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

July 14, 2021/7160 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?

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

November 13, 2020/10902 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.

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

August 25, 2020/11913 views / 0 Comments/in BLOG, Connected Health, Data Integrity, Duplicate Medical Records, EHR, healthcare, Infection Control, Medical Record Mix-ups, Patient Experience, Patient Identification, Patient Matching, Patient Outcomes, Patient Safety /by Matt Gibson

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

A brief refresher

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

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

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

Who needs to ensure it?

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

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

Identifying patients correctly is required for CMS compliance

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

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

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

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

RightPatient helps identify patients correctly

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

How it works

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

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

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

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

Identifying Patients Accurately is Critical for Ensuring CMS Compliance

July 27, 2020/8230 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Patient Errors, Patient Identification, Patient Safety /by Matt Gibson

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

CMS Interoperability & Patient Access Final Rule

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

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

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

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

Why are the CoPs important?

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

What the healthcare providers are doing

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

How identifying patients accurately is related to e-notifications

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

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

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

Identifying patients accurately with RightPatient

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

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