Jamie Hernandez, a 41-year-old former Division III soccer player, walks into a physician-owned outpatient surgical center for a knee arthroscopy. Due to an innocent keystroke error, a staff member sends the invoice for Jamie’s procedure to Jaime Hernandez, a 72-year-old retiree who had a total knee replacement at the center a couple of years ago. The error is eventually discovered, of course, when Jaime calls confused about the invoice, and a replacement invoice is quickly sent out to Jamie. By then, however, several weeks have passed, and payment is delayed.
We see scenarios like this play out at our clients’ facilities every day. Nicholas Payne comes in for an MRI in January and ankle surgery in March and ends up with two patient records, under Nicholas Payne and Nick Payne. Claire Boswell has two records, one with her birth year as 1987 and the other listing her as born in 1978. Bill Johnson is one of nine Bill Johnsons in the database, but three of the patient records belong to him, with three different addresses listed.
These things happen—any organization dealing with a lot of data and customer information is bound to end up with a duplicate record problem. Many of our clients are surprised to learn that what seems like a simple administrative issue can cripple your revenue cycle if you let it get out of control. Duplicate patient records and an inaccurate master patient index (MPI) affect your bottom line in multiple ways that can all be detrimental to your organization.1
Duplicate Patient Records Make Achieving EHR Success Difficult
For organizations who want to use electronic health record (EHR) technology for better overall outcomes, duplicate patient records can easily derail you from achieving this goal.
Many incentives for the Centers for Medicare and Medicaid Services (CMS) Meaningful Use program are tied to measurements that have to do with patients served. If you have a high number of duplicate records, your statistics in that area will tend to be artificially inflated, which can adversely affect your ability to qualify for some incentives. For instance, your organization is required to maintain an active medication list on which 80 percent of patients must have at least one medication recorded as a structured data entry. If you have a large number of duplicate records, your percentage may include a higher number of active accounts (80 percent of 10,000 v. 80 percent of 8,529 if you eliminate duplicates, for instance).2
A Messy MPI Means Direct Financial Impact on Revenue Cycle
The most obvious way a high number of duplicates can affect your revenue cycle is through collections and claims. As in the story of our client at the beginning, incorrect names or nicknames can cause issues with collecting, causing invoices to go awry or procedures charged to incorrect accounts. This can lead to a lot of wasted time with your staff trying to figure out where the issue occurred so they can get payment from the right patient. In addition, it is a HIPAA violation to release patient history information without permission to another patient, which can happen if you send a billing statement to the wrong patient. All breaches of regulations must be instituted, which is very costly.
If a health insurance company or another payer is involved, things can get even uglier for your revenue cycle. It’s important to always use the name that appears on the patient’s insurance card for the account name because not only can using a nickname or mixing up duplicate accounts cause you to submit claims incorrectly, but it can also result in duplicate claims. This could also result in a HIPAA violation and possible filing of fraudulent claims.
Some of our clients don’t believe that their duplicate record issue can be that widespread because they use medical record numbers (MRN) to identify each patient across different systems. However, even the use of an MRN isn’t immune to duplication. It’s possible for multiple MRNs to be associated with one actual patient. If your organization sends information to and from specialists and other clinics with different systems, easily mixed-up patient demographic information may be required to validate a record.3
Patient Care and Brand Identity Can Suffer
Most of our clients aren’t necessarily thinking of their organization’s overall brand when they set out to investigate an MPI issue, but this can also be a compelling reason to fix messy records. If patients are consistently on the receiving end of patient experience mishaps, such as incorrect invoices, misidentifications during scheduling, or rejected claims from their insurance, it will almost certainly affect their feelings toward your organization.
Patients who associate your brand with quality care and a great experience are much more likely to return for repeat services and refer other patients. For most healthcare organizations, especially smaller clinics and outpatient practices unaffiliated with well-known hospital systems or healthcare brands, a patient’s sentiment is entirely neutral when he or she first interacts with your organization. Factors like the smoothness of the patient’s administrative experience can easily influence that attitude for good or bad. Ultimately, poor patient satisfaction scores also can harm your revenue cycle through referral leaks and lost business.4
Recognizing that you have a duplicate records problem is the first step. If you’re not sure of the extent of your issue, it is probably worth talking to your practice management system partner because duplicate records have such an effect on revenue. Solving the duplicate patient record problem can lead to much faster cash flow and a cleaner claims process, after all, and that’s worth an investigation at the very least.
The next step will be to conduct an assessment of your MPI to determine the extent of the problem. Read the second part of this article to learn how to eliminate duplicate patient records and fix your master patient index for better a better revenue cycle.
Physician Revenue Navigators is a leading healthcare revenue cycle management partner, supporting health care organizations of all different practice types in all aspects of a healthy revenue lifecycle, including coding, billing, contractual adjustments, collections, HIPAA compliance and more. Contact us to learn more about how we can assist your organization.
- Brooke Murphy, “How biometrics can help maximize hospital cash flow,” Beckers Hospital CFO, December 11, 2015, http://www.beckershospitalreview.com/finance/how-biometrics-can-help-maximize-hospital-cash-flow.html. ↩
- “Meaningful Use Definition & Objectives,” accessed January 14, 2016, https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives. ↩
- “Managing the Integrity of Patient Identity in Health Information Exchange,” AHIMA, July 2009, http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_044000.hcsp?dDocName=bok1_044000. ↩
- Sagar Anisingaraju and Mo Kaushal, “Predicting patient experience with narrative data: a healthcare goldmine,” Healthcare Analytics, July/August 2015, http://www.analytics-magazine.org/july-august-2015/1336-healthcare-analytics-predicting-patient-experience-with-narrative-data-a-healthcare-goldmine. ↩