No More Nightmares: Eliminate Duplicate Records in Your Master Patient Index for a Better Revenue Cycle
Posted on February 4, 2016
Imagine this nightmare scenario: You’ve decided to take a good look at how duplicate patient records might be wreaking havoc in your master patient index (MPI) and handicapping your revenue cycle. You’re relatively certain that a few clerical errors—like transposed dates or letters—led to a small number of duplicate records. That sort of thing happens, after all.
Instead, what you find is a veritable epidemic of patient records that may or may not be duplicates, as well as a long trail of claims denials, appeals, delayed payments, fractured demographic documentation, and already-performed services for which you cannot collect reimbursements because it’s too late to get authorization, and the error was found past the claim-filing deadline. Everywhere, of course, are signs that your staff has spent untold hours trying to fix these problems. There also is evidence of payments that never made it into your revenue cycle, or that did so only after so much rework that your organization likely paid for the privilege of receiving that payment for services rendered.
Of course, it isn’t always such a dire situation when we advise our clients to look into duplicate records issues and clean up their MPI. However, because duplicate records so directly affect revenue cycle, the process is almost always a worthwhile one and can yield hidden revenue and close the gaps on administrative issues.
Posted on February 2, 2016
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
Posted on January 27, 2016
Just the other week, we spoke to a Western regional provider of diagnostic and outpatient services who told us that the most surprising thing about the healthcare industry’s ICD-10 transition wasn’t the coding changes themselves, but the unexpected ways in which their payers responded to the changes.
“We felt like we did everything right,” the chief financial officer told us. “We trained our staff and physicians; we prepared all our systems and technology. We just never thought to ask the payers, ‘so what are you going to change when ICD-10 hits, and how can we make sure we’re working together?’ We ended up doing some scrambling after Oct. 1.”
Had this provider been working with us on revenue cycle preparations for ICD-10, we would have definitely advised them to add “remember that ICD-10 impacts your payment partners, as well” to their preparation list.
Focusing internally probably helped ensure that everyone and every system within your organization was prepared for the ICD-10 transition. In fact, early reports after the Oct. 1 implementation indicated that most organizations were adequately prepared. But you might be operating completely in the dark about how your payers have been impacted by ICD-10, or what they may be planning to change.1
Posted on January 25, 2016
Now that October 1 has come and gone, many of us in the healthcare world are breathing a sigh of relief that the move to the International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and its more complex codes appears now like our equivalent of the Y2K scare — much ado about nothing. For the most part, healthcare organizations used the grace year when implementation was pushed back from Oct. 1, 2014, to Oct. 1, 2015, to prepare for ICD-10’s massive code expansion. Recent reports cite successful implementation at 80 percent of surveyed healthcare organizations, with few reported technological snags and mostly uninterrupted claims processing across the board. 1
So is there a problem? Underneath the rosy trend reports celebrating a smooth transition, healthcare organizations who are struggling may be wondering what went wrong in their situation, and even those who navigated the transition without a ripple might find some issues lurking under the surface. For one thing, professional claims rejections have risen, and coder productivity has dropped almost 40 percent. Regardless of your size and the current success (or not) of your organization’s ICD-10 transition, it’s a good idea to make sure you and your professionals and partners understand all the changes, and why education can help bridge some of the remaining gaps.2