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Dealing with Claim Denials in Healthcare Facilities

April 22, 2022/4398 views / 1 Comment/in BLOG, Data Integrity, Denied Claims, Duplicate Medical Records, EHR, healthcare, Patient Data, Patient Identification, Patient Safety /by Matt Gibson

Healthcare providers have always been under a lot of pressure. Patient mix-ups, identity theft cases, denied claims, medical record errors, data breaches, and patient safety incidents are just a few examples of the challenges. However, all of these issues were more visible than ever with COVID-19. Claim denials were one of the most difficult challenges, as there were more patients in need of healthcare services during the pandemic’s peak. Both healthcare providers and payers were (and still be) at odds over denied claims, and the situation will only worsen as rules and regulations change. While hospitals are already suffering from massive losses, refused claims exacerbate the situation. That being said, let’s take a look at a few strategies for dealing with claim denials in healthcare facilities.

Strategies that can help reduce claim denials in healthcare

Provide training to the coding team

Coding errors are one of the most regular reasons for claim denials in healthcare facilities. For example, suppose a patient came in and requested healthcare services; the latter has a unique code. However, the coding team utilized the incorrect code, and when the payer inspects the claim, it is classified as denial because the incorrect code was used.

To avoid such errors, healthcare providers must train the coding team on topics such as common coding errors, coding do’s and don’ts, recent updates, and so on.

Ensure that physicians record information correctly

A lack of proper clinical documentation is another factor that contributes to claim denials in healthcare. The coding team is not responsible for every denied claim. When clinical documentation problems occur, wrong codes are almost always selected, resulting in denied claims.

As a result, healthcare providers must guarantee that physicians properly and timely record all paperwork in suitable medical records. RightPatient can aid in the proper identification of medical records and the reduction of denied claims.

Ensure that claims are submitted timely

Another reason contributing to denied claims is the failure to submit them on time, which can be easily rectified. Healthcare providers should set goals for their coding teams in order for them to process claims in a fast and accurate manner. They should, for example, categorize which batch of claims will be delivered and when they should be sent and check for errors.

While this does not always succeed, detecting the issues that cause late submissions can assist providers in addressing the issue and reducing future claim denials.

Ensure accurate patient identification to reduce denials in healthcare

One common cause of denials in healthcare facilities is medical record errors such as duplication and overlays, the majority of which result in mix-ups, improper treatment, and, predictably, billing and coding issues. The majority of medical record errors arise because there is no standardized patient identification in the US healthcare system.

While many healthcare providers waited for a standardized and effective patient identifier while dealing with duplication and denied claims, forward-thinking health systems already prevent them with RightPatient.

RightPatient is a touchless biometric patient identification platform used by top healthcare organizations such as Terrebonne General Medical Center, Duke Health, Community Medical Centers, and University Hospital. RightPatient uses one of the most secure, sanitary, and non-transferable properties of patients: their faces.

During registration, patients must look at the camera; RightPatient takes a snapshot and compares it to existing medical information to identify duplication. If no matches are identified, a new EHR is created with the patient’s photo attached. Whenever the patient comes to the hospital for additional healthcare services, they only need to look at the camera, And RightPatient generates the necessary medical record in seconds.

RightPatient isn’t just for registration; healthcare providers can use the platform throughout the care continuum. After scheduling sessions, remote patients can send selfie photographs as well as a photo of their ID card. RightPatient examines the photographs for a match, then searches to see if there are any existing records, and either produces new credentials for new patients or sends the proper EHR to the hospital for existing patients.

RightPatient not only makes accurate patient identification simple, but it’s also safe, secure, clean, and seamless. Healthcare providers may smoothly link RightPatient with their EHR systems, making the latter part of the EHR workflow.

Using RightPatient, some prominent healthcare providers reduce patient misidentification, eliminate duplicate medical records, minimize denied claims, and enhance patient safety and quality.

Common Reasons for Patient Identification Errors in Hospitals and How to Solve Them

April 20, 2022/4513 views / 1 Comment/in BLOG, Data Integrity, Denied Claims, EHR, healthcare, Patient Data, Patient Identification, Patient Safety /by Matt Gibson

Positive patient identification is an important but underappreciated component of the US healthcare system. Healthcare providers maintain patient safety, appropriate medical treatment, and good healthcare results by precisely identifying patients and using their relevant electronic health information. For instance, the physicians know of the patient’s comprehensive medical history, the revenue cycle team knows which claims to submit to the insurer, and the hospital records the patient’s information in the appropriate EHR. Unfortunately, this isn’t always the case; patient identification errors in hospitals are all too common and can generate a slew of issues for healthcare providers, patients, and insurance companies.

Patient identification errors in hospitals generate a variety of issues, including:

Patient safety issues
Patient data integrity failure
Patient mix-ups
Medical record errors like duplicates and overlays
Denied claims
Detrimental patient experience
Medication administration errors
Financial and legal issues

While those are some of the issues created by patient misidentification, let’s look at some of the common reasons why they happen in the first place, as well as how a touchless biometric patient identification platform like RightPatient ensures positive patient identification.

Common reasons for patient identification errors in hospitals

Patient misidentification during registration

In hospitals, patient misidentification is most common during registration. Patients are wrongly identified and linked to the incorrect EHRs from the start during the registration procedure. As a result, the patient will receive ineffective care because the physicians will be relying on someone else’s medical history.

The patient’s EHR is difficult to find

The registration areas are arguably high-pressure situations, as patients are constantly arriving, and a limited number of workers are required to process them for treatment. However, when the registrar examines the EHR system, they may discover that no medical records match the patient. At times, registrars may detect that too many EHRs correspond to the patient. In these instances, registrars must select an EHR, and the chances are that they will select the erroneous one, resulting in improper patient identification.

Reducing patient waiting times

As previously said, any given healthcare provider’s registration area is quite hectic. Patients are begging for treatment, and registrars are under intense pressure to shorten patient wait times. Because there is no standardized precise patient identifier in place, searching for the relevant medical records can take a long time. Because the EHR system contains tens of thousands of medical records, the registrar may wind up picking the incorrect medical record.

Existing duplicate medical records

This may appear perplexing, but patient identification errors in hospitals and medical record errors are inextricably linked; the other will follow naturally if one occurs.

Patient identification, for example, occurs when an incorrect medical record is picked. When the registrar searches the EHR system and finds no EHRs with the patient’s name, they create a new medical record. However, due to a lack of definite patient identification, the patient’s genuine medical record could not be identified, resulting in a new duplicate medical record.

Similarly, duplicate medical records within the EHR system are bound to induce patient misidentification because all of the records are inconsistent and fragmented, resulting in patient safety issues, incorrect treatment, and worse.

Human errors

Human error is another prominent cause of patient misidentification in hospitals. While registrars, nurses, and other healthcare workers already work in a high-stress environment, a single typing error can force them to select the wrong EHR.

Patients themselves submit false, wrong, or incomplete

Patient misidentification in hospitals happens when patients offer insufficient or incorrect information to medical employees. For example, a patient’s medical record is maintained with the name “William Smith,” yet he gives the registrar the name “Bill Smith.” The registrar will search for his medical record using the keyword “Bill Smith,” which will not yield the genuine EHR.

On the other hand, patients falsify information to obtain treatment in the name of someone else. It’s nearly impossible to identify the falsehood because healthcare providers don’t employ a reliable patient identification system throughout the states.

RightPatient can prevent all of the above and more.

RightPatient prevents patient identification errors in hospitals

RightPatient is a touchless biometric patient identification platform that accurately identifies patients across the treatment continuum. During the registration process, the platform captures patients’ photographs and ties them to the proper EHRs, effectively locking the medical records. When the patients return, the platform must authenticate their identities – the patients only need to glance at the camera – it’s that simple!

RightPatient enhances patient safety, minimizes denied claims, strengthens patient data integrity, and ensures that the proper patient is receiving the right treatment at all times.

How Patient Safety and Quality in Healthcare Can be Improved With Positive Patient ID

February 14, 2022/4285 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Infection Control, Medical Record Mix-ups, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

While COVID-19 has been arguably the most talked-about issue over the past few years, it’s not the only problem that healthcare providers face. Even now, a plethora of problems continues to plague the US healthcare system. Duplicate medical records, overlays, medical identity theft, lack of proper patient identification, labor shortages, massive financial losses, and infection control issues are just some of them. While not all of these factors are solvable by the hospitals themselves, ensuring positive patient identification can help reduce many significant problems. With that being said, today, we’ll be considering how effective patient identification can improve patient safety and quality.

Five ways that patient identification improves patient safety and quality

It ensures patient data integrity

One significant issue that healthcare providers face in the US is the lack of data integrity in medical records or EHRs, which can often be traced back to patient misidentification. It’s pretty simple: if a patient has more than one EHR, their medical history, allergies, medications, vitals, etc., will be spread across several different medical records.

There are thousands of fragmented EHRs like these. As such, the patient will receive treatments based on a highly fragmented EHR; it doesn’t provide the complete collection of patient information. As a result, treatments may be inaccurate or less effective. However, there’s an even more severe scenario. In cases where there’s a lack of accurate patient identification, hospitals could use one of these EHRs to treat the wrong patient!

The presence of positive patient identification, on the other hand, ensures patient data integrity at all times since patients are treated using accurate EHRs whenever they come in. This remains true both for virtual and inpatient visits.

It ensures positive patient outcomes

Positive patient identification ensures that accurate EHRs are associated with the correct patients across the care continuum. Doing so helps the patients receive the best possible treatment plans and care without inaccuracies, helping them recover without any unwanted incidents, thereby enhancing patient safety and quality in the process.

Patients can receive the wrong treatment without accurate patient identification since they’re associated with incorrect medical records, which can lead to dangerous and adverse incidents.

It reduces medical record errors

One of the biggest problems caused by patient misidentification is that it leads to medical record errors, such as duplicates and overlays. Naturally, these can be detrimental to patient outcomes. Imagine a scenario whereby a patient has multiple EHR documents; if just one of those records is used to treat them, the treatment plan would be based on incomplete information, hence leading to ineffective treatment. On the other hand, overlays are even more dangerous; these are merged EHRs, but they often belong to different patients! Whichever patient gets treated using such an inaccurate EHR record could naturally face detrimental and wrong treatments down the line unless it’s detected and resolved quickly.

Fortunately, accurate patient identification prevents medical record errors right off the bat. Ensuring that accurate EHRs are used every time that patients come in for an appointment helps avoid the creation of duplicates and overlays, thereby saving considerable costs for the hospital and improving patient safety and quality of care overall.

It avoids mixups

Patient mix-ups can be hazardous and can even lead to the wrong patient getting the treatment or surgery intended for another. It might sound like a basic mistake that would never happen, but in reality, such an event has happened numerous times where the wrong patient received kidney transplant surgery.

One of the most common reasons for this is because patients had similar names and characteristics on their EHRs, which can easily lead to mixups, especially in high-pressure environments. In other cases, the wrong patient may have received chemotherapy that was assigned to a different patient for lifesaving treatment. Meanwhile, patients receiving the wrong medication and so on are potentially common risks due to mixups and mistakes.

Most of these mixups can be traced back to – you guessed it – patient misidentification. As such, ensuring positive patient identification is one of the most effective ways for hospitals to prevent these mixups and avoid jeopardizing patient safety overall.

It boosts infection control efforts

It might seem a little unclear as to how accurate patient identification can help boost infection control issues? Well, integrating a touchless patient identification platform such RightPatient helps with that. RightPatient doesn’t just ensure that the patients are identified correctly across the care continuum, but it also ensures that this care is provided hygienically.

Patients only need to look at the camera for registration; the platform captures a photo and attaches it to their EHRs, essentially locking them. Whenever patients come in for subsequent visits, all they need to do is look at the camera, and the platform automatically matches the current photo with the saved one.

RightPatient is already helping several healthcare providers ensure accurate patient identification, improve patient safety, and bolster infection control efforts effectively. As such, it could be a valuable tool to implement for your own healthcare facility’s management systems, too; why not give it a try?

Patient Safety Improvement in Hospitals with 5 Strategies

November 11, 2021/5230 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Medical Record Mix-ups, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

Patient safety is one of the key components that is crucial for preventing patient harm, ensuring proper healthcare outcomes, and reducing redundant costs for healthcare providers. Without it, adverse events lead to patients receiving the wrong care, and according to WHO, one in ten patients is harmed while receiving healthcare services. Fortunately, half of these adverse events are preventable – let’s take a look at some patient safety improvement strategies that can help with that.

5 strategies for patient safety improvement

Nurture a patient safety-focused culture

One of the best patient safety improvement strategies is to foster a culture that focuses heavily on improving patient care. All employees, from the janitors to the decision-makers, must be a part of the culture and focus on patient safety and quality healthcare more than anything else. In fact, healthcare providers that aren’t fostering such patient-centered cultures are struggling with adverse events, medication errors, and worse. For instance, physicians must focus on patients themselves rather than their medical records and involve them in the decision-making process. This way, they can get better insights into the patient’s ailments to help them identify the problems in a more reliable manner.

Identify and work on mistakes

Rather than only acknowledging the mistakes that lead to patient safety incidents, working towards preventing future incidents is a much more sensible strategy. What’s even better is identifying the issues before they happen and preventing them. For instance, there are different solutions available that can help identify potential issues and address them effectively. In the case of mistakes that already took place, identifying why they occurred and coming up with strategies that can prevent future occurrences is the tried and tested solution.

Reduce chances for human error

While technology is evolving rapidly, most healthcare providers, unfortunately, are still stuck with ancient processes and manual methods. This leaves room for human error, something that can jeopardize patient safety in hospitals significantly. For instance, if paper is used for recording medicine administration, handwriting or common names can lead to mix-ups, leading to an adverse impact on healthcare outcomes. On the other hand, if digital solutions are used, then not only will it speed up the process, but it will also make it more reliable and safe (especially if patient photos are used for identification). This is just a simple example, but reducing chances for human error ensures patient safety improvement across the care continuum.

Ensure a clean environment and enforce hygiene rules

While many might have forgotten that we’re still going through a pandemic, hospitals and health systems must ensure that they are providing a safe environment for everyone involved. Not only must hospitals ensure that they keep their facilities clean, but they also need to ensure that everyone in the facilities is complying with safety rules such as wearing masks and maintaining distance. All of this leads towards reducing HAIs (hospital-acquired infections), improving patient safety in the process.

Ensure accurate patient identification

One of the topmost patient safety goals for many years has been improving the accuracy of patient identification, and according to the Joint Commission, it will once again be the number 1 goal for 2022. This just shows how important accurate patent identification is for patient safety improvement.

The problem is that patient misidentification leads to a number of issues – duplicate medical records, patient record mix-ups, wrong treatment, and even medical identity theft. All of these lead to adverse healthcare outcomes, hospital readmissions, and even deaths.

Fortunately, accurate patient identification IS possible – hospitals that have been using RightPatient are protecting millions of patient records and improving patient safety.

RightPatient is a touchless biometric patient identification platform that essentially locks medical records during the registration process with patient photos. Registered patients only need to look at the camera when they revisit hospitals – RightPatient compares the photos and provides the accurate medical records for use, preventing duplicates, overlays, and medical errors. Moreover, it also helps prevent HAIs as it’s entirely touchless – improving patient safety on two fronts.

How are YOU improving patient safety at your hospital(s)?

RightPatient Partners with Harris Healthcare to Secure and Maintain EMPI Data Integrity

November 8, 2021/4893 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, HIM, Partnerships, Patient Data, Patient Identification /by Michael Trader

Very recently, RightPatient and Harris Healthcare’s DIS (Data Integrity Solutions) Business Unit have announced a strategic partnership to tackle patient data integrity issues by ensuring accurate patient identification.

Harris DIS includes QuadraMed, which focuses on EMPI management and data cleanups, and Just Associates, focused on helping hospitals and health systems achieve and maintain a highly accurate and quality MPI. QuadraMed provides end-to-end patient identity management to prevent duplicate medical records and dirty patient data to improve patient data integrity. From data analysis to cleanups, Just Associates performs the critical tasks necessary for a pristine MPI. Its state-of-the-art suite of identity management solutions and services includes continuous duplicate detection (IDSentry™), ongoing MPI management (IDManage™), and customized MPI clean-up services (IDResolve™).

By using the RightPatient Integrity Platform with Harris DIS’ existing solutions, patient identity management will be much more secure, accurate, and efficient. The collaboration provides important protections against front-end contamination of the MPI and EMPI and helps eliminate patient misidentification and safety issues created by “dirty” patient identification data.

The problem of patient misidentification and dirty patient data

Several factors cause front-end contamination and dirty patient data within an MPI or EMPI, such as frequent flyers, medical identity theft, and duplicate medical records. There may even be duplicate records that have very limited or contrasting information.

RightPatient Integrity Platform incorporates patient photos into the Quadramed SmartID platform, helping identify and resolve these challenging duplicate records that were created from cases of alias or stolen identities. This helps reduce new duplicate and overlaid medical records right from the start, while Just Associates focuses on creating and maintaining a pristine MPI/EMPI environment and supporting rapid and accurate patient identification.

RightPatient advances Harris DIS’ ability to address key health information issues by reducing the volume of potential duplicate medical records, preventing patient misidentification, enhancing patient safety, and ensuring patient data integrity across the care continuum. Doing so is more important than ever as remote patient registrations have increased due to COVID-19.

RightPatient and Harris DIS’ partnership aims to improve the overall efficacy of medical data clean-ups and ongoing data integrity efforts with RightPatient’s robust de-duplication engine. It secures patient information and minimizes the ongoing cost of maintaining quality patient data.

How RightPatient and Harris DIS improve patient identity management

Typically, an EMPI contains patient information from a health system’s several facilities such as labs, hospitals, physician practices, and pharmacies. Front-end contamination is common if positive patient identification isn’t ensured during the registration process. This later leads to dirty patient data, duplicates, overlays, patient safety incidents, write-offs, and more.

RightPatient and Harris DIS can address and solve patient misidentification right off the bat using patient photos.

During the registration process, hospitals collect the patient information along with their photos. The MPI data is then sent to QuadraMed for analysis and cleaning, after which RightPatient Integrity Platform receives a copy of the patient photos along with the corresponding MRNs (medical record numbers). Using RightPatient’s powerful photo-matching engine, the patient photos are deduplicated to bolster overall system analytics.

RightPatient Integrity Platform with Harris DIS can be used for:

Existing EMPI data cleanup projects
Identifying duplicates during the registration process
Hospitals that are starting to capture patient photos

The impact of effective patient identity management

RightPatient’s leading touchless patient identification platform is being utilized by numerous healthcare providers to identify their patients safely, reliably, and effectively.

During the registration process at hospitals and healthcare facilities, patients just look at the camera and the platform takes a photo and attaches it to the medical record. During remote registrations, patients receive an SMS after which they provide a selfie and a photo of their driver’s license. The platform then searches for a match between the two photos and assigns biometric credentials to new patients.

The same expertise comes with the RightPatient Integrity Platform which can be seamlessly integrated with any EHR, including QuadraMed’s SmartID Platform. This enables healthcare providers to:

Prevent duplicate and overlaid medical records during registration
Ensure remote patient photo capture and authentication
Bolster de-duplication and EMPI data cleanup efforts
Ensure clean patient data across the care continuum
Improve patient safety and prevent medical errors
Reduce write-offs and denied claims
Prevent cases of identity theft and “frequent flyers”

Patient Verification Helps Hospitals Deal with Decreasing Revenue as COVID-19 Cases Rise

August 31, 2021/7559 views / 0 Comments/in BLOG, COVID-19, Data Integrity, Duplicate Medical Records, EHR, healthcare, Medical Record Mix-ups, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

Hospitals and health systems are constantly being challenged by the pandemic. Sure, COVID-19 has affected virtually every business – many organizations have declared bankruptcy while others have shuttered their doors. However, most, if not all of these organizations, had their employees work from home. Healthcare providers, on the other hand, had to face unprecedented challenges head-on, such as frontline healthcare teams risking their lives, losing billions of dollars, patient verification issues, data breaches, and more.

Unfortunately, it looks like the battle with COVID-19 is far from over for healthcare providers. With the Delta variant once again wreaking havoc, caregivers are experiencing razor-thin margins. That being said, accurate patient verification CAN prevent many issues, helping hospitals survive this challenging period. Let’s take a look at a few stats that show how concerning the new variant is and how positive patient identification can help caregivers.

Some recent statistics that show a rise in margins and expenses

While things were definitely getting better with millions being vaccinated across the U.S. and businesses slowly opening up, the Delta variant of COVID-19 has struck back with full force. While healthcare providers have been facing lower losses and improved margins when compared to the first half of 2020, a new report sheds light on many facts. While many indicators show that things are going in the right direction, some show that the effects of COVID-19 are far from over.

The “median operating margin index” in June was 2.8%, excluding funding from the CARES (Coronavirus Aid, Relied, and Economic Security) Act. When taking funding into account, it was 4.3%.

What do these numbers mean for hospitals and health systems? Well, it’s an increase of almost 90% (excluding CARES Act Funding) or 48.7% (including the funding) when compared to the first half of 2020. All of these numbers are based on 900 hospitals that have participated monthly for the last three years.

When it comes to patient volumes, it’s a mixed bag. Patient volumes were higher when compared to 2020, but lower than they were before the pandemic. For those who want specifics, discharges between January and June of 2021 were 10.1% higher than in the first half of 2020, but when compared to the first half of 2019, patient volumes are down 4.4%. A similar trend can be seen for ER visits in hospitals, i.e. higher than in the first half of 2020 but lower than in the first half of 2019.

Fortunately, the revenue of hospitals and health systems has increased compared to both 2020 and 2019! According to the same report mentioned above, this is because of outpatient visits. “Gross operating revenue,” excluding CARES Act funding for January to June of this year, was 18.2% higher than the same period of 2020 and 7.9% higher than the same period of 2019.

But all of these statistics look good for hospitals, right?

Well, while all of these do look good, expenses have also increased – affecting margins significantly. The first half of 2021 saw an 8.5% rise in expenses when compared to the first half of last year, and an increase of almost 10% when compared to the first half of 2019.

While margins are increasing, expenses are increasing as well

Unfortunately, the COVID-19 pandemic is far from over – the Delta variant has reached the U.S. and has been in the news for the past few weeks. While healthcare providers have opened their doors to regular patients, COVID-19 cases are spiking once again, and this might be detrimental to hospital margins according to an official associated with the study mentioned above.

Hospitals need to identify ways to reduce losses, improve patient safety, and avoid unwanted incidents that hurt the bottom line. But how can patient verification help?

How patient verification helps improve hospital margins

Accurate patient identification has been a topic of discussion for several years now, and identification errors have also given rise to a number of studies.

Accurate patient identification helps

Prevent medical record errors such as duplicate medical records and overlays
Prevent medical identity theft in real-time
Protect patient data integrity
Reduce denied claims by ensuring accurate, consistent information within medical records
Prevent medical errors that might lead to patient safety incidents
Avoid dangerous patient mix-ups, including transplant mix-ups
Ensure CMS compliance by sending out proper e-notifications to appropriate caregivers
Improve patient outcomes
Reduce hospital readmissions

All of the above, when considered together, can drastically reduce losses and improve a hospital’s margin. We know this because our leading patient identification platform has been helping several healthcare providers for years.

Patient verification made easy with RightPatient

A number of healthcare providers have chosen RightPatient to manage their patients’ medical records. In a post-pandemic world, RightPatient’s touchless patient ID platform makes the most sense, as it keeps everyone safe by preventing physical contact (when compared to other methods of identification).

RightPatient reduces denied claims, improves patient safety, prevents duplicates and overlays, and prevents patient identity theft – boosting the bottom line of hospitals.

How are YOU planning to reduce losses and improve margins at your healthcare facility?

Denied Medical Claims Are Costly but Preventable with Patient Identification

August 23, 2021/6821 views / 0 Comments/in BLOG, Data Integrity, Denied Claims, Duplicate Medical Records, EHR, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

The U.S. healthcare system is no stranger to problems, unfortunately. In fact, it has been plagued by a plethora of issues for several years. While some of the problems are definitely solvable, external issues alongside other factors cause the problems to continue. Some of the many problems are astronomical prices, the lack of price transparency, interoperability issues, the abundance of data breaches, medical identity theft, and patient safety issues. While we have covered some of these topics at one point or the other, let’s take a look at another crucial problem, denied medical claims, how they are problematic for everyone, and how positive patient identification can prevent them.

Denied medical claims are costly and cumbersome for everyone involved

Denied claims are not a recent problem within U.S. healthcare – most hospitals and health systems are quite familiar with them. One can safely say that denied medical claims are quite expensive – an average hospital can lose around $3.5 million due to them. However, denied claims not only affect hospitals but also insurers and patients, albeit in different ways – let’s see how.

Claim denials in a nutshell

In the U.S., healthcare is closely related to reimbursements from Medicare, Medicaid, and commercial insurers. Patients get health insurance, go to their healthcare provider, get treated, and that’s about it. However, a lot more goes on behind the scenes regarding healthcare reimbursements.

After providing healthcare services to the patients, the hospital processes the information and sends the claims to the insurance company. While healthcare providers usually get reimbursed by the payer, some of them face expensive hiccups. Due to billing or coding issues, patient identification errors, medical record mix-ups, or other problems, the payer identifies inconsistencies after receiving claims, and they might reject or deny said claims. While some claims can be resubmitted, checking for and fixing the errors is time-consuming, costly, and requires a considerable number of resources.

All of the above leads to back-and-forth exchanges between care providers and payers. Insurers have to reject claims, caregivers lose out on a significant amount of revenue, and many patients even receive shocking, incorrect bills. However, some even lose healthcare services, especially those associated with Medicaid.

Let’s take a look at a few statistics to see how Medicaid patients suffer due to denied medical claims. However, do keep in mind that denied claims can be detrimental for any patient.

A worrying study regarding denied claims

A very recent study has shed light on denied claims and how physicians or hospitals are reluctant to see Medicaid patients due to reimbursement issues.

According to the study, at least 25% of Medicaid claims have been denied upon initial submission. On the other hand, 7.3% of Medicare claims were denied whereas commercial insurers denied 4.8%.

Moreover, the study also states that around 17% of revenue is lost due to billing problems associated with Medicaid patients, whereas the numbers are quite lower for patients covered by Medicare (5%) and other payers (3%).

While any type of denied claim is extremely costly, the statistics show that the Medicaid ones are quite problematic. Moreover, since Medicaid is associated with low-income families, reimbursements are lower as well.

All of this just leads to caregivers being reluctant to look after Medicaid patients.

Denied medical claims are preventable

One of the topmost priorities of physicians and healthcare providers is to look after the patients, Medicare or otherwise. Instead of worrying about denied claims, hospitals and health systems can work on reducing or eliminating them with the right tools and strategies.

Fortunately, RightPatient, the industry’s leading touchless biometric patient identification platform, can help reduce denied claims substantially.

Denied and rejected claims typically occur because of billing and coding errors – most of which can be traced back to medical record errors, patient mix-ups, and identification issues. RightPatient eliminates all of that, and more, as it ensures that the accurate information is fed to the correct EHR at all times. As a result, billing and coding errors are drastically reduced and so are denied claims – boosting the bottom line.

How are YOU reducing denied claims in your healthcare facility?

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

July 25, 2021/7255 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.

Preventing Medical Record Errors Improves Patient Safety

June 28, 2021/7326 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, EHR, healthcare, Patient Data, Patient Identification, Patient Safety /by Matt Gibson

Healthcare providers in the U.S. never seem to catch a break – they’ve always faced a plethora of issues even before the pandemic. For a brief refresher, the U.S. healthcare system suffers from outrageous costs, the lack of price transparency, ancient laws that hamper healthcare outcomes, the lack of proper interoperability, medical record errors, preventable medical errors, patient safety incidents, and more.

While all of that seems like a bit too much, there are actually far more issues that regularly challenge health systems and hospitals and hold them back from providing positive patient outcomes. One such crucial but overlooked issue that hampers healthcare outcomes is medical record errors. Let’s explore how they are created, what are the consequences, and how proper patient identification can enhance the quality and safety in healthcare facilities.

Medical record errors jeopardize healthcare outcomes in several ways

Patient safety incidents, detrimental healthcare outcomes, denied claims, patient mix-ups, and other adverse effects can be traced back to errors with medical records – the most common ones are duplicates and overlays. In fact, whenever an EHR error occurs, it typically goes undetected until an unfortunate event occurs such as the ones listed above. However, if one goes even further back, patient identification errors are likely to be the main culprit – let’s see how that happens.

Patient misidentification leads to most medical record errors

One of the most common causes that lead to medical record discrepancies is patient misidentification, and that’s because most healthcare providers are using obsolete means to identify their patients – more on that later. Let’s take a look at how duplicates and overlays are created within EHR systems.

Duplicate record creation

It’s quite straightforward – let’s start from the beginning. A patient comes into the hospital for a checkup, and since most hospitals suffer from patient identification problems, the EHR user is left with a difficult choice if they can’t find the accurate medical record. This happens because:

The patient has a common name
There are multiple patient records with the same characteristics
Searching for the right medical record is virtually impossible

Now, the choices the EHR user has are either diving deep and painstakingly finding the accurate medical record, assigning the medical record that seems to be the “closest match”, or, just to be safe, creating an entirely new medical record. However, the latter can be catastrophic for both the patient and the hospital. Saving a discussion about the consequences for a later part, let’s see how overlays are far more damaging.

Overlays are extremely dangerous

Duplicate records are created when a patient has multiple medical records. Overlays, however, are single medical records that contain information about multiple patients – clearly, these medical record errors can be very dangerous.

Let’s continue from the previous example – the EHR user selected a medical record that best matched the patient (X), but it actually belongs to a different patient (Y). When patient X has their medical checkup, their health information is recorded into patient Y’s medical record, rendering it corrupt, unusable, and dangerous. Next time, when either patient returns for medical treatment, they’ll be facing detrimental healthcare outcomes because the data in their medical record is unreliable.

Moreover, with the growing adoption of EHR systems, these issues are becoming far more common. In fact, according to AHIMA, smaller hospitals have around 5-10% of these duplicate medical records whereas larger health systems can have a whopping 20%. These errors can cause around $40 million in unnecessary costs in clean-ups, litigation costs, and others.

Unfortunately, the biggest issue with these duplicates and overlays is that, as previously mentioned, they remain undetected until an adverse event occurs. The best way to resolve medical record errors is by preventing them right from the start – accurate patient identification can help with that.

RightPatient prevents duplicates and overlays

RightPatient has been helping responsible healthcare providers accurately identify patients at any touchpoint with its robust biometric patient identification platform. It can be seamlessly integrated with any EHR system and it becomes a part of the EHR workflow.

Patients only need to look at the camera – the platform automatically locates the accurate medical record for the EHR user, making it a seamless, safe, and hygienic experience for everyone involved. It has been helping reputed caregivers like Grady health, TGMC, and Community Medical Centers prevent duplicate record creation, ensure patient safety, and boost the bottom line.

4 Innovative Ideas that can Bolster Transformation in Healthcare

June 15, 2021/6912 views / 0 Comments/in BLOG, Data Integrity, healthcare, Patient Data, Patient Identification, Patient Outcomes, Patient Safety, Telehealth /by Matt Gibson

It’s quite safe to say that healthcare has undergone radical changes since the pandemic struck with full force. While COVID-19 has had unprecedented effects on everyone and everything, it affected hospitals drastically and forced them to come up with alternatives that have led to transformation in healthcare, for instance, telehealth. While the pandemic is hopefully behind us as we return to the “old normal”, let’s take a look at some ideas that healthcare executives believe will transform healthcare and some technologies that already exist such as contactless patient identity verification solutions.

4 ideas that bolster transformation in healthcare

Patient engagement and patient monitoring going full digital

While we have been hearing about remote patient monitoring and digital patient engagement for quite some time now, the CIO at Cherokee Nation Health Services believes that adopting said solutions into healthcare will vastly improve healthcare outcomes as patients will be more engaged regarding their health and wellness by putting the power in their hands. Not only do such solutions improve patient outcomes but they also allow both caregivers and patients to engage with each other in a more proactive manner beyond the healthcare facilities’ walls by means of text messaging, digital platforms, and chatbots, leading to a digital door, per se.

Introducing meaningful technology in relevant department(s)

The future of healthcare is digital, there is no doubt about that. Healthcare providers that are still using ancient methods and obsolete technology are beginning to feel the heat as the disadvantages keep on piling up. However, innovative hospitals and health systems are going the other way – they are overhauling their processes by implementing technology in almost all of their departments. For instance, while many are using RCM solutions, others are introducing technology in their HR department, inpatient services, nursing department, and so on. While it might not directly generate transformation in healthcare, implementing useful and relevant technology in various departments can bring in better talent, optimize operations, and improve healthcare outcomes – boosting the bottom line.

Making telehealth a permanent part of the facility

While telehealth has been around for a long time and has not seen success until recently (in response to COVID-19), many caregivers are still quite wary about it. However, even the most skeptical ones cannot deny that it has introduced significant transformation in healthcare. For instance, patients can communicate with their caregivers from the safety and comfort of their houses and reduce significant risks and expenses, among other things. Caregivers can also divert non-critical patients towards virtual visits, reducing the pressure on physical locations and staff and keeping the physical patient volume low, something that is a must to keep COVID-19 at bay.

While telehealth can never replace conventional healthcare or in-person visits, it has definitely become an extremely useful tool of healthcare itself, something that caregivers must utilize to its full extent. It can save costs, improve patient satisfaction, enhance outcomes, and keep COVID-19 at bay – creating a win-win situation for everyone involved.

Implement contactless technologies can truly introduce transformation in healthcare

Speaking of COVID-19, it has spread the fear of getting infected via physical contact to virtually everyone. This is quite surprising, as healthcare providers have always had this fear of hospital-acquired infections (HAIs). Hospitals that take patient safety seriously have always focused on infection control, and these are the ones that are always looking for contactless solutions.

While COVID-19 has pushed infection control into overdrive, many recent innovations in this area include touchless IoT-based systems, patient check-ins, payments, and so on. However, did you know that touchless solutions were already being used in several hospitals across the U.S.?

That’s right – RightPatient is a touchless biometric patient identification system that responsible and innovative healthcare providers have been using for many years. Since it attaches patients’ photos to their medical records, patients only need to look at the camera to validate their identities. It can also be used at any touchpoint across the care continuum – making it ideal for telehealth. RightPatient has been ensuring patient safety, hygiene, reducing denied claims, preventing medical identity theft, and much more via accurate patient identification.

Are you one of the providers who’s looking to introduce transformation in healthcare to your facility?