Don't let your bad data do too much damage
Technology tools that facilitate the capture and communication of data are essential for patient access, but there is a downside. "The scary part is that systems today have the capacity and structure to get bad data out faster, and can do a lot of damage if not managed or used correctly," says Kathryn Stevens, PhD, MBA, CHAM, northwest regional delegate for the National Association of Healthcare Access Management.
This may be more of an issue for Integrated Delivery Networks (IDNs), where physicians and hospitals share a patient record, notes Stevens. "Several systems use queues or work lists to make sure claims are clean before they go out the door," she says.
However, despite sophisticated electronic claim scrubbing technology, quality reviews are still manual and often retrospective.
"It is critical that the patient be correctly identified and selected from an existing record or a new record created, if necessary," says Stevens. "If the patient is identified incorrectly and the IDN has an electronic record, a rapid series of negative events can occur, including inappropriate medical care."
This is not a new problem to patient access professionals, except that now automated medical record numbers are created at the time of patient selection or data entry and orders and results are automatically attached to the record number. "Care providers are required along the way to verify each time they speak with the patient that the information on the label or armband is accurate," says Stevens. "If the difference is only the middle initial, then it is difficult to detect an error. The errors may not be identified until after discharge when the patient record is being coded."
Several fields are "shared," and the vendor promotes that integration by making available data entry in certain fields that serve multiple purposes. For example, the hospitals enter information about the primary care physician (PCP) and the attending physician, with the names selected from a pre-populated master file. If the name does not match the file, they enter name and address.
This field is used by clinicians to make contact with the physician, if needed, and, medical record information is automatically sent to the PCP of record to notify them that the patient has been in the hospital.
"This is a great feature for both patients and physicians - unless the PCP name is incorrect," says Stevens. "Staff members who update these data don't always know which PCP to select. Updates are too late to stop the electronic communication."
Staff may enter the resident's name or list the cardiologist as the primary - in which case the PCP does not get notified. "Fortunately, physicians are considered covered entities so there is no breach of confidentiality," says Stevens. "It does create additional paperwork and communication on the part of the incorrectly selected physician."
Other problem areas include erroneous insurance information that may not be detected until a denial by the incorrectly identified payer lets the billing office know that the patient is not one of their insured. "Additionally, if anyone in the IDN changes an address that was perceived as incorrect, but really was not, it sets up a series of events including billing the wrong patient," says Stevens.