Home Health & Hospice Week

In preparing their Red Flags programs, some providers plan to check patients' identification cards to ensure that patients are using their own Medicare or insurance cards. In a Feb. 4 letter to the American Medical Association, the FTC noted that requesting a photo ID at patient visits is "consistent with the objectives of the Red Flags Rule."

Good idea: "It is our recommendation to American Medical Billing Association members to have their providers check a photo ID for each encounter," suggests AMBA's Cyndee Weston.

Why it's important: Recently a Long Island medical office employee was charged with stealing patients' identities from medical files and using the information to go on a spending spree.

The case of the Long Island woman should be a reminder that providers should include employee background checks in their Red Flags program, says Barbara J. Cobuzzi, senior coder and auditor for The Coding Network, and president of CRN Healthcare Solutions.

You may be on the ball and have implemented a Red Flags program at your home care organization already, but do you know what to do if you identify an issue? You should not only determine how you'll identify red flags, but also create steps to deal with any that arise.

For instance: If you decide to check patients' ID cards for visits, your employees should be on the lookout for discrepancies.

"We've identified the following as a red flag regarding patient IDs," Weston says: "A photograph or physical description contained on the identification presented is not consistent with the appearance of the person presenting the ID or there are obvious differences between the age, gender, or ethnicity."

If there is a breach, providers should be asking some vital questions, Weston advises. (See box,p. 102, for questions).

But remember that you don't have to implement a program that's out of proportion to your organization. "FTC is flexible about the design and implementation of a program," NAHC points out. "It should be appropriate to the size and complexity of the entity and the nature of its operations."

Don't be daunted: Some patients may balk at your tighter patient identity protocols, but you should remind them that your goal is to ensure that no one else is using their identity to get medical care.