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Red Flag Rules: What they are? & What you need to do

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Presentation on theme: "Red Flag Rules: What they are? & What you need to do"— Presentation transcript:

1 Red Flag Rules: What they are? & What you need to do
Employee Training for Identity Theft : “RED FLAG RULES” February 2010

2 Identity Theft Training
Introduction Obtaining & Protecting Patient Information Overview of “Red Flag Rules” Procedures for Red Flag Rules Identification Prevention & Mitigation Resolution Questions

3 Obtaining & Protecting Patient Information
What do we ask for? Why do we ask for it? Authenticate, Confirm Medical Record and Billing Purposes What happens if it is inaccurate? Errors cause rework, inefficiency, lost time, revenue Increased exposure, risk for breach

4 Red Flag Rules Section 114 of Fair & Accurate Credit Transaction of 2003 (FACT Act)
Requires financial institutions and creditors to develop, implement and administer an Identity Theft Program Hospital falls into “creditor” as we establish accounts and allow “customers” to defer payment.

5 Minimum Requirements Identify Red Flags Detect Red Flags
Take Action/Respond to Red Flags Provide training to staff Patient Access, Patient Financial Services, Health Information Mgmt, RAD, LAB Update program annually

6 Red Flags Definition – Policies & Procedures
Suspicious patterns or practices or specific activities that indicate the possibility of identity theft Policies & Procedures Organizational Policy Identity Theft Program Patient Access/Registration Policy & Procedure For use by supervisors & managers

7 1- Identifying/Detecting Red Flags
Suspicious Documents Suspicious Identifying Information Notices from other sources Address discrepancy Law enforcement Victim of identity theft

8 Red Flags: Specific Examples
Documents that appear to be altered or forged Photo ID that is inconsistent with appearance of the person Patient providing different social security number than on prior visit Patient giving information that conflicts with info on file Family members/friends calling patient by different name

9 Red Flag Rules 2 – Take Action & Respond
Staff member recognizes activity has occurred or is occurring – notifies Department Manager Department Manager reviews the situation and notifies Health Information Mgmt Director HIM Director reviews and assesses information, consults with other departments if needed Director of HIM will respond as appropriate, under direction of the compliance officer. Notifications to patients, authorities and/or privacy officer as per procedure Issues will be tracked and reviewed for trends and system improvements

10 Identity Theft Training
Objectives of Case Situations and Discussion Detect and Identify suspicious situations Take Action to Prevent or Mitigate the situation Resolution of Issue

11 Identity Theft Training
Conclusions, Questions, Concerns Ask for Driver’s License & Insurance Card Explain if necessary this is for their protection against identity theft Ask, Don’t Recite identifying information What is your address? Not – Do you still live at 6 Main Street? If it doesn’t feel right, stop and ask or get your manager

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