Patient Identification in Healthcare Must be Accurate for CMS Compliance

Patient identification in healthcare, especially in the US, has always been problematic. Just look up patient identification errors on the web - you will be bombarded with numerous articles about how they plague the US healthcare system, why they still exist, and why they are so prevalent. Talks happen every year regarding the unique patient identifier (UPI), which might effectively solve the issues once and for all, but it has been around two decades since healthcare organizations have been clamoring for a UPI. However, ensuring patient identification is more crucial than ever for CMS compliance - but how are they related? Let’s look at why patient misidentification is so prevalent, what are its consequences, why CMS compliance requires proper patient identification, and how providers are identifying their patients.

Patient identification in healthcare over the years

Patient identification has never been the US healthcare system’s strong suit. It has been one of its overlooked but serious problems. Even this year, it has secured a position in the top ten patient safety concerns, as per the ECRI Institute. But given the technology we have available today, shouldn’t patient identification in healthcare be accurate and effective?

Well, as previously mentioned, a state-funded UPI was supposed to be made around two decades ago. Unfortunately, its detractors imposed a ban on its creation, citing privacy and safety concerns. Since then, it has been a long wait for a UPI - coalitions form every year, urging Congress to lift the archaic ban on the identifier. The result - patient identification errors are more common than ever.

Effects of inaccurate patient identification

Patient identification errors cause suffering for everyone involved - healthcare providers, insurance companies, and patients being more prominent victims. But what are the consequences of inaccurate patient identification? Let’s take a look.

Patient safety

Patient safety is severely hampered by patient misidentification. For instance, patient A comes to their healthcare provider. During the registration/identification process, A is misidentified as another patient. The result is that A will now be attached to a wrong medical record and will receive treatment based on that inappropriate medical record. Repeated lab tests, delays in treatment, wrong procedures, and wrong medications are just some of the consequences - all of which will impact health outcomes, and in turn, jeopardize patient safety. This was just an example - there are many more complex patient safety issues that can be tied to patient misidentification.

Patient data integrity failure

Patient data integrity is compromised due to patient identification errors. This is closely tied to the previous example as well. Whenever a patient’s data is mixed up with another patient, the data becomes corrupted - leading to data integrity failure. The effects are the same - wrong or delayed treatments, wrong medications, procedures, and so on, as the data is inaccurate and unreliable - it is not applicable for a single patient anymore.

Duplicate records creation

More duplicate medical records are created as a result of patient misidentification. There are already quite a significant amount of duplicate records in the majority of the healthcare providers’ EHR systems. Whenever a patient walks in, the EHR user is bombarded with a sea of medical records that apply to the patient in question. The EHR users have two options - either find out the accurate medical record painstakingly or else create a new medical record. There is a high chance that both of the options will lead to negative consequences. If the patient already has a record and if the EHR user creates another one, he/she is adding just another duplicate record in the system. On the other hand, if there are multiple records of the same patient, finding out the accurate one will be tedious, time-consuming (there are many records that look similar). This is why patient identification in healthcare needs a dire upgrade. Fortunately, many providers are ensuring accurate patient identification with RightPatient - but more on that later.

Medical identity theft

Medical identity theft cases are prevalent just because healthcare providers are not being able to ensure patient identification. Hackers steal the patient data, sell it on the black market for high prices, which are then bought by the fraudsters. Healthcare in the US itself is expensive, and the fraudsters do not mind paying around $1,000 for stolen patient data. Armed with the information, the fraudsters visit the providers’ facilities, assuming the identities of the victims. Since there is no robust patient identification platform in place to red-flag the fraudsters, they easily get access to the victims’ healthcare services - committing medical identity theft. They have access to expensive drugs, equipment, and medical procedures, and the bills for the services will be sent to the victims. Hospitals might face lawsuits, unwanted attention, and will also face litigation costs due to such cases.

Denied claims and losses

Denied claims, another consequence of patient misidentification, occurs when patients are mixed up, and thus, bills are sent to the wrong patients. When the billed patient looks at the wrong bill, he/she simply contacts the insurance company, and after verification, the healthcare provider is notified that their claim has been denied, hence the term “denied claim”. These are quite undesirable as denied claims are extremely costly and lead to financial losses for any given healthcare provider.

How patient identification and CMS compliance are connected

Healthcare providers have until May 1, 2021, to ensure CMS compliance. There have been some more adjustments to the Medicare Conditions of Participation (CoPs). The “companion final rule”, according to CMS, requires healthcare providers to send out real-time e-notifications for every patient admission, discharge, or transfer (ADT) to other entities such as post-acute providers & suppliers, other practitioners responsible for the patient’s care, established PCPs (primary care physicians), and so on. If not done properly, not only will providers be fined, but their CMS provider agreement will be in jeopardy, leading to losing out reimbursements.

While the establishment of the CoPs is another solid step towards interoperability, healthcare providers are now searching for ways to implement e-notifications. However, it will all be in vain if providers cannot ensure accurate patient identification. Think of it - wrong patient identification leads to wrong notifications being sent to the wrong parties - it will wreak havoc across the providers of the patient! Thus, accurate patient identification in healthcare is crucial, otherwise, the ADT notifications will be ineffective.

What are healthcare providers using for patient identification?

While many healthcare providers are still struggling with patient identification errors, others have chosen to deploy platforms that help boost accurate patient identification. Let’s look at the most common patient identification systems providers are using.

Many are using patient ID wristbands, and while they have far more accuracy than asking patients questions to determine their identities, it still has its own set of issues. It can be transferred, lost, stolen, etc., leading to medical identity theft cases, and it is not hygienic, as it is touch-based.

One of the most accurate patient identity matching platforms is biometric patient identification. These use characteristics which can improve the accuracy of patient identification significantly. However, most of these also raise infection control concerns - fingerprint and palm-vein scanning are both touch-based.

So, is there an appropriate solution that ensures accurate patient identification and is touchless?

RightPatient leads the pack

It is a touchless and photo-based biometric patient identification platform used by leading healthcare providers. By locking patient records with their photos upon registration, it ensures that a patient is accurately identified every time they visit the hospital just by looking at the camera. It prevents medical identity theft as well - fraudsters get red-flagged whenever they stand for patient identity verification.

Providers looking to ensure CMS compliance must also ensure that they are ensuring accurate patient identification - something that RightPatient has years of experience with.