Title: Patient Identity – A Hospital’s Clinical Responsibility (Continued)
Using just one piece of information, in this case a Social Security Number, could identify a patient and reunite him with his family. While I don’t know if the patient ever woke up from his coma, at least his daughter could see him again and not live the rest of her life wondering about his whereabouts.
For those financially minded, the daughter was also aware of her father’s Medicare benefits and provided the needed documentation to recover some of his medical costs from his hospital stay.
The patient and his family benefited much from the hospital’s automated capabilities, which provided an accurate address match from just a single piece of information. Without it, the reunion and subsequent care would not have followed the same path and the man would have passed on alone. Automation improved this patient’s care and future.
Stop Fraud Before Care Starts
Identity theft is increasing, and hospitals need to be smart about the credence they give to documents provided directly by a patient. While most patients are honorable and represent themselves accurately, there are those who try to cheat our healthcare systems.
A third-party solution can be used to quickly and accurately validate the information provided by the patient – their name, address, SS#, Date of Birth (DOB), etc. The following example, the technology would have provided the accurate DOB, showing the patient would be in his 80s, not his 30s as his paperwork claimed. The registrar would have been alerted to the discrepancy and able to address the situation prior to providing any medical services.
A 30-something year old disabled truck driver was admitted to the hospital for elective back surgery to minimize his pain due to chronic back issues. After surgery, he recovered as an in-patient for 2 ½ weeks, running up a hospital bill well over $200K. Since he had provided appropriate documentation, the hospital was able to submit his bill to Medicare and receive payment for his stay.
Nine months later, a phone call came into the billing department. A man in the southern part of the state (approximately 300 miles away) had received a Medicare statement showing they had paid for his back surgery and related hospitalization at our facility. The man had never been to our city, let alone the hospital.
The patient had falsified documents and received elective care using fraudulent means.
The hospital had to reimburse Medicare for the expenses, and never recovered the cost of the surgery or hospital stay. The patient had committed a crime, but the hospital found out too late to minimize any impact and/or stop him from doing it again.
In reviewing the case, the hospital discovered that the man’s Social Security Number hadn’t been validated. If it had, it would have shown that the man going into surgery should have been 89, not 39.
Every patient who enters a hospital through the ER or regular admittance must have their identification validated by a third party system. Hospitals such as the ones in this article have learned hard lessons – ones that should be learned from, not repeated.
Every patient, no matter how urgent their medical need, how complete their paperwork, how incapacitated, should be screened to verify their basic information. It is the hospitals clinical and civic responsibility.
B. Christopher Linder is a Senior Client Executive at SearchAmerica, and has worked in healthcare for over 25 years. Mr. Linder graduated from The Ohio State University and his expertise is in banking finance in the healthcare industry.
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