Is patient misidentification really such a big deal?

Nov 16, 2017

In New Medicare Card is just like other big changes CMS has made, right?, the scale of the change presented by MACRA’s New Medicare Card initiative was compared to other recent changes the Centers for Medicare & Medicaid Services (CMS) has implemented. These included the introduction of the Medicare Part D program, and the rollout of the Medicaid expansion and The Affordable Care Act exchanges in 2014. It’s clear that the scale of the New Medicare Card change is far greater than anything in recent CMS history. But does that just mean a bigger logistical headache for CMS, providers, and beneficiaries? Or could this chaos lead to more serious issues as well?

When patients experience a change in personally identifying information, such as their Medicare beneficiary number, providers face a greater risk of making errors in the patient identification process. That is, the process of accurately identifying a patient and matching them to intended services, treatment, and their unique medical record. And patient identification is a serious issue. In fact, patient identification errors are so critical that the Joint Commission has made accurate patient identification one of its National Patient Safety Goals since it first issued the goals in 2003.

MACRA and the potential for misidentification

Even without the complication of new Medicare cards, studies indicate that patients are misidentified during medical records searches between 7 and 10% of the time.1 But the complication of the New Medicare Card initiative could make this number even higher. Consider these three scenarios:

  1. A Medicare beneficiary registers with a provider, they present their Medicare card and another form of identification. The registrar queries the electronic medical record using the new Medicare identification number, doesn’t find a record, and mistakenly assumes the patient is new. The registrar then creates a new, duplicate, and incomplete record.

  2. The intake staff correctly matches the patient to their existing medical record, but makes a data entry error when updating the new Medicare Beneficiary Identifier. The error isn’t caught in a timely manner, causing claims processing disruption for the provider.

  3. When intake staff can’t find a patient using their new Medicare identifier, they select the wrong patient record at registration and clinical staff continue to use that incorrect record throughout the encounter (an overlaid record). The patient’s care is compromised, the wrong patient’s insurance is billed for services provided, and providers incur costs to resubmit the claim and to correct the medical record that was overlaid with another patient’s information.

As laid out in these examples, patient identification errors have both quality and financial consequences. A recent study of patient identification events found that 23% resulted in a harm score. Of these events, 9% caused temporary or permanent harm, or even death.In addition to the risks for clinical error, healthcare providers can lose between 1-4% of net patient revenue each year due to claims denials that are often due to misidentification.The Advisory Board estimates that 30% of these denied claims are due to patient misidentification and that accurately identifying patients could reduce claims denials by 25%.

In addition to revenue loss from denied claims, providers also face internal costs of fixing duplicate and overlaid records. Estimates indicate approximately 8-12% of all hospital medical records are duplicates, and that fixing them can cost up to $1,000 per record.Overlaid medical records, when the information for one patient is mistakenly entered into another patient’s medical record, are even more complex and costly to fix, approximately $5,000 per record.

So is patient misidentification is a big deal? It is. And with the New Medicare Card initiative roughly doubling the number of Americans with new insurance identifiers, it’s worth planning for this transition before it creates real problems.

Preparing for MACRA changes

To learn more about the New Medicare Card initiative and to understand potential impacts on patient identification, download our whitepaper, The challenges of MACRA – and how biometric patient identification can help, or watch our on demand webinar, Overcoming MACRA obstacles with positive patient identification.



1 http://www.rand.org/news/press/2008/10/20.html
2 https://www.ecri.org/Pages/Patient-Identification-Deep-Dive.aspx
3 http://www.beckershospitalreview.com/finance/4-ways-healthcare-organizat...
4 AHIMA MPI Task Force. “Building an Enterprise Master Person Index.” Journal of AHIMA 75, no. 1 (Jan. 2004): 56A-D