Handle red flags differently in the ED

Suspected 'red flags' must be handled differently in the emergency department than other registration sites, according to Joyce L. Predmore, associate director of patient access services at Ohio State's University Hospital East in Columbus.

"Staff are trained to safeguard information, look for suspicious activity, and report issues as soon as suspected," she says.

The registration process can be stopped in areas where the health care needs are not urgent, which gives staff members the ability to ask the patient for satisfactory identification information or documentation, Predmore explains. This situation isn't the case in the emergency department, as patients must be provided with a medical screening examination to comply with Emergency Medical Treatment and Labor Act (EMTALA) requirements, says Predmore.

"With that in mind, registration staff use the best identifiers provided to them to access the correct medical record number or to create a new one when the identity is questionable," she says.

These steps are taken:

• If ED registrars believe a patient is falsifying information because of significant changes in demographic information, altered IDs, or a patient photo in the registration system not matching the person who presents, they share their suspicions with the appropriate clinical staff.

• The clinical staff then follow their "Red Flag" procedures for suspicious activity. Based on the patient's condition, they might make inquiries regarding past medical history.

• The clinical team and the registration staff collaborate to research as much information as possible, to determine the next steps.

• A report then is submitted to the hospital's Red Flag Workgroup for further research.

In addition to the hospital's privacy officer, the Red Flag Workgroup includes representatives from patient access services, medical information management, physician offices, the central billing office, legal services, and security. Police are involved when necessary, depending on the nature of the case.

"They determine the next steps for the medical record numbers involved," says Predmore.

• Security is typically not involved until a discussion has occurred between the administrative/clinical team and legal services.

"Examples of when we have involved the medical center's security department or the University police department include cases in which a suspect is on site and using the identification of a known identity theft victim," says Predmore.

Other cases have involved individuals known to have presented under multiple names, or those suspected of obtaining services under another individual's name for purposes of insurance coverage or other financial gain, she says.

• Registration staff use system notifications to further validate a patient's identification.

"Depending on the complexity of the situation, relevant comments may include other known aliases used by the patient or instructions to page an on-call supervisor for detailed action steps to take after initial registration," says Predmore.

Photo IDs taken

Registrars routinely validate a patient's name, date of birth, and address, says Predmore, but when suspicions are raised and urgent care is not needed, other steps might be taken to ensure a patient's identity.

Registrars might compare signatures, inquire about previous addresses, or review insurance coverage, and they will notify a member of the management team if needed, says Predmore. In addition, registrars now take patient photos at the point of registration and offer an informational handout to explain why this is necessary.

Registrars tell patients that they need to ensure the right care is being provided to the right person and that these are extra measures to protect the patient's medical record and keep an individual's identity safe.

"Our registration sites also display signs informing patients about showing photo IDs at check-in and taking pictures for our records," says Predmore.