Red Flag Rule
What is the Red Flag Rule?
- The Federal Trade Commission has issued a set of regulations called “Red Flags Rule”, this requires all “creditors” to follow certain rules. We are considered creditors because we accept insurance and allow payment plans. This rule is a safety net for our business and for the patient – otherwise known as an identity theft prevention program. It applies to patient billing records and medical records.
What do we need to do?
- Prove that our patients are who they say they are.
- Make sure we have a photo ID and another form of verification in the patients’ chart. This is an absolute requirement for all new patients and conforms to the policies we already have in place for check in.
What if I suspect a Red Flag - someone is not who they claim to be?
- Have the patient show I.D.
- Compare signatures
- Alert management
- If management is not able to reconcile and verify identity, they will contact law enforcement officials
What would make me suspect someone is not who they claim to be?
- Inconsistent addresses
- Inconsistent Social Security numbers or the lack of them
- Multiple requests for changes to a medical record or chart.
- Reports from law enforcement regarding suspicious activity.
How is the Red Flag Rule different from the HIPAA privacy and security rules?
- Much of it is similar, but it extends to include:
- Credit card information, Tax ID, SS#s, etc
- Other Identification numbers,
- Background checks for employees as a safety net for fraudulent use.
What should I say or how do I respond when patients question why we are doing this?
- Explain to the patient that we are required by new Federal Trade Commission rules and must verify identification.
- Reassure the patient that we are doing this for their protection and ours. Due to growing concerns regarding identity theft the FTC has new rules in place to protect the patient and the business.
What if the patient gets upset or angry about providing form of identification?
- If necessary, calmly explain we understand any frustration involved, however we feel the extra few seconds needed to verify their identification are well worth it. And, that we are obligated to follow the law and it is in place to protect them as well as us.
Where can I find examples of how to find or address red flags?