Articles-Thought Leadership Reimbursements at Risk Article | Page 2

“Organizations need to direct resources where they can
make a positive and significant difference: patient identity
errors, point of service collections, and denials.”
Patient Identification Issues: Train Staff, Avoid
Mistakes, Share Best Practices
Several authorities point to identity errors as a significant
problem in healthcare, both clinically and financially.
“Some estimates put identity errors in medical records
at 14% to 20%, racking up an annual estimated cost of
$8 billion, according to the RAND Corporation,” states
Gurzynski-Wells. “It’s no wonder: from registration to
billing, it’s estimated that upwards of 250 people process
and treat each patient,” she elaborates.
According to the Journal of the American Health
Information Management Association (AHIMA), the
average hospital master patient index (MPI) has a
duplicate record rate of 8% to 12%, meaning one in ten
patients have multiple medical record numbers. “Many
organizations are spending large amounts of capital to
clean up their MPI. In the age of the Electronic Health
Records (EHR), it’s even more difficult to find all the
encounters belonging to one patient. This is mostly due
to the computerized sorting that’s unable to find
patients in records with slight variations in spelling or
name order or the addition of a middle initial or suffix,”
notes Gurzynski-Wells.
There are two major types of duplicate records:
overlays and overlaps. “Approximately 2% of MPI errors
are overlays. Overlays occur when two or more
patients’ data is combined into a single record. Overlaps
occur when a patient is seen at two or more facilities
within a health system and their records are maintained
separately. In multi-entity systems, the occurrence of
these overlaps can be as high as 40%,” Gurzynski-Wells
explains referencing the AHIMA article.
Duplicate medical record numbers, overlaps, and
overlays are causing financial risk, as well as clinical risk.
They have an interdepartmental impact on patient
access, HIM, and patient financial services by creating
inefficiency, duplication of effort, lost productivity, and
higher operational cost. “Duplicate medical records and
incorrect patient identifiers also lead to reimbursement
losses. They compromise our data integrity, increase
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administrative waste, diminish staff effectiveness,
increase our liability, and most significantly, they can
lead to poor quality of care and diminished patient
safety,” warns Gurzynski-Wells.
Ultimately, mismatched patient identifiers result in
denials and are linked to catastrophic adverse events,
medication errors, and unnecessary procedures.
Successful enterprise integrity management and
thoughtful training of registration staff will help
hospitals and other providers minimize these errors.
AHIMA recommends creating an enterprise identity
management strategy to address these issues. “This
requires governance policies and procedures across the
organization. As you push for data integrity, you must
provide regular staff training to ensure they understand
the importance of compliance”.
Many mismatched patient identifiers and duplicate
medical record numbers happen at the point of patient
access. Problems occur when registration is
decentralized and registrars report to different
individuals within the same organization. “The people
registering patients in a lab or physical therapy
department, for example, have other responsibilities
besides registration, and they may not understand the
consequences of mismatched patient identifiers.
Further, they may not receive regular training on the
consequences,” says Gurzynski-Wells.
“Common causes of patient identity errors are typing
and entry errors, unfamiliar name structures, adding or
deleting a middle initial, unfamiliar foreign names, and
ID and insurance cards shared by multiple people. We
depend on technology to solve the problem, but we
still need to educate healthcare professionals about
critical thinking, best practices, and how to avoid
identity mistakes,” she adds.
“For many busy registrars, it’s a lot easier to just do
their jobs and let the next person handle it, but it’s
important these staff members also understand how
their activities or actions can affect the entire revenue
cycle,” she explains. “We need to make sure our best
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