Medicare bill requirement sparks patient name debate
Safety issue cited
When the physician billing department at the University of Arkansas for Medical Sciences (UAMS) Medical Center in Little Rock urgently requested that hospital registrars enter the patient's name into the system exactly as it appears on the Medicare card, it started a round of problem-solving efforts.
The issue, says Holly Hiryak, RN, CHAM, director of hospital admissions, was the Centers for Medicare & Medicaid Services (CMS) requirement that the name used on the claim form match the name on the patient's Medicare card. While the requirement is confined to Medicare at present, she notes, the expectation is that other third-party payers will follow suit.
The challenge, Hiryak adds, stemmed from the large number of patients who use initials, or some other version of their name, on the Medicare card, instead of their legal name, and the hospital's concern that not using the legal name would be a problem.
"The physician billing side wanted us to enter the insurance card name at the corporate person index [CPI] level," she says. "That's the master file that goes across the system, with the demographics of the patient, the guarantor, etc. [The name] is part of the permanent medical record, and it's what the nurses write on the labels or forms coming out of the system."
Hiryak didn't want the clinical staff dealing with patient names that included initials or nicknames, she adds, "because the name and date of birth are two of the identifiers they use to ensure patient safety."
The problem doesn't arise with hospital claims, Hiryak notes, because that billing system allows the patient name to be entered as it is on the card, used on the claim, and yet "never hit the CPI" or the medical record.
While the UAMS legal department actually gave the OK to use whatever version of the person's name appeared on the Medicare card in the billing system, the patient safety officer said no, Hiryak says.
When the physician billing department kept pressing the point "and made it a huge issue," she notes, the hospital access staff began documenting cases of patients with the same last name in the system, and showing how variations in the first name could pose a threat to patient safety.
"Physician billing [staff] kept saying, 'Well, we're not going to get paid,' and we said, 'Go back to your system — there's got to be a way,'" Hiryak explains.
The resolution came after a UAMS manager explained the dilemma on the University Hospital Consortium (UHC) listserv and asked members whether there had been similar debates at their organizations and, if so, how they had been resolved.
The clear-cut response was that the issue was being handled before reaching the CPI or medical record level, she explains.
One UHC member said his hospital's registration system has a field that captures the patient's name as it appears on the Medicare card, and that name goes on the claim. "However," he adds, "we store the patient's legal name at the patient level and it is used for all other correspondence/communications, etc."
Another member said his organization's solution was to use the HIPAA 270/271 electronic eligibility software with its admission/discharge/transfer (ADT) system.
"When we register a patient with Medicare or Medicaid, the request for the eligibility response is returned to us with the name of the recipient as it appears in the Medicare and Medicaid databases," the respondent continues. "This information then is interfaced to the billing screens for Medicare and Medicaid so that the name on the claim matches what is in the Medicare and Medicaid system.
"We keep this at the insurance account level and do not allow it to update the patient's legal name on the medical record," that member adds. "We have significantly reduced our [percentage of] Medicare Return to Provider [RTP] for mismatch of names."
As a result of the definitive nature of this feedback, Hiryak notes, the physician billing department is now working with the UAMS information systems staff to change the field from which the computer interface is sending the patient name. "It is currently the CPI [field], but soon they will send from the insured name field."
[Editor's note: Holly Hiryak can be reached at [email protected].]
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