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Verifying patient data can reduce claim denials

Rachel Wheeler Archive
Getting claims right is essential for the healthcare industry, especially in anticipation of reimbursement changes as the result of the Affordable Care Act (ACA). While denials are generally perceived to be the responsibility of back-end claims departments, Richard Williams, the managing director for Chicago-based Protiviti’s healthcare practice, told Healthcare IT News that 60 percent of information is collected at the front end.

When patients arrive for an appointment, they provide the front desk staff member with their name. If this data is entered incorrectly into a system, the results will be evident at the back end when claims are denied. This could become even more problematic as physicians take on new patients and see scheduling increases.

Physician's Practice recommends that practices have steps in place to verify the data quality at the point-of-entry. If the name a patient provides doesn't match his or her insurance information - such as shortened version instead of a legal moniker - practices could run into problems.

Moreover, an efficient system for processing data can help practices improve their performance, reports American Medical News.

"Things improve if we can show data, and the data is believable, and we can benchmark that data against something," Todd Shuman, the director of quality at Roper St. Francis Healthcare, told the source.