Issue link: https://beckershealthcare.uberflip.com/i/731691
119 Executive Briefing Positive Patient Identification: The Key to Improving Revenue Cycle Efficiency and Reducing Denied Claims H ospitals across the country are exploring ways to reduce patient identification errors — a problem that poses serious risk to patient safety, undermines patient satisfaction and leads to revenue loss. Patient identification errors are fairly common, with as many as 7 to 10 percent of patients misidentified during medical record searches at hospitals, according to Imprivata, a health IT securi- ty company based in Lexington, Mass. Although patient misidentification is a pervasive problem, hos- pitals across the country have been able to significantly reduce these mistakes by investing in the right technology. The Causes of Patient Misidentification Patient misidentification can occur in a number of ways and is often rooted in the rudimentary oral registration processes hos- pitals rely on. There is ample opportunity for mistakes when patients vocally relay information to registration staff who manually enter the in- formation into a sophisticated electronic system. For example, a patient could intentionally provide false information, such as an incorrect Social Security number, at registration. This most commonly occurs in hospital emergency departments and, in most cases, it's simply because the patient is trying to avoid a hospital bill, according to Mollie Drake, former senior director of corporate access management at San Diego-based Scripps Health. Patients will also sometimes provide incorrect informa- tion to avoid immigration issues, she said. Some hospitals pull information from a patient's photo ID at registration, but that can also lead to identification problems. For example, a patient who has been to the hospital on numer- ous occasions may get married and change the last name on their driver's license, causing the registration worker to create a duplicate record missing the patient's medical history. This raises patient safety concerns, as the duplicate record may lack the patient's allergies, medications or other vital information. A physician who relies on this fragmented view of a patient's medical history may order duplicate or unnecessary tests or prescribe medications that negatively interact with other pre- scription drugs the patient takes. A duplicate record may be created even when a patient pro- vides correct and up-to-date information. Schedulers at hospi- tals are under very tight time constraints and may not have time to locate the correct patient in the electronic system. "If a name is typed in and 183 records pop up, a new record is likely creat- ed," said Ms. Drake. A more serious problem occurs when numerous records pop up during a search and the hospital worker selects the wrong patient's medical record. This results in overlays, which occur when patients are mistakenly sharing a medical record. Such a serious mistake can cause physicians to rely on the wrong infor- mation when treating a patient. Patient Identification Problems Hurt a Hospital's Bottom Line Hospital and health system reimbursement is more closely tied to patient satisfaction than ever before, and the direct link between patient satisfaction and revenue is expected to strengthen in coming years. Patient misidentification can cause hospitals to lose revenue, as it negatively affects patient satis- faction in a number of ways. For example, when a physician mistakenly relies on a duplicate medical record, the patient may have to endure the trouble of undergoing unneeded tests and subsequently shoulder the cost of that care. Or, when the wrong patient's record is select- ed at registration, a patient may receive a bill for another per- son's medical treatment. Patient identification errors also contribute to revenue loss by causing insurers to delay payment or deny a hospital's claims, according to Aaron Miri, vice president of government relations and CIO of Imprivata and former CIO of Walnut Hill Medical Center in Dallas. If an insurer can't identify a patient based on information sup- plied by the hospital, the insurer will deny the claim for reim- bursement. According to the Advisory Board, demographic and technical errors are by far the leading source of claim de- nials and write-offs, causing healthcare organizations annual losses of net patient revenue from 1-5 percent, or $2 million to $3 million annually, for an average 300-bed organization. Therefore, it is critical that hospitals provide accurate informa- tion for the more than 300 data elements in a claim. It is fairly common for hospitals to provide faulty patient information in a claim when a patient provides information verbally at check-in or when registration staff pulls information from a patient's ID. Although hospitals are given the opportunity to rework or ap- peal claims that are initially denied, that process is a drain on a hospital's finances. According to a Medical Group Manage- ment Association report, it costs approximately $25 to rework a single denied claim, which quickly adds up. When a claim is properly reworked, a hospital typically receives payment once the claim is resubmitted to the insurer. However, there are times when patient identification errors force hospi- tals and health systems to absorb certain costs in full. For exam- ple, when a physician relies on a duplicate medical record that Sponsored by: