Inpatient Facility Coding & Compliance Alert

Safeguard your facility from medical identity theft with these 8 tips.

How safe is your medical identity? The thieves of this new age have now their eyes set on your TINs (Tax Identification Numbers) and billing numbers, beware! Save yourself from becoming victims of this growing trend with a little word of caution from CMS.

8 Ways to an Unbeatable Firewall

“All providers are at risk for medical identity theft,” says CMS. “Criminals use various approaches to bill fraudulent claims with stolen medical identities.” To make sure you aren’t next in line for medical thieves, follow these eight steps that will help keep your information safeguarded.

1. IRS Notices Reveal More Than You Think: If your identity is stolen, that income is reported to the IRS. Therefore, pay attention to any notifications that the IRS sends—they could alert you to fraudulent activity that’s taking place with your Medicare number. This can happen to doctors, nurses, NPs, PAs, and other medical professionals.

2. Keep Track of Prescription Pads: Medicaid regulations began requiring tamper-resistant prescription pads on April 1, 2008. Says CMS, “All written prescriptions must include security features like a watermark or thermal ink that shows any attempt to alter a prescription.” Always take every precaution by locking up prescription pads when not in use.

3. Activate Computer Log-ons: To keep the information on the computer safe, each staff member should have a unique log-on code, which should be removed as soon as the employee leaves the facility.

4. Actively Manage Enrollment Information With Your Payers: Physicians can actively manage enrollment information with payers by updating them about material enrollment changes, especially when opening, closing or moving practice locations, or when separating from an organization. This way, if a payer receives unusual claims or reimbursement requests they can contact you.

5. Monitor Billing and Compliance Processes: Be aware of billings in your name and pay close attention to the organizations and mid-level providers to whom you have assigned privileges. What’s more, compare remittance notices with medical record documentation and ensure that mid-level practitioners’ documentation supports billed services. Read all items before signing them, keep copies, and document conversations about billing issues. Whether a staff member or a third party biller provides the organization’s claims processing services, the physician of record is legally responsible for the claims submitted.

6. Pay Attention to Patient Complaints: Listen when a patient tells you he started receiving medical items that he never ordered. It’s possible that someone is ordering the items in the patient’s name or maybe even with your provider number to collect reimbursement they don’t deserve.

7. Avoid Sharing When Possible: Every time you give your TINs and NPIs to various clinics, hospitals, doctors and mid-level providers, you put yourself at a potential risk. Try to avoid sharing to the extent possible.

8. Report Potential Issues to the Police: Any type of theft—including medical—should actually be reported to the police department.

These small measures will go a long way in protecting your hard earned prestige and revenues from falling into the wrong hands.

For more information, read https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Med-ID-Theft-Booklet-ICN908264.pdf