might seem inevitable for many, patient data can be protected, but how?

RightPatient is the answer.

It is a touchless biometric patient identification platform that prevents medical identity theft in real-time. By ensuring accurate patient identification, RightPatient successfully red-flags fraudsters during the registration process. This prevents fraudsters from tampering with the EHRs, ensuring patient data integrity, and protecting patient data in the process.

How are you protecting patient data at your healthcare facility?

Ensuring Data Integrity in Healthcare Facilities is Critical in a Post-Pandemic World

June 29, 2021/6515 views / 0 Comments/in BLOG, Data Integrity, EHR, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

Starting on a positive note, it’s safe to say that we’ve seen the worst of the pandemic, at least in the U.S. Now that over 310 million Americans are vaccinated against the notorious COVID-19, almost everything is slowly but surely returning to the “old normal”. We’re saying “almost” because COVID-19 is still affecting a lot of people, businesses, institutions, and industries. The U.S. healthcare system, for instance, arguably faced the worst challenges it has ever had last year, leading to astronomical losses. While providers are opening their doors slowly, it’s estimated that they will face collective losses of over $120 billion this year. This makes it quite clear – hospitals need to implement strategies that can reduce losses, and ensuring patient data integrity in healthcare facilities might just be the answer, leading to improved quality and safety in healthcare – let’s dive deep.

How COVID-19 changed our realities

Well, even if you’ve been living under a rock, you’d have noticed that the entire world changed last year. Social gatherings, sporting events, rallies, basically anything that included a large number of people were suspended and lockdowns were imposed to flatten the curve and reduce the infection rate. While different countries implemented lockdowns differently, all of them had one thing in common – the healthcare systems were shaken to their cores due to the unprecedented challenges.

COVID-19 was devastating for healthcare providers

In the U.S., hospitals had to suspend their regular operations, elective procedures, and in-person visits to take care of the COVID-19 patients. Healthcare teams and frontline workers did everything possible to fight COVID-19 as they risked their lives. As a result, hospitals had to cut off sources that normally would bring in revenue, and losses were around $323 billion last year. Surgeries usually are a huge source of revenue for healthcare organizations, and as they were postponed indefinitely, hospital finances plummeted.

Before going into how ensuring patient data integrity in healthcare facilities can reduce significant losses down the line, let’s take a look at some stats regarding surgeries.

Some worrying stats regarding surgeries

According to research conducted by McKinsey & Company, hospitals and health systems saw (on average) a 35% decline in surgical cases from March 2020 to July 2020. The same research also mentions that working on this backlog might require at least two years even if facilities can operate at 110% capacity!

According to additional research, elective surgeries declined by around 193% after CMS recommended healthcare providers postpone non-emergency procedures back in 2020 – leading to unprecedented losses.

Moreover, only half of the healthcare providers want to implement strategies or solutions that can help them deal with this growing backlog. Moreover, around 80% of these same individuals believe that they can grow next year.

What they are failing to realize is that times have changed and so has the healthcare space. Telehealth is dominating and everyone is worried about hospital-acquired infections – healthcare has changed significantly. In this case, the hospitals and clinics that adapt themselves to the new changes will be the ones that will not only survive but will also thrive in the long run. While data integrity in healthcare has been sidelined during the pandemic, ensuring it becomes an important priority now can make all the difference.

But how is that relevant to surgeries?

Patient data integrity in healthcare facilities can go a long way

Well, collecting and analyzing data properly can prevent losses, ensure smoother operations, and lead to boosted bottom lines. In fact, healthcare organizations that properly utilize data can make accurate forecasts, provide improved healthcare outcomes, and prevent medical errors. One of the key components of that is patient data – something which must be accurate at all costs.

Ensuring patient data integrity in healthcare facilities can be challenging, but using the proper tools can drastically reduce adverse effects.

For instance, patient data integrity failure can lead to duplicate medical records or overlays, patient safety incidents, detrimental healthcare outcomes, patient mix-ups, wrong procedures, and more. However, RightPatient is a solution that ensures patient data integrity right off the bat.

RightPatient ensures patient data integrity in healthcare facilities

RightPatient is a robust touchless patient identification platform that solves one of the most crucial but overlooked issues of healthcare – patient misidentification. However, it brings several other benefits to healthcare providers and their patients.

By ensuring that the accurate medical record is used every time the registered patient comes in, RightPatient prevents mix-ups and duplicates, ensures patient data integrity, and ensures that data quality is maintained at all times.

RightPatient has been proudly protecting millions of patient records at several hospitals for years now with positive patient identification – are you protecting your patients properly?

Patient Data Integrity During Virtual Visits Must be Ensured as Experts Debate About Telehealth

June 21, 2021/7461 views / 0 Comments/in BLOG, COVID-19, healthcare, Medical Identity Theft, Patient Data, Patient Identification, Patient Safety, Telehealth /by Matt Gibson

Let’s face it – telehealth has been a huge driving force that made treating non-critical patients possible during the pandemic. Once COVID-19 hit the U.S. in full force, every healthcare provider dropped their regular operations and scrambled to care for the overwhelming number of COVID-19 patients. Regular patients, however, were pushed towards remote visits, resulting in telehealth’s explosion in popularity. One of the best aspects of virtual visits was that patients received care right from their homes – one can even say that telehealth somewhat helped “flatten the curve”. While the major effects of the pandemic are fortunately behind us, many are questioning telehealth’s future now. That being said, let’s take a closer look at what experts think, why many are advocating for telehealth, and why ensuring patient data integrity during such visits is a must.

Telehealth is universally acclaimed

While countless brave frontline healthcare teams worked to save COVID-19 patients that went to hospitals in huge numbers, telehealth helped non-critical patients during the pandemic. As more people agreed to virtual visits, healthcare providers, patients, vendors, insurers, and everyone else involved realized telehealth’s potential and approved its usage.

In fact, telehealth has become so popular that as we return to the “old normal”, many healthcare providers, experts, consumer groups, advocates, and even state Medicaid officials are pushing Congress to keep its expansions in place so that even more people can access and benefit from using it. This is because all of these people believe that virtual visits can transform healthcare. For instance, many services that used to warrant in-person visits can now effectively be provided via video communication platforms, sometimes, even audio calls are enough!

But, like everything else, there are two sides of the coin, and telehealth is no exception.

There are skeptics of telehealth – many worry about patient data integrity

While telehealth has been growing at a rapid pace since the pandemic, there have been skeptics concerned about it. However, telehealth is no stranger to adversaries.

Telehealth has been around for several years, and since its inception, it has had its fair share of detractors. Why else do you think it took so long for telehealth to be where it is today?

While it can be said that telehealth is “transforming” healthcare, there are skeptics worried about the “side effects” it might bring. Even among supporters, there’s concern regarding its usage, costs, medical identity theft that will cause patient data integrity issues, and inequality for low-income patients. In fact, many fear that it will become a tool that will simply increase costs without adding additional value. While there might be safeguards in place down the line to control costs, the fear of medical identity theft bleeding over to virtual visits is quite natural. It occurs with in-person visits, and without proper safeguards, fraudulent cases might become a part of virtual visits too, hampering patient data integrity – let’s see how it might happen.

Medical identity theft is a common concern regarding telehealth

During in-person visits, the lack of a positive patient identification system leads to fraudsters getting away. Fraudsters are usually armed with the information required to bypass the security measures – most of the time, these security measures are questions regarding the patient. If the fraudster has access to the patient’s information (many buy the information from the black market), it’s easy to know the right answers. As these caregivers cannot accurately identify patients, fraudsters get access to healthcare services, medical devices, etc., and if they opt for treatment, it hampers patient data integrity. The same can happen during virtual sessions too – as long as there’s no effective way to identify patients accurately, fraudsters cannot be stopped.

Thankfully, RightPatient can prevent medical identity theft during telehealth visits and in-person visits.

RightPatient protects patient data integrity

As a touchless patient identification platform, RightPatient is being used to protect millions of patient records across a variety of health systems and hospitals. Using patients’ photos, the platform validates whether the patient is real or a fraudster, preventing medical identity theft in real-time.

RightPatient makes patient identification in hospitals and virtual visits accurate, prevents impostors, and reduces substantial costs down the line – try our platform now to see how it can boost the bottom line at your healthcare facility.