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End-to-End Revenue Cycle Management

Patient Misidentification: 5 Tips to Ensure Patient Safety and Prevent Revenue Leakage

Patient misidentification is a topic most of us as healthcare leaders and as patients would rather not think about. But it can't be ignored. According to the Ponemon Institute’s 2016 National Patient Misidentification Report, 30% of medical errors and 35% of all denied claims are the results of patient misidentification. 86% of respondents to the report’s survey have witnessed a medical error due to misidentification. In addition, medical identity fraud, such as stolen or shared insurance cards, impacts roughly 2.3 million patients each year. Furthermore, medical identity theft is expected to see a 20% rise year over year. The statistics presented above are quite troubling indeed, and there isn’t a surefire solution to this growing problem in healthcare.

The leading cause of patient misidentification happens at registration, at the very outset of the patient experience. Perhaps registration staff are rushed, do not have adequate tools, or are not properly trained. Or there may be a communication issue between the registrar and the patient: a language barrier or the patient may be unconscious. The difficulty in finding the correct medical record (out of thousands, sometimes millions) and the creation of duplicate records are the top reasons for misidentification.

Patient misidentification is downright dangerous, and needs to be addressed in a proactive manner to ensure patient safety and prevent revenue leakage.

Danger to patient safety

Patient safety is the number one concern when it comes to correctly identifying patients. A misidentified or duplicate record with incorrect or incomplete patient information can all too easily create a life-threatening problem if clinical information is missing or inaccurate. The scenarios are frightening: the wrong blood type is infused, a drug-to-drug or drug-to-allergy interaction is missed or tragically, the wrong patient’s family may be contacted about a loved one in the hospital, creating unnecessary grief and significant HIPAA compliance breaches.

Danger to your organization’s reputation

Along with the patient safety risks, correcting patient identification errors is time consuming and costly. Even if there isn’t an immediate safety threat, there is a high risk of patient dissatisfaction.  Patients may feel frustrated that their healthcare provider didn’t get their information correct the first time around and they may feel bothered when asked to provide it a second time. If the misidentification goes so far that a balance owed for a visit is billed out to the incorrect patient, it could end up costing your organization in protected health information security fines.

Danger to your revenue

With 35% of all claim denials attributed to some form of patient misidentification, including missing or invalid insurance information and inaccurate/incomplete patient information, there’s no denying the impact on your revenue and the extra work for your A/R follow-up staff. On average, per the Ponemon study, misidentification errors cost healthcare facilities 17.4 million dollars each year in lost revenue and denied claims. Getting it right the first time can reduce denials and allow your follow up staff to focus on other issues.

While there is no silver bullet to solve patient misidentification, the following tips can aid in the prevention of errors:

  1. Be proactive in training your clerical staff to use multiple identifiers to ensure they select the correct patient at check in.

  2. Implement a formal procedure for registration with your health information management division to prevent duplicate records, or use a J. Doe process if the registrar is not able to match all patient identifiers to the medical record.

  3. Train clinical staff to verify the patient’s name and date of birth in each and every interaction throughout the visit. This is imperative to ensure that the correct patient record matches up to the patient in front of them. If the information isn’t matching, it should be an immediate red flag to further verify patient identity.
  4. Educate patients on the importance of providing the correct demographic and insurance information. During initial patient contact —whether it’s scheduling, pre-access, in the emergency department, or in the urgent care clinic —registration staff should capture proof of identification, such as a driver’s license and insurance cards to store on file, while explaining the importance of patient’s providing correct and up to date information.

  5. Invest in biometrics technology to take the guesswork out of patient identification. Popular biometric software includes palm-vein, fingerprint, and iris scanners that instantly identify the patient — even when they are unresponsive. While this option will cut down on duplicate records and medical identity theft, keeping accurate demographic and insurance information will still be the responsibility of the registration staff.

The Bottom Line

Patient misidentification is an ever-present threat to patient safety as well as to a healthcare organization’s reputation and revenue. As healthcare continues to change rapidly, this problem is anticipated to grow unless there is a diligent focus on reducing the number of patient misidentifications now. Evaluate the number of instances within your own organization and collaborate with your compliance department and Health Information Management to determine the proper solution. 


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