Mitigating patient misidentification in a new era dominated by Medicare Beneficiary Identifiers

As the Medicare Access and CHIP Reauthorization Act of 2015 drives sweeping changes in care delivery, reimbursement models and reporting requirements, healthcare leaders are scrambling to understand all of its elements and implications.

Broadly, MACRA is a movement from volume-based to value-based reimbursement models. To determine financial incentives for physicians, CMS will begin evaluating and comparing physicians using outcomes-based data for Medicare patients. Its many facets will impact more than 600,000 clinicians in the healthcare industry, revealing the importance of understanding the legislation in full.

The new Medicare patient identification cards are one often overlooked aspect of MACRA that could hugely impact revenue cycle efficiency, EMR integrity and patient safety. Under MACRA requirements, randomly assigned 11-digit codes — Medicare Beneficiary Identifiers — will replace all Social Security-based health insurance claim numbers, likely increasing the risk of patient misidentification.

In an Oct. 17 webinar sponsored by Imprivata and hosted by Becker's Hospital Review, Christy Murfitt, vice president of product marketing for Imprivata, and Jordanna Davis, president of Rockingstone Group, discussed the challenges involved with the transition to MBIs, the impact of patient misidentification, and the preemptive strategies healthcare leaders can employ to decrease patient safety risks and lessen the financial burden of patient misidentification through the transition to MBIs.

MACRA's affect on patient identification

Since Medicare began in 1965, CMS has assigned beneficiaries Social Security-based health insurance claim numbers, which are printed on beneficiaries' ID cards. As identity theft and medical and financial privacy have become increasingly concerning, legislators took action through a provision in MACRA.

Under MACRA, Social Security-based claim numbers must be replaced with Medicare Beneficiary Identifiers by January 2020. On April 1, 2018, CMS will begin sending replacement Medicare cards with MBIs to more than 150 million beneficiaries — 60 million living and 90 million deceased beneficiaries — inevitably leading to challenges as the healthcare system transitions.

According to Ms. Davis, the transitional period could potentially create significant administrative challenges for providers, leading to patient misidentification at the point of care.

"When you change the personal identifying information of 60 million patients in a span of 21 months, there's simply a greater risk of patient misidentification — even without the changing Medicare cards, patients are misidentified 7 to 10 percent of the time," Ms. Davis added.

The affect of patient misidentification on patient safety, revenue cycle

Patient misidentification can severely impact patient safety and revenue cycle efficiency, according to both speakers.

"The increased risk of patient misidentification [with the transition to MBIs] … leads to an increased risk of medical errors, duplicate and overlaid records and ultimately a risk of revenue loss and data scrubbing costs," Ms. Davis explained.

Patient safety is compromised when a patient's record becomes duplicated or overlaid as a result of misidentification. A duplicate medical record could harm patients because 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 prescription drugs the patient takes. An overlaid medical record — intermingling two patients' medical records — could result in a HIPPA violation if patients receive another person's bill or record. Misidentifying patients and pulling the incorrect EMR also significantly increases the risk of clinical errors, such as receiving the wrong blood type. 

"We are causing harm [adverse events] to almost 1 of 1,000 patients because of misidentification. That, in anybody's terms, is not acceptable," Ms. Murfitt said.

Not only does patient misidentification cause patient safety concerns, it also impacts health organizations from a financial perspective.

"Patient identification is the front door to patient care. If we get it wrong upfront, there are a series of downstream ramifications that cost our health system a lot of money and cause lower quality care," said Ms. Murfitt.

Patient misidentification disrupts various parts of the revenue cycle. An employee may use inaccurate demographic and insurance data to send bills and submit claims, leading to increased denials, longer days in accounts receivable, missed revenue and  increased bad debt.  

In further detail, Ms. Davis explained specific amounts misidentification can cost providers. "If registrars create new incomplete records, it costs nearly $1,000 per denied claim … if registrars find the right record but input the wrong MBI, it will cost $25 to fix … and if patients are misidentified and registrars create an overlaid medical record, it can cost $5,000 per record to fix," she said.

How health systems can mitigate patient misidentification

Properly identifying patients and linking the patient to his or her correct medical record is one of the best ways to mitigate preventable medical errors and optimize revenue cycle efficiencies.   

Prior to April 2018, when CMS begins sending out new Medicare cards, hospitals and health systems can employ preemptive strategies to promote positive patient identification at registration to diminish these risks.

One highly accurate strategy to decrease patient misidentification is biometric identification, which uses a biological marker, such as a palm vein configuration or an iris scan, to identify the patient. Biometric identification systems ensure front-line staff correctly identify patients to retrieve the correct record in the EHR, according to the speakers.

"Biometrics creates a 1-1 link between the patient and their medical record … to improve first and foremost patient safety, but also to eliminate duplicates and overlays and prevent insurance fraud," Ms. Murfitt said.

Biometric identification is a highly accurate and widely accepted method because it is unique to each individual, is usable and is easy to adopt.

"When patients hear why you are scanning their biometric … to ensure the safety and accuracy of their medical record, it is very well received. In addition, patients appreciate not needing to say identifying characteristics out loud, such as their SSN," Ms. Murfitt added.

Another method to mitigate patient misidentification, which becomes even more vital in the transition to digital healthcare, is ensuring data integrity. Some of the best approaches to ensuring data integrity include implementing enterprisewide governance policies, providing continuous patient access training and establishing patient identity metrics and patient matching algorithms.

Overall, the Medicare card initiative under MACRA will create logistical challenges for providers as 60 million patients receive new identifiers. It is important to employ positive patient identification strategies to mitigate patient misidentification and avoid the ramifications of preventable medical errors, erroneous data and financial losses.

To view the webinar recording, click here. To view the webinar slides, click here.

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