Healthcare Call Centers – Questions, Answers And Healthcare Records Privacy
According to an informative research article published by Javelin Strategy, it shows that in the past year there were 12.6 million victims of identity fraud – equating to about 1 victim every 3 seconds. Newspapers and TV news report daily about people having their personal information taken because of scammers claiming to be from a credit card company, insurance company, or government agency. This means everyone, especially the healthcare industry and medical facilities, need to be mindful when guarding healthcare records’ privacy, deciding who collects the information, and who has access to the information. Healthcare call centers are at the heart of this information privacy issue and their agents are trained to protect the privacy interests of those they interact with.
What questions are legitimate to ask as an agent in a healthcare call center? This should not be an issue an agent decides. Your healthcare call center and agents should be HIPAA certified and compliant. Additionally with the Data Protection Act, there are question that must be asked of the caller in order to establish identity, and this Act coupled with HIPAA requirements determine the scripting that a healthcare call center use when collecting information. Safeguards are in place to assure information is not shared with any unauthorized persons or organizations outside of the call center. There can be no cameras or pencils or devices of any kind used to capture a caller’s data other than the computer terminal being used. It’s a computer terminal because no hard drives can be attached that would permit data storage.
The healthcare system is extremely complex, and can be a bit confusing if you don’t know how to ask the right questions. The questions typically asked by healthcare call center agents are comprehensive enough to establish the caller’s identity and generally follow a three-question check.
Questions To Ask
During security checks, representatives will ask questions that come from these three groups:
- 1st question: Account number, reference number, contract number, or phone number
- 2nd question: Name
- 3rd question: Address, partial address, postal code, date of birth, payment method, last payment made, other phone numbers, email address
Often times, a call center for financial services will ask questions that require a numerical question, such as “what is your current account balance?” Of course if you’re calling to find your current account balance you will be asked several additional questions until your identity is established.
Questions That Are Avoided – It’s In The Agent Scripting
In a healthcare call center, proper training will not only instruct agents as to which questions to ask, but also which questions to avoid. That’s precisely why agents scripts are carefully crafted to include more open ended responses on certain places. An agent might ask, “What type of insurance do you have?” instead of “Do you have a PPO or an HMO plan?”.
asking questions, agents need to be careful that they aren’t giving a scammer a 50-50 chance at getting the question correct. That’s precisely why the agent scripts are a little more open ended is certain places. An agent might ask, “What type of insurance do you have?” instead of “Do you have a PPO or an HMO plan?”
When scripting and FAQ’s are developed for agents in healthcare call centers, there needs to be a balance struck between something that a legitimate policyholder or patient should be able to answer and avoiding questions where the answers can be easily found on a bill or receipt.
If a wallet is lost or stolen or a bill is removed form a mailbox scripting guides the agent not to ask questions that a thief might have in their possession. For example, health insurance call center agents, typically avoid asking a member “what was your last claim under this policy?” A thief could look at a stolen bill or the account they have hacked into and know that answer. Instead, insurance representatives ask “how long have you had this policy?” or something along those lines where the answer requires knowledge beyond the most common documents. The goal being to assure there is a balance between something that a legitimate policyholder or patient can answer and something that won’t appear on any documents.
Agents are trained not to be afraid to challenge a customer is they fail to provide accurate answers to security questions. If given the wrong answer to two or three questions, there can be a good chance it isn’t the legitimate customer. Politely end the call and tell them they have failed the security checks. In most cases a legitimate customer should be able to pass the security checks for their accounts even if they fumble through. Ultimately, the security lengths that a healthcare call center goes through are essential to help keep healthcare records’ privacy intact.
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