Wiki Patient and Insurance Demographic Question

DoubleD

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We are trying to get some guidance as to the following; occasionally, our billing staff encounter a situation where the patients’ insurance card or portal does not agree to the demographics entered into the practice management screen, such as date of birth or spelling of name.
Our current practice is to change the registration to match the insurance card and flag the front desk to contact the patient that their insurance company has different information, and that if the insurance company has the wrong information the patient needs to contact them to fix their record.

Although I believe this is the way this is handled at most practices, I do not know if it is considered best practice or if you have ever encountered anything official around this. I can’t find any specific guidance from an official source.

Input / suggestions / ideas?

Thanks in advance.
 
Compliance

As a long standing healthcare manager I have personal witnessed these errors and was unable to find anything specific or related to this issue. However, compliance is pretty clear.

The information regarding patient legal names and date of birth should be accurate. Using incorrect information can become a permanent imprint in a patient medical record. Which could lead to many other issues.

In my current practice if such an issue is identified it is corrected in the system to reflect the legal name and DOB. The patient is then contacted and advised of the issue, given direction to resolve with health insurance administrator and payer contact information.

The end result is if this information is not corrected, it should be clearly documented in the patient's account.

Hope this helps some.
 
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