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Lowering the duplicate patient record rate increases revenue cycle efficiency by improving the accuracy of information used to submit claims, collect payments, and provide care. Texas Health Resources, a 13-hospital system with more than 1 million patient registrations per year, reduced its duplicate patient record rate to 0.36 percent over six years—far less than an 8 percent duplicate record benchmark found in a 2008 RAND Corporation study.a Texas Health has also established an ongoing process to prevent the creation of duplicate records.
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Duplicate records detract from patient safety by giving providers a fragmented view of the patient’s medical history, thereby increasing the chances of medical error. The negative effect of a high duplicate record rate on the revenue cycle is not as widely recognized. Duplicate records affect a number of downstream financial activities as well as other key initiatives a hospital or health system may undertake, such as the implementation of an electronic health record (EHR) or a new patient registration system.
Direct impacts on payment. Incorrect identification of patients by registering a nickname, for example, instead of the legal name used on the health insurance policy, may result in denials, subsequent appeals, and delayed payments. Duplicate records may also lead to the repetition of lab or diagnostic tests already performed but documented in a different record. If the costs of these tests already have been paid by the insurance company, they will not be covered a second time, resulting in unreimbursed care for which the hospital cannot collect.
Obstacles to achieving meaningful use. Meaningful use provides another motivation for achieving a clean master patient index (MPI). It is strongly recommended that a medical record clean-up be done before attempting to qualify for meaningful use. Also, because Stage 1 incentives are tied to the number of unique patients served, duplicate patient records result in an inflated list of patients across a health system. This artificially increased number of patients makes it more difficult to prepare for meaningful use. For example, the Stage 1 measure related to maintaining an active medication list requires that 80 percent of unique patients have at least one medication entry recorded as structured data. For 1 million unique patients as identified by patient records, an organization must prove an active medication entry for 800,000 patients. However, if the duplicate rate is 8 percent and those duplicates are eliminated, then only 736,000 records would have to demonstrate an active medication entry to reach the meaningful use standard.
EHR and IT upgrade readiness. In preparation for EHR implementation, Texas Health initiated an MPI cleanup and developed a streamlined, ongoing process to reduce the creation of duplicate records. Texas Health also sought to reduce duplicate records ahead of a transition to a single registration system that would replace two different legacy systems. Together, these initiatives were slated for implementation over a two-year period.
Realizing the impact of duplicate records on its revenue cycle, Texas Health made the necessary commitment of time and money to put the right processes and technology in place. During the two-year transition to EHRs and the new patient registration system, four key steps were taken to eliminate duplicate records:
Scrubbing the MPI. A thorough, initial scrubbing of the existing MPI enabled the organization to get a handle on how many duplicates existed and identify problems that led to the creation of duplicates. The availability of data that documents root causes for duplicates makes it easier to correct improper registration habits. Detailed information about what is happening—as well as where and how often –—enables development of overall communications, education, and training programs for registration and medical records staff. Fixing a problem at registration saves considerable time and cost later in the revenue cycle.
At Texas Health, one common reason for duplicate records was an inconsistent approach to patient identification. For example, some Texas Health hospitals registered patients using legal names as they appeared on drivers’ licenses or insurance cards, while other hospitals used more commonly used nicknames. Patients who went by a middle name with friends and family were registered under the middle name instead of their legal first name. Suffixes such as junior or III were not always used, even though the suffix was part of a patient’s legal name.
Identifying and selecting the right patient records. Advanced probabilistic matching tools were incorporated into the patient record’s “search and selection” process to help registration and scheduling staff easily identify and select the right patient records. These tools ensure search results are sorted based on the likelihood that the records match. The results are presented in a ranked and color-coded display so that staff only needs to review the top choices and select the correct patient record.
In addition, technology that improves the process of merging duplicate records was implemented to save time when records were inadvertently duplicated.
Educating key stakeholders. Key staff members in both the registration and medical records departments were educated about issues related to duplicate records, the new system, and the steps needed to avoid duplicate creation. Staff education sessions were launched and the importance of using a full, legal name was addressed. The education sessions also provided strategies for minimizing patient wait times to keep satisfaction scores high and meet productivity goals.
Many staff did not realize how a simple error at the time of registration would affect downstream activities, so the sessions also focused on how duplicate records affect other areas. Examples include:
Monitoring performance. Data integrity teams were established to monitor records, identify trends that require re-education, and provide real-time support to registration staff when they encounter problems.
At Texas Health, the combination of technology that simplifies access to correct records and alerts staff to potential duplicates, thorough stakeholder education, and consistent follow-up training has resulted in outcomes that exceeded expectations. Texas Health’s initial goal of achieving a duplicate record rate of 0.9 percent or less has been surpassed; the actual rate has fallen to 0.36 percent over the period from 2006 to 2013, as shown in the exhibit below. The low duplicate record rate has contributed to a decrease in the number of A/R days—from 48.4 in 2006 to 38 in 2012. And the enhanced patient safety allowed Texas Health to go to a single EHR platform with clean data that helps ensure the validity of each patient’s medical record.
Texas Health’s new streamlined process involving registration data scrubbing, electronic identification readers, and real-time alerts to avoid potential duplicates positions the health system to improve patient safety and the organization’s financial health. Ongoing maintenance of a clean MPI, as well as technology that provides continuous monitoring and staff support, result in patient record accuracy levels that translate to cleaner claims and faster cash flow.
Patricia Consolver, CHAM, is corporate director of patient access, Texas Health Resources, Arlington, Texas, and a member of HFMA’s Lone Star Chapter.
a. Hillestad, R., Bigelow, J.H., Chaudhry, B., et al., "Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System," RAND Corporation, 2008.
Publication Date: Thursday, May 02, 2013
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
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