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 IntroductionObtaining & Protecting Patient InformationOverview of “Red Flag Rules”Procedures for Red Flag RulesIdentificationPrevention & MitigationResolutionQuestions
3 Obtaining & Protecting Patient Information What do we ask for?Why do we ask for it?Authenticate, ConfirmMedical Record and Billing PurposesWhat happens if it is inaccurate?Errors cause rework, inefficiency, lost time, revenueIncreased 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 ProgramHospital 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 FlagsProvide training to staffPatient Access, Patient Financial Services, Health Information Mgmt, RAD, LABUpdate program annually
6 Red Flags Definition – Policies & Procedures Suspicious patterns or practices or specific activities that indicate the possibility of identity theftPolicies & ProceduresOrganizational PolicyIdentity Theft ProgramPatient Access/Registration Policy & ProcedureFor use by supervisors & managers
7 1- Identifying/Detecting Red Flags Suspicious DocumentsSuspicious Identifying InformationNotices from other sourcesAddress discrepancyLaw enforcementVictim of identity theft
8 Red Flags: Specific Examples Documents that appear to be altered or forgedPhoto ID that is inconsistent with appearance of the personPatient providing different social security number than on prior visitPatient giving information that conflicts with info on fileFamily 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 ManagerDepartment Manager reviews the situation and notifies Health Information Mgmt DirectorHIM Director reviews and assesses information, consults with other departments if neededDirector of HIM will respond as appropriate, under direction of the compliance officer.Notifications to patients, authorities and/or privacy officer as per procedureIssues will be tracked and reviewed for trends and system improvements
10 Identity Theft Training Objectives of Case Situations and DiscussionDetect and Identify suspicious situationsTake Action to Prevent or Mitigate the situationResolution of Issue
11 Identity Theft Training Conclusions, Questions, ConcernsAsk for Driver’s License & Insurance CardExplain if necessary this is for their protection against identity theftAsk, Don’t Recite identifying informationWhat 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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