Patient Misidentification and its Impact on Patient Safety and Hospital Revenue

by | Last updated Jul 4, 2023 | Published on Dec 1, 2017 | Insurance Verification and Authorizations

Patient Misidentification
Share this:

The routine process when a patient arrives at a healthcare facility is to go to the front desk, hand over a form of ID and/or insurance details for medical eligibility verification. The front office staff takes a copy of those personal ids, and then a clipboard with forms will be given to fill out and then the patient will be sent to the waiting room to be seen by a clinician. The concern here is about the patient identification method.

Inadequate identity verification can endanger the patient’s safety and the safety of other patients often resulting in medication errors, transfusion errors, lab and testing errors, wrong patient procedures, and more.

The Social Security Number Removal Initiative (SSNRI) that comes as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be providing new Medicare cards from April 2018 and ends on December 31, 2019. Though the Centers for Medicare & Medicaid Services (CMS) has taken this initiative to reduce Medicare beneficiary vulnerability to identity theft, the removal of Social Security-based health insurance claim numbers is likely to increase the risk for patient misidentification at hospitals.

Patient misidentification can severely impact patient safety and revenue cycle efficiency. It leads to:

  • increased risk of medical errors
  • duplicate and overlaid patient records
  • wrong procedures
  • risk of revenue loss and data scrubbing costs

Patient safety could be compromised with duplicate medical records, as the new record may lack the patient’s allergies, medications as well as other vital treatment information. Claim submission with such inaccurate data could also lead to increased claim denials.

The 2016 National Patient Misidentification Report

Published by Ponemon Institute in December 2016, the report highlights that of the 503 individuals that participated from a range of facilities across the U.S,

  • 63% respondents said that the primary cause of patient misidentification is incorrect identification of patients at registration
  • 35% of all denied claims result directly from inaccurate patient identification or incomplete patient information, costing the average healthcare facility $1.2M/year
  • 67% of respondents said that when searching for information about a patient, they find duplicate medical records for that patient almost all the time
  • 76% of respondents said that positively identifying a patient at registration through biometrics could reduce denied claims

To prevent this risk, it is critical for healthcare organizations to employ preemptive strategies to lessen the impact that MACRA could have on their medical record integrity, revenue cycle efficiency, and ultimately patient safety and satisfaction.

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.

Two recommended options to reduce this risk are

  • To use biometric identification that uses a biological marker such as a palm vein configuration or an iris scan to identify the patient. With this system, front-line staff can correctly identify patients to retrieve the correct record in the EHR.
  • To ensure data integrity by implementing enterprise-wide governance policies, providing continuous patient access training and establishing patient identity metrics and patient matching algorithms.

Before CMS begins sending out new Medicare cards, it is important for healthcare organizations to employ such positive patient identification strategies, preventing medical errors, erroneous data and financial losses. An experienced insurance verification specialist with in-depth knowledge in coverage guidelines would help to check whether the patient is eligible for the treatment, before the consultation.

  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
    Meghann Drella
    CPC: Senior Solutions Manager: Practice and RCM

    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

  • Amber Darst
    Amber Darst
    Solutions Manager: Practice and RCM

    Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.

  • Loralee Kapp
    Loralee Kapp
    Solutions Manager: Practice and RCM

    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.