Now, as we all know, the deadline for enforcement of the Red Flag Rules is looming … May 1st. Providers are struggling to implement red flag compliance policies. It’s another big PROVIDER compliance panic.
We know that the provider community, specifically the AMA is pushing to have the rules declared inapplicable to physicians. And we all also know that the red flag rules are the wrong tool to fix the real problem.
The real problem?
Medical identity misuse … not
medical identity theft.
If I’m uninsured and having a serious medical issue, I’m probably not going to go out and steal someone’s purse for their Insurance ID. My sister is going to lend me hers so I can get the care I need. It’s often not an act of theft… it’s an act of love. (I hope my sister is reading this.)
The Red Flag Rules are intended to prevent identity theft. Any impact on medical
identity misuse is a side effect.
What does identity misuse (and theft) cost insurers? Many of them probably don’t know. When I have spoken with folks I know at health insurance companies, this issue seems to be flying completely under the radar. As one in-house attorney for a large insurer and former fraud investigator told me, “Geez, I never thought of that. I have no idea how much it costs us. I don’t know of anything we’re doing on that issue.”
I am told that Ingenix has developed an alogrithm to help payors identity likely identity misuse on the back end … after the claim has been paid. So, once payors learn that identity misuse may have occurred, they have to verify it, possibly triggering an appeal, reverse the claim, recoup the money from the provider and then the provider is stuck.
Disclaimer: I
represent a company that offers a really interesting identity misuse compliance
tool.
Question: Why don’t payors help physicians to comply on the front end? Why don’t they provide compliance tools, sample scripts, training and rewards for providers who are good at implementing identity misuse prevention programs? Why don’t payors and providers work together on this one? They both have a vested interest in working together to wipe out this activity.
What if you (insurers) included in your eligibility verification system some demographic information
about the insured that the front office / admitting staff could use to help
authenticate the ID?
What if you provided training and scripts to provider admitting and front office staff?
What if you offered
an incentive to physician’s offices whose staff took the training or
demonstrated that they did it well?
I’ve been scanning some of your Provider Manuals and don’t see you mentioning this issue…
What if you marketed this new tool to self insured groups as a feature of your
services as a TPA?
Hmmm… What am I missing? Who’s working on this and what are you doing?
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