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.
Audit and Assess Your Master Patient Index to Identify Problem Areas
Once you’ve decided to take a look at the issue, the first step is to do an assessment of your current MPI to see where the issues occur. The objective is to view the detailed data to form a larger picture of why these duplicates are happening, which can help you and your revenue management partner figure out ways to close those gaps. In particular, you should pay close attention to three metrics that will come from the review:
- Total number of duplicates. How many duplicates do you have in your MPI? What percentage does that represent of all your records?
- Duplicate creation rate. How quickly are new duplicates being added? As an oversimplification, this rate is the number of duplicates created per total number of records created. You also can examine duplicates chronologically if you’re looking at a specific time frame. This metric could point to a systemic issue if you are creating duplicates at a high rate or only began creating them after particular staff members started, for instance.
The American Health Information Management Association estimates that duplicate creation rates in hospital settings are around 10 percent, which we feel is quite high. Best practices put the number around five percent, although we would recommend that our smaller clients aim even lower than that. A lower rate can be easier to achieve for smaller practices because they have fewer staff members to train and fewer records to review on a regular basis.1
- The cost of each duplicate record. Not all data from your MPI, or any software you may be using, will be sophisticated enough to tell you how much each duplicate record costs you. However, if you can tell how much time and funds you are spending fixing these errors, or how much each duplicate is costing you in missed collections, this could easily tell you the ROI of embarking on your MPI cleanup in the first place.
Merge and Eliminate Duplicates in Your Current MPI
Not all duplicates are the same when it comes to engaging an MPI to merge records. Some types of duplicates you might see include:
- True duplicates. This is when there are multiple entries for the same person. This can occur in a single-level MPI or an enterprise MPI that covers multiple facilities.
- Overlapping records. This occurs when a patient has an entry in your MPI and the MPI at another facility, and the entries become duplicates when the facilities put their records into a combined MPI after a merger or acquisition.
- Overlays. These are situations in which one patient’s medical information is entered into the record of another person. This can happen through staff error or when two patients’ records are incorrectly merged.
Usually, facilities employ patient record-matching software to merge and eliminate records in a current MPI because manual matching at such a volume would take forever. Large organizations should run this program on a daily basis to catch duplications before claims are processed or statements are sent. In situations in which you are establishing an enterprise-level MPI, however, there may be a certain volume of records that must be manually matched and combined.2
Educate Staff to Lower Duplicate Creation Rate
Once you’ve cleaned up your MPI and identified the key factors behind the creation of duplicates, it’s time to educate staff in your registration and records departments. We’ve found that keeping the tone of these sessions collaborative, open and educational is crucial. Most duplicate error issues are innocent mistakes brought about by too much haste or simply a poor understanding of how errors can affect revenue cycle and other areas of the organization. However, tracking duplicate error issues should be a part of an employee’s evaluation process and salary review because making too many errors for an extended period of time is not acceptable.
As a leader in your organization, it’s your responsibility to ensure your staff members understand the ripple effects of their actions. You also may take this as an opportunity to learn how you can serve your staff better to ensure they can do their jobs accurately. Are there stressors on this staff that you weren’t aware of previously? Are there technology gaps that make it difficult for them to do their jobs? We sometimes hear that clients are surprised and glad to learn about these factors.3
All staff members that interact with medical records should understand:
- Use of full legal name. That can mean different things in different organizations, so be sure your meaning is clearly defined. If you mean the insurance card name, ensure everyone knows that should be the only name used—no nicknames, middle names, or other variants.
- Triple-checking records before entering new information. This type of duplication can be the most difficult to find and correct, so staff should ensure they have the right file open before adding information.
- Consistent validity procedures. Staff should use a cascading checklist when identifying records, and it should be consistent every time. This typically goes last name, first name, middle name, date of birth, social security number and so on, with each new layer used as confirmation of the patient in question. This rubric helps staff consistently establish on a consistent basis whether two records may belong to the same patient.
- The consequences of duplicates. Take staff on a tour of the entire revenue cycle, highlighting how their part of the process—usually the front-end information capture point—interacts with every other part. This will help them understand how their actions affect the wellbeing of the entire organization.4
Assessing and cleaning up an MPI is not a fast process—for some organizations, it can take as long as two years to do properly. It is a worthwhile process, however, for improving your overall systems and, ultimately, your revenue cycle. It can be necessary for facilities preparing for mergers, acquisitions, or the establishment of a multi-level MPI.
When done, and done correctly—and then maintained daily by a staff member who checks rejected claims—a cleaned-up MPI with a more educated and empowered staff can result not only in smoother sailing for your collections and claims processes but also a vastly improved patient experience.
Physician Revenue Navigators is a leading healthcare revenue cycle management partner, supporting healthcare 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.
- Mike Bassett, “How to Measure Duplicate Rates,” For the Record, April 2013, http://www.fortherecordmag.com/archives/0413bonusp18.shtml. ↩
- “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. ↩
- Molly A. McClellan, “Duplicate Medical Records: A Survey of Twin Cities Healthcare Organizations,” November 14, 2009, AMIA Annual Symposium Proceedings, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815491. ↩
- Robin L. Altendorf, “Establishment of a Quality Program for the Master Patient Index,” AHIMA, October 2007, http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_039331.hcsp?dDocName=bok1_039331. ↩