24 hours ago Duplicate and fragmented medical records of patients can be a potential risk to the patient’s safety, continuity of care, billing, and leads to financial losses for the hospitals, as well as reduction in reimbursement rates and patient satisfaction scores for providers. In addition, the privacy of the patient is at stake, if the wrong patient ... >> Go To The Portal
As the patient, maybe you thought your healthcare insurance company was at fault by the second duplicate bill. Erroring on the side of caution, you give them a call. After calling, your insurance will begin losing trust in your physician. The more often double billing occurs, the more scrutiny your doctor faces.
The more often double billing occurs, the more scrutiny your doctor faces. Your doctor would soon face a series of investigations, audits, and an eventual fraud dispute if he doesn’t change his processes. But how bad could these fraud cases be? According to Health Payer Intelligence, 46% of medical fraud cases in 2016 were due to either...
There are two main types of duplicate claims; exact and suspect. The general definition of an exact duplicate claim is pretty straightforward. This type of claim contains the same information as a previously submitted claim. Although that’s the generally accepted definition, it may differ based on the insurance payer.
When your doctor submits the claim, it is their responsibility to record that the submission occurred. There are thousands of variables these systems use to determine whether to accept or reject a claim.
Duplicate medical records and overlays are created as a result of patient identification errors. A duplicate medical record occurs when a single patient is associated with more than one medical record.
Duplicate medical records often contain inaccurate or incomplete medical history and can lead to wrong treatments due to factors like medication, lab test results, and allergies not being mentioned. These can even cost a patient their lives.
Consider these strategies to help prevent duplication:Avoid rushing during the registration process, even during volume surges.Ask patients to spell their names instead of making assumptions.Meet with health information management to discuss ways to avoid duplicates.Implement consistent policies organization wide.
If patients ask for copies of their electronic protected health information (PHI), the fees you charge must be reasonable and cost-based, according to federal and state regulations.
Duplication of ancillary services is associated with higher return on assets. Duplicated high-tech services are financial losers for hospitals. Higher levels of duplicated high-tech services are associated with higher cost per day, higher cost per discharge, and lower operating margin.
Duplicate records cause delay and improper treatment One-fifth of the patients have incomplete health records due to duplicate data, so they cannot fully view the patient's medical records. This also leads to delays, unnecessary tests, or improper treatment of the patients.
Duplicate records are associated with a higher risk of missing important laboratory results when compared with non-duplicated records.
Overlap is when a patient have more than one health record number at different locations in an enterprise.
Training the staff on policies and procedures of creating or updating a patient's record, especially when the patient is in-house, goes a long way toward limiting mistakes. One effective method for preventing overlays is to require legal proof before updating a patient's key demographics, e.g. name or date of birth.
A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
The HITECH Act encouraged healthcare providers to adopt electronic health records and improved privacy and security protections for healthcare data. This was achieved through financial incentives for adopting EHRs and increased penalties for violations of the HIPAA Privacy and Security Rules.
Unless otherwise limited by law, a patient is entitled to a copy of his or her medical record and a physician may not refuse to provide the record directly to the patient in favor of forwarding to another provider. 5.
Duplicate or incomplete patient records can cause hospitals to inadvertently bill payers or patients for more than or less than the correct amount, leading to direct revenue loss. Incorrect billing results in wasted time and resources, lengthening of days in accounts receivable (A/R), and an increase in bad debt write-offs.
There are numerous ways in which duplicate or incomplete patient records can undermine hospitals’ quality efforts and metrics that directly drive the payment formulas for Medicare, Medicaid, and other private payers under various value-based payment methods.
Duplicate and incomplete records can hurt revenues under both fee-for-service and value-based payment, and these issues are intensifying as providers with disparate systems merge. To improve performance on traditional and emerging revenue cycle metrics, revenue cycle leaders should consider technology that improves data quality.
Duplicate medical records are defined as numerous records of one person. For example, a person might have visited the hospital several times, and every time they got a new profile because workers could not find the previous record.
The impact of duplicate medical records in healthcare is huge and affects everyone and everything: patients, personnel, facilities budget, and workflow. While numerous healthcare units think that it is easier to ignore the duplicates than fix them, they do not know how they actually slowly kill the system themselves.
As we have mentioned before, duplicates and overlays are the consequence of impatience. Medical workers do not take their time to actually look through the profiles or insert more information. Creating a new record seems to be much quicker but all the tests and denial claims are telling otherwise. According to a survey, 66% of leaders at provider and HIE organizations believe that data entry errors cause significant amounts of data duplication in healthcare facilities.
However, the best way to prevent duplicate records and improve patient data integrity is to use the power of modern technology. Combining biometrics with a record matching technology can help hospitals overcome such challenges as the absence of data standardization, lack of information, and human mistake.
It is simply annoying when you have to choose between two identical records in order to find out later that they are the same person. Personnel spends too much time choosing the right record. They may help another patient in the time that they spend on matching the records in the system or save precious time that not every patient has. In the end, they may just create the new one to save time. This vicious cycle will never stop if overlays and duplicates exist.
Record overlays emerge when the information of one patient is overlapping with the record of the other person with the same name. So the final record contains fragments of information about each person. The main cause of this problem is that there might be several people with the same names in one city and hospital personnel can confuse them.
According to statistics, between 2009 and 2020 there was a spike in healthcare data breaches. During these years, 3,705 breaches …
As the name clearly indicates, duplicate medical records are defined as two or more records assigned to a single person at the same healthcare facility. These duplicate records are created mostly due to patient identification errors. It is also to be noted that a major chunk of these duplicate records consists of partial duplicates which only contain a portion of the actual patient data. Sometimes, a patient’s record is overwritten using data from another patient’s record, hence creating an inaccurate combined record (also called as overlay).
For instance, consider a patient record which has many duplicates, each of these duplicates will have some information or the other and will be missing some details too. The duplicate record may miss out on critical information such as the medical history of the patient, ongoing medications, blood type, allergies, or any other diagnostics. Imagine that a patient is treated on the basis of these incomplete or inaccurate details, serious complications are bound to occur, right?
Many healthcare providers make use of multiple systems for different processes, which increase the issue of duplicate data. Facilities that register patients at multiple checkpoints face significant problems related to the creation of multiple records for a single patient. Most times, with multiple checkpoints in the picture, ...
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There has indeed been rampant digitalization across majority of the organizations throughout the world and the healthcare sector isn’t far behind. Digitalization entails that there is an integration of inherent digital technologies into everyday business processes. With the increasing number of healthcare providers revamping their processes and going digital, data quality issue remains a major concern. Most healthcare service providers have very well-identified that their Master Patient Indexes (MPIs) have significant issues related to data quality. According to the American Health Information Management Association, an average hospital has a 10% duplicate rate of patient records. The negative implications of duplicate medical records are many and these records adversely affect patient safety, medical care costs, data accuracy, and the quality of reports.
The prevalence of duplicate records in most hospitals has been generally estimated between five percent to 10 percent of all stored records. 1,2 However, health systems that have multiple facilities or have merged with other systems are seeing duplicate rates around 20 percent. Duplicate rates also differ based on healthcare setting. For example, physicians’ office settings are known to have a duplicate rate at five percent, which is the “acceptable” rate for all healthcare settings. In contrast, according to a Gallagher Healthcare Practice report, one medical record consulting firm was employed to remove approximately 250,000 duplicate records, which represented 22 percent of the Master Patient Index (MPI) of one metro urban hospital system. 3
When patients present to the registration department, they may provide different names during their encounter than what is listed on their photo ID, such as nicknames, married names, or a middle name. As such, incorrect information could be used and thus duplicate records created.
Algorithms are automatic rules to identify problems. Algorithms can solve and prevent duplicate records by providing patient registration clerks and HIIM professionals with an accuracy rate between two records that may or may not be the same person. Algorithms are used in hospital information systems, and several different algorithms are used, including deterministic, probabilistic, and rules-based. Deterministic algorithms yield a 50 to 60 percent accuracy rate as they require exact or phonetic matches on certain data elements. 4 Deterministic means the results are predictable. For example, if a duplicate record pair has the exact name, address, and date of birth, it is more likely to be the same person. Probabilistic algorithms provide an accuracy rate up to 95 percent or higher as they determine precise record linkages by using complex mathematical principles to help analyze organization-specific data. Rules-based algorithms have a more advanced matching method that utilizes pre-set confidence levels for certain data elements and offers an accuracy rate between 70 to 80 percent. 5
Duplicate records are a popular issue amongst healthcare organizations since they wreak havoc on organizational performance and data quality. Health informatics plays a pivotal role in minimizing the rate of duplicate records. HIIM professionals must take the lead in recognizing and understanding this problem and ultimately providing viable solutions through not only technology but collaboration amongst other major stakeholders that share the common goal of tackling duplicate records as well.
Biometrics is another informatics approach gaining popularity. With biometrics, physiological characteristics of the human body can be used by healthcare facilities to seamlessly identify a patient by scanning their biometric identity. Biometrics include iris, palm vein, and fingerprint scanning. Iris scanning supports hospital infection control initiatives and is very effective in preventing duplicates as there is a low occurrence of false positives and extremely low (almost zero percent) false negative rate. 7 Palm vein biometric identification relies on matching technologies that can’t completely prevent duplicate medical records at the point of service. As such, fingerprints are the most well-known biometric modality but require physical contact with a hardware device, which is not conducive to infection control in a hospital setting.
When duplicate records are present in the EHR, data can become conflicted amongst providers, causing poor patient care and incorrect treatment. For example, a physician may locate two records for a patient and select only one of the records as a reference for how he/she would administer treatment for the patient. This physician could then prescribe a medication for the patient that produces an adverse reaction, causing the patient to be referred for emergency treatment.
Patients must understand the importance of providing consistent identification information across facilities to prevent duplicate entries, especially as mobile health becomes more prevalent and patients start taking a more active role in managing their information through personal health records.
Economic Costs. According to the same Black Book survey, each duplicate record costs healthcare organizations over $800 per emergency department (ED) visit and over $1,950 per inpatient stay due to redundant medical tests and procedures.
In fact, 88% of consumers directly blame the hospital system for their dissatisfaction with the lack of portability of their health care records. [4] This is becoming even more important as patients gain visibility into their health records through patient portals and personal health record apps—because these portals and apps also give patients instant visibility into any missing health records.
According to Ponemon Institute, 86% of nurses, physicians, and IT practitioners say they have witnessed or know of a medical error that was the result of patient misidentification. [5] A letter to Congress sent by AHIMA and cosigned by 32 other organizations (including Verato) spelled out the problem more poignantly: “Patient identification errors often begin during the registration process and can initiate a cascade of errors, including wrong site surgery, delayed or lost diagnoses, and wrong patient orders, among others.” [6]
If duplicate billing or “double billing” lands within their top five, there is a serious problem. If they continue to ignore that type of denial, government agencies may accuse them of fraud. These fraud cases result in massive fines (more on that later).
The general definition of an exact duplicate claim is pretty straightforward. This type of claim contains the same information as a previously submitted claim. Although that’s the generally accepted definition, it may differ based on the insurance payer.
CRC Health was also required to pay $2.2 million to the state of West Virginia. First, CRC Health collected blood and urine samples from drug testing facilities. Once collected, they then sent the samples to San Diego Reference Laboratory. The double billing fraud occurred when CRC would bill Acadia.
Every insurance company defines how they accept claims within their provider manual. Once your doctor submits the claim, your insurance checks if it meets their criteria.
Re-submitting duplicates without proper remediation negatively impacts your revenue and trust. If this form of negligence continues, the healthcare organization will face an investigation and a massive fraud penalty.
The discovery came from more than 13 audits conducted on MassHealth.
Pentec Health Pharmacy. In February 2019 Beckers Hospital Review reported that Pentec Pharmacy agreed to pay $17 million in fraud fines. The Department of Justice accused Pentec of over-billing Medicaid for wasted amounts of product while compounding its drug, Proplete.