Avoid 3 Major Healthcare Industry Challenges with Identity Proofing

February 21, 2019

As virtual care and digital patient experiences become commonplace for patient acquisition and retention, the healthcare industry is forced to consider new ways to verify patient identity, and to integrate identity proofing into every touchpoint of the care continuum.

  • Providers need to know a patient’s identity to access their relevant medical and treatment histories, and to ensure consistent and appropriate care.
  • Patients need documentation to prove insurance and other enrollments that support medical expenses.
  • Administrators and Researchers need patient identifiers to generate statistics and data for planning, evaluating, emergency response, improved treatments, and disease management.
  • Health Insurers need to be able to verify a patient’s healthcare coverage and facilitate claims adjudication based on the patient’s history.

Beyond simply knowing with confidence that a patient is who they claim to be, identity proofing is also key to mitigating fraud, which, according to The Institute of Medicine, costs the U.S. healthcare system more than $75 billion annually.

Identity proofing can help diminish, if not eliminate, fraud that results from three major challenges that regularly impact a wide range of clinical and financial operations in the healthcare industry:

  1. Duplicate Records
  2. Medical Identity Theft
  3. Payment Fraud

Duplicate Records
About 5-10% of all stored medical records are duplicates. Duplicate medical records, which occur when a patient is associated with more than one medical record, are a result of patient identification errors. The potential for fraud emerges when a patient’s “partial duplicate record,” that only captures a portion of their medical history, is overwritten with data from another patient’s record, creating a combined, inaccurate record.

Medical Identity Theft
Medical identity theft costs the United States $84 billion annually, forcing organizations to innovate the entire healthcare system and develop customized solutions from check-in and discharge to patient rooms, labs, and data centers. With increased instances of medical identity theft comes escalated misdiagnoses, ineffective treatment plans, and, unsurprisingly, payment fraud.

Payment Fraud
More than $272 billion is lost to healthcare fraud and abuse annually from Medicare and Medicaid alone (not accounting for finances lost from private healthcare fraud.) Payment fraud is a byproduct of medical identity theft wherein either an individual’s identity is misrepresented, or their identity is accurate, but their payment is fraudulent.

Each of the aforementioned challenges can be alleviated, if not bypassed entirely, when healthcare organizations leverage identity proofing. Verifying a patient’s identity upfront can help consolidate the amount of records attached to that individual, reduce medical identity fraud, and can even mitigate payment fraud.

Perhaps secondary to fraud prevention, but nonetheless important to retention efforts, is an organization’s ability to provide patients with digital experiences that are simple and easy to use. The recent shift in customer expectations has prompted healthcare industry companies to implement automated identity proofing technology that is accurate, safe, and requires little back-and-forth.

Healthcare organizations considering new identity verification mechanisms might find success with platforms that offer modern, intuitive account registration and that can quickly verify a patient’s identity to provide them with secure digital access to their medical records, physician messaging, appointment scheduling, lab results, prescription refills, and more.

Evident’s seamless user experience helps healthcare organizations simplify their patient onboarding experiences and decrease fraud, all while limiting exposure to the patient’s personal data, which supports HIPAA and other global privacy regulation compliance.

Click here to learn more about our enterprise Identity Assurance Platform.

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