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Patient Demographics

Author: Konda Ashwini

ENTRY OF PATIENT DEMOGRAPHICS.

Providing the greatest treatment and services for patients is the top priority of every healthcare professional. The provider must first have a thorough understanding of their patients in order to do that.

Patient demographics are crucial for this reason. The data you gather from patients can reveal a lot about their requirements, enabling you to deliver better care and the most efficient therapies.

This article is intended for medical professionals and practice owners who want to understand better regarding the entry of patient demographics and their billing procedures.

Definition of Patient Demographics:

The data that patients give to hospitals or medical facilities is known as Patient Demographics.

Hospitals and physician clinics need to be particularly careful when recording patient demographics.

The crucial data serves as the foundation in the medical industry, particularly for insurance claims. The patient demographics data includes information on the individual patient, such as Name, Age, Gender, Allergies, Previous Medical History, Insurance ID number, SSN, Address, and Contact details.

The following patient demographic information must be guaranteed by medical offices and hospitals:

• Authentic:

Since data is the foundation for claim filings, data accuracy is crucial. A single mistake or data omission could result in the denial or rejection of a claim.

The information gathered during the demographic entry process not only serves as the foundation for the medical record but it also has an impact on the settlement of Insurance claims.

One of the most undervalued steps in the revenue cycle process chain is the accurate recording of the patient information.

• Prompt :

Medical practices find it simpler and faster to submit claims when patient data is organized and stored in a systematic way.

For a claim to be submitted correctly and for the payers to process claims quickly or promptly, error-free patient data must be collected.

Patient’s demographic data that is readily accessible when needed can be of great value and helpful to medical billing professionals.

• The front desk at the facility where the patient is receiving care should appropriately record the patient’s information, either through paper-based registration procedures or through the scheduling systems.
• For the purposes of determining the patient’s eligibility and benefits, securing prior approval, and filing claims without error, accurate information on the patient is essential.
• Furthermore, correct patient information is required for population health analytics to be successful.

Information gathered during the course of Patient Registration /Patient Demographic Entry:

• The revenue cycle specialists – staff at Medical Billing Wholesalers have received training to verify all the data on the face-sheets.
• In case of any irregularities, the team contacts the provider’s office or the medical billing organization.
• Within a time period of 24 to 48 hours, members of the team accurately and quickly enter the valid data into the client’s practice management software.

Regarding the practice management system, update, review and examination of  the following data is done:

Demographics data

Insurance Information for Healthcare

Health Information

Payment Details.

Family Doctor’s Name and his contact number details.

1. Demographics data:

Legal name, age, DOB, gender, residence, blood group, nationality and contact number of the patient.

Social security number for the patient as proof of identity.

2. Insurance Information for Healthcare:

Payment details (name of the Payer, mailing address for claims, and group and policy numbers)

Information about both the primary and secondary payers.

Health insurance or Medicare card (if the patient receives federal or state assistance).

3. Health Information:

Any kind of Allergies.

Major diagnosis.

Unique specifications (interpreter, assistance for physically disabled people, past medications history, Ambulance, stretcher access, etc.)

4. Payment details:

The person who will be in charge of payments must include their name, address, and phone number.

A patient registration form that should be simple to fill -up:

The patients could become annoyed if they are asked too numerous or open-ended questions, even though gathering this information is crucial.

Therefore, it is imperative that maintaining the patient appointment/registration form as straightforward and easy to use as possible.

To make filling out the form simpler, there should be more closed-ended questions of the yes/no variety. Similarly to this, healthcare staff must emphasize the important information that must be filled out in full for their own advantage.

Make sure that the computer receives accurate data from the patient registration form:

The gathered data must be electronically entered by using computer.

Human mistake is possible while entering the patient demographics information into the system.

There is a greater likelihood of typing errors or omitting crucial information because the majority of hospital employees will be rushing to attend to patients.

Human mistake is unavoidable, but as a fallback, we may always hand file all patient demographic entry forms in a physical file because we know that human error is unavoidable.

The manual entry and the digital entry can be cross-checked with the aid of this. The patient’s information should be verified, which is another crucial point to keep in mind.

Since the patient fills out the form by hand, they occasionally may forget to complete a few crucial fields or their handwriting may not be readable.

The filled-out form must therefore- should be reviewed by the hospital staff as soon as the patient gives it to them. At that point, you can ask for clarification if there are any questions about the spelling or if any crucial information is missing.

• Example:

It will be quite impossible to submit an insurance claim if the spelling of the name of the person is “Rama”, but in the computer record/entry of name is done as “Ramu”.

Numerous other significant factors, including age, race, etc., are also essential to the processing of the claims in a similar manner. A higher chance of claims denial exists if the information submitted contains errors.

Issues with patient data maintenance:

Maintaining patient information is another significant issue that hospitals face. Outsourced billing businesses /companies enter the picture in this situation.

When the hospital’s billing procedure is outsourced, the outsourced company is responsible for handling claims, patient information, and data accuracy. They have received thorough training on how to obtain insurance claims, procedures, processing times, and so forth.

They are also knowledgeable about various medical billing programs. Hospital jobs are made simpler as a result. Most importantly, outsourcing lightens the load on medical professionals and personnel life. On the other hand, it also readily raises claim revenues by 20 -30%.

Updating Patient Data On A Regular Basis:

One may also experience a change in contact information, such as an address or phone number. Therefore, it’s important to stay in touch with your patients so that you’re aware of any changes to their information.

While keeping in touch with the patients is a good idea, but having too many conversations can sometimes be detrimental. A newsletter or email sent once per month or for every two months might be sufficient.

Perhaps every six months, we could send them an online form asking them to fill out the most recent updated information regarding them.

INFORMATION ABOUT THE COVERAGE:

• Primary, Secondary, and Tertiary are the three modules. The following will be present in each module:

Insurance Number, Insurance Name, and Type of Patient, First ID, second ID, relationship, effective from, effective to, detailed relationship.

Example:

If a Patient have multiple insurance policies. In this situation, one of them may function as the Primary Coverage and handle the claim and payment before the others. There is no obligation for the Secondary and Tertiary coverages if the Primary Coverage pays in full. The secondary, tertiary, or patient will be liable for it if the primary coverage allots a portion of its permitted amount as co-insurance.

Each plan will give its members an identification card with the Plan name, member name, policy number, group/plan number, and effective dates on it. The claims mailing address and phone number are listed on the reverse of the card. The information above must be completed based on this card copy and the data on the patient registration form.

The demographics can be adjusted/updated once all information above as been entered. If any of the crucial data is not accessible, then the demographics can be kept on hold or waiting.

The software’s mandatory fields are all similar to this above image.

The following could appear during patient demographics entry:

If a Patient Record is already in existence:

There is no need of registering a patient again in the system if you come across one who already exists in the batch for which you are performing demographics. However, you must confirm that the data on the demographics sheet matches what is in the system. You can immediately edit information in the system and note the change if it differs from the coverage. You must archive coverage if the coverage is different.

By removing the current coverage and adding a new one to the patient demographics in the system, you can archive coverage. The patient’s coverage history includes a record of the current coverage. Nevertheless, if the new coverage is worker’s compensation, you must re-register the patient because worker’s compensation is for a specific incident involving an injury sustained at work or while performing official duties and supersedes any other health coverage the patient might have as of the date of service.

Why is it vital for the medical billing cycle to have a demographic entry process?

The initial stage of the medical billing cycle is the demographic entry process, and study shows that one of the main causes of claims denial is due to incomplete or inaccurate patient information submitted to the insurance company. This has an immediate impact on the insurance companies ability to quickly pay out claims.

If claims are submitted to an insurance provider with incorrect patient demographic information, the top refusal causes are listed below:

• Incorrect/Invalid Patient details.
• Unable to identify patient.
• Unreliable patient name and date of birth.
• Mismatched patient gender.
• Mismatched Insurance ID.

Examples Include

• Instance I:

Consider that when the Demographic Entry Team submitted the claim on paper for the patient Rama, they entered the wrong BCBS insurance information rather than UHC insurance. As the patient cannot be recognized, BCBS insurance decided to reject the claim (BCBS insurance’s system does not include this patient’s information).

• Instance II:

Assume, therefore, that the patient’s gender was entered mistakenly as Male rather than Female.

Since some procedure codes are listed according to the patient’s gender; therefore, if the patient’s gender is mismatched and the procedure code is mentioned, the claim will be rejected

Thus, the first stage in the medical billing cycle for filing the clean claim and getting reimbursed very quickly if everything seems to be in order is an accurate patient demographic input. In order to avoid rejection from the clearing house or denials from insurance companies, the first crucial step is proper demographic entry.

CONCLUSION.

As a healthcare professional, be aware of the difficulties in obtaining prompt payments for unpaid patient bills. Don’t undervalue the significance of patient demographics if you want to enhance your billing and collection process.

The initial stage of collecting data that is often acquired from a patient is called patient demographics, which includes details like from the patient’s date of birth to the insurance companies they are enrolled with. In terms of billing, customers choose who to address the claim to, where to send the final bill, and who to contact if there is a problem with payment. If the right information is not gathered when the patient is at clinic, this procedure could fall apart at any step.

In order to maintain a relationship with patients, it is crucial to gather demographic details about them. This data will give significant insights into patients’ needs and enable to offer the most effective care and treatment.