Biometrics adds security and streamlines system
Embracing technology for solutions — and fine-tuning the revenue cycle so you’ll have the capital needed to pay for it — will be keynotes of the future for access professionals, says Katherine H. Murphy, CHAM, patient access coordinator for Nebo Systems, an Oakbrook Terrace, IL-based company that specializes in online real-time electronic data processing for the health care industry.
"The focus is definitely on the front end, as it always should have been. Its importance has come to light because of the decrease in reimbursement and more complex requirements, but what is needed hasn’t really changed," she explains. "Technology is what will drive this home."
Murphy, who began working for Nebo in October 2004 after about 20 years of experience in patient access and revenue cycle management, says biometrics is a process that should be looked at closely by the health care industry as a whole, and in particular by access leadership. (See Annual Worldwide Biometric Technology table, below, and International Biometric Group charts.)
With identify theft on the increase, concerns about patients misrepresenting themselves, and the possibility that the public is going to put a stop to giving large numbers of individuals access to its protected health information (PHI), she says, biometrics is a field whose time has come.
Important issues include ensuring the right medical record is accessed and protecting the integrity and accessibility of the patient’s identifying method, Murphy notes. (See list.) "Payers have started to abandon the Social Security number as an identifier, but eventually they’re going to run out of numbers," she adds. "Some form of biometric identification will really make people more secure."
A biometric ID system would help the access front line by streamlining check-in, Murphy says. "It’s much easier to ask for a biometric than for an insurance card and driver’s license. People don’t know their medical record number, and they don’t want to carry extra cards with them."
Though fingerprint biometrics still is considered "out there" by most health care organizations, some providers are turning to this high-tech means of combating fraud, she notes.
Catholic Health Systems in Buffalo, NY, and the Advanced Ambulatory Surgical Center in Chicago have patients place a finger on a biometrics scanner during the front-desk registration process, according to a December 2004 article in Network World Fusion (www.nwfusion.com/news/2004). In that process, the fingerprint image is captured electronically and made part of the patient’s permanent record in a database that is accessible over an internal LAN (local-area network). If another individual at a different time attempts to use the same insurance card, the transaction is stopped.
The surgical center’s primary motivation in using the biometrics was preventing the fraudulent use of insurance cards, notes Severko Hrywnak, MD, owner and CEO of the center. Patients have been discovered switching cards with others, he adds, most commonly with family members. "You don’t see [biometric technology] enough," Murphy contends. "It’s seeping in so slowly, and we trip over ourselves trying to get it to work. It’s also being willing to take a risk."
Patient access directors should review their technology and demand solutions that will work effectively, she advises. "Demand that vendors perfect the technology and be willing to use it. Say, This is what we want, but we want you to make it work right. If you invest in it for one [provider], 10 others will buy it.’"
When she was trying out a thumbprint identification system, Murphy adds, "we had to scan six or seven times."
In some cases, "we have resources, but we ignore them," she says, suggesting, for example, that access directors could use a focus group of hospital volunteers to determine how people might respond to a biometric ID system, and they could write a script staff could try out in learning how to oversee the process.
Solutions may be close at hand
Integrating precertification into registration, creating work lists and other automated tools, and striving for a paperless environment also are important pieces of the access puzzle, says Murphy. "Sometimes there is an opportunity to take what you have and enhance it," she points out. Her observation during time spent working in a hospital was that "a lot of people went out looking for a solution when they had it there at home."
There is a big advantage in working with vendors who are receptive to helping with future problem solving, she suggests. "It’s cost-effective, and you’ve already established a relationship."
In one instance, Murphy says, her hospital asked the vendor who had installed a scanning system to develop a fax scanner. Another time, she notes, the vendor that did the hospital’s eligibility and billing put in place a product that worked with outpatient precertification. "Then we took it a step further and said, We have an issue with how to manage precerts off a work list,’" she adds.
Streamlining collections, registration
On-line credit card payments — at the time of service or in advance — and the use of electronic signature pads are effective collections tools, Murphy notes. In addition, she says, "the question has come up: Can you create at preregistration a point-of-service bill, calculate it with copays, and just e-mail it to the patient? It can’t happen for every patient, but it can for some."
She poses another question that could impact the future of access: "Will there be self-registration at home?"
Patient, hospital, and physician portals will increase connectivity with the patient at home, and will allow the physician to communicate more easily, she says. Based on how the portals are set up, Murphy adds, verification, precert, and payment calculations can be accomplished with the patient sitting at his or her home computer. "Communicating electronically gives patients the option of doing it in their own time frame," she says, noting that such an option also could help spread out the calls that come in at a hospital contact center’s crunch time.
If a professional building is attached to a hospital, Murphy points out, patients often assume that, when a physician’s office takes their data, the hospital also gets it, which isn’t always the case. "With this portal, they’d have it."
The scenario, she continues, could work something like this: "I’m at home at the computer. I enter my unique identifier, and am able to communicate with the hospital or physician to request an appointment, pay a bill, request information on services or programs, or self-register, by responding to prompts that instruct me to fill in insurance information, etc."
The response time may not be immediate, but the arrangement will allow a patient who gets off work at midnight, for example, to perform the tasks then, Murphy points out.
While registration kiosks in hospital lobbies may be an interim step, she continues, "I don’t think it will last long. Why wouldn’t you register at home, walk into the department already registered and verified, put your thumb on a pad, swipe your debit card, sign electronically, and then have everything done?"
"Most people have computers now, and in the next 10 or 15 years, that will only increase," Murphy adds.
Are house calls coming back?
With some insurers already allowing physicians to submit bills for answering patients’ questions over the Internet, she notes, will the next step be "house calls" for procedures normally done in a hospital? There already is remote electronic monitoring of patient care with electronic intensive care units (EICUs), "so, can a procedure be done in your home and monitored electronically?" Murphy asks. When you consider the cost of land in some communities, she says, such an eventuality seems less far-fetched.
That kind of twist on the access paradigm — "truly bringing care to the patient" — would certainly change the way registration takes place, Murphy points out. "If you don’t look ahead and plan, you won’t be ready when this happens."
In some cases, she says, "we have the technology, but are we really using it?" she asks. "Are [access managers] embracing these kinds of solutions, pursuing them with their vendors?"
Communicating with other access professionals through organizations such as the Washington, DC-based National Association of Healthcare Access Management and its local affiliates is another way to find technology ideas that can make the next step easier, Murphy notes. "Never before has networking been more important," she says. "We have really embedded into our places and sometimes don’t look outside. Why reinvent the wheel?"
This recommended embrace of technology comes with a price tag, Murphy concedes, going back to her advice regarding the revenue cycle. "You have to be concerned about the capital dollars," she says, "so you have to look at how you can incrementally accomplish and push for some of these things — and at how you can move the revenue cycle success story closer to the front of the process.
"The smaller the back end and the exception work," Murphy adds, "the more it’s a cycle that will keep contributing to your ability to move forward with technology."
[Editor’s note: Katherine Murphy can be reached at (630) 916-8818 or by e-mail at [email protected]. Look for more information on the use of biometrics in patient access in the next issue of Hospital Access Management.]
Embracing technology for solutions and fine-tuning the revenue cycle so youll have the capital needed to pay for it will be keynotes of the future for access professionals, says the patient access coordinator for Nebo Systems, a company that specializes in online real-time electronic data processing for the health care industry.
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