Author: Dr. Vajrala Supriya, Pharm.D

Abstract:

Healthcare organizations are aware that the most important part in the process chain for the revenue cycle is the accurate entry of patient demographic data. The overall revenue cycle may be affected by inaccurate or incomplete demographic information entry, which can lead to claim denials and subsequently delayed payments. Every detail of the patient is included in the data collected during the demographic entry process, which forms the basis for the medical record and has an impact on the payment of insurance claims.

Accurate information of patients is the key to ascertain the patient’s eligibility and benefits, obtaining prior authorization, and error-free claims filing. Keeping up & updating the patient demographic data without any errors can be a daunting task for any healthcare center. If you are finding it challenging to record and manage this huge amount of data, Outsourcing Patient Demographic Entry Services is the solution to ensure successful claim processing.⁽¹⁾

Introduction:

Patient demographics consist the information issued by the patient to the hospitals or medical centers. Physicians’ clinics and hospitals need to be very careful when collecting patient demographic information. Checking the vitals is the core in the medical field, principally for health insurance claims.

Patient-specific information including Name, Age, Gender, Allergies, Previous Medical History, Insurance ID number, SSN, Address, and Contact Information are included in the patient demographics data. ⁽⁴⁾

Medical practices and hospitals must ensure the patient demographics data is: ⁽⁴⁾

Accurate: Accuracy of data is essential as the data forms the basis of claim submissions. A single inaccuracy or data omission may result in the denial or rejection of a claim.

Quick: Medical practices that store patient data in a systematic format find it easier and quicker to find submit claims. Medical billing professionals deeply benefited through patient demographics details that can be retrieved rapidly whenever desired.

Importance of Patient Demographics:

When done manually, the medical billing procedure can be very difficult. The process is tedious and requires utmost care. Submitting claims with inaccurate or outdated information about the patient can lead to a delay in reimbursement of the payment or in worse case denial.

Patient demographics are crucial for both reimbursement and doctor assistance. Medical history and/or allergies part of critical information will help the clinicians in decision-making and framing a treatment protocol. Patient demographic details not only helping in reimbursement and also assist the doctor.

Things to keep in mind for Patient Demographics:

Capture with care: The patient’s information must be recorded with the utmost attention and care. The information provided should be checked thoroughly and making sure the information is genuine.

Eliminate all possible errors: All the data must be accurate. Look out for possible errors and be vigilant to guard against those. Technology can help practitioners be informed of any mistakes in the demographic information for the patients and make timely corrections.

Update at regular intervals: Periodical updation of the information in the system provided by the patient. Reimbursements will be difficult with the outdated data.

Practices can get up-to-date coverage information for each patient demography with the help of eClaim status’ real-time eligibility and benefits check. When necessary, the system emphasizes and makes it possible for clinics to update a patient’s demographic information. Technology-enabled seamless processes can aid in minimizing denials and reducing errors. ⁽⁴⁾

Patient demographic entry

Also termed as “face sheets” or Patient demographics sheets include all the basic demographic information about a patient. Each piece of information is crucial since the accuracy and quality with which it is entered will have an immediate influence on the physician’s monthly income. ⁽²⁾

A good patient demographic form is essential to obtaining accurate information which is required for claim submission. Providing more than enough information will decrease the chance of getting rejected by the insurance companies. Most of the insurance will not process claims if any piece of information is missing from the demographics ⁽²⁾

1. Patient Information.
2. Patient Employer Information.
3. Patient Guarantor Information.
4. Physician Information.
5. Insurance Information.

Before updating the data in the billing software following the patient’s service, CNTI thoroughly verifies all of the patient’s insurance and demographic information. When a patient returns for more care while a current patient, the team confirms their eligibility. By minimizing data entry through inventive integration of cutting-edge technologies in the billing software, our knowledgeable billing professionals guarantee a flawless solution. ⁽²⁾

This department is responsible for entering all information received from the Physician’s office. Gathers information from patient demographic file, client file and charge ticket/ sheet. The act of entering this data into the billing program is known as charge creation. ⁽²⁾

Information Captured in the Patient Demographics Entry Process

Medical billing professionals carefully record patient demographic information that was provided by the patients at the time of their appointment, including name, date of birth, residence, insurance information, medical history, guarantor, etc. We verify these facts for current patients and make any required corrections to their patient records on the practice management system. ⁽²⁾

Process details: Listed below are the different steps involved in creating a Demographic detail of a patient in the system. ⁽²⁾⁽⁷⁾

1. Patient details ^{(2) (3) (4)}

• Patient id #: (If applicable)
• Patient name
• Date of Birth
• Sex
• Marital status
• Social security number
• Address (physical and mailing address)
• Medical history
  • Drug allergies
  • Surgeries
  • Medical conditions
  • Current medications
  • Family medical history
• Home Telephone number
• Employer name and address
• Work Telephone number
• Family Doctor’s Name
• Emergency Contact
• Ethnicity
• Allergies   
• Blood Type
• Major Diagnoses

2. Guarantor/Account details ⁽²⁾

• Guarantor name
• Date of Birth
• Sex
• Marital status
• Social security number
• Address (physical and mailing address)
• Home Telephone number
• Employer name and address
• Work Telephone number

3. Insurance details ⁽²⁾

• Insurance name and address
• Insurance identification number
• Group name/Group number
• Validity of the policy
• Name of the insured (subscriber)
• Relationship of the insured to the patient/guarantor.
• Financial Class (FC)

Conclusion:

Patient demographic data entry errors result in claim denials, which in turn lead to delayed payments. Research shows that healthcare organizations lose as much as 7% of their annual revenue due to errors in demographic data capture. Establishing a precise and standardized process for collecting patient demographic information helps safeguard against serious mistakes and errors being made at an early stage. Accurate demographic data collection decreases payment delays and denials while increasing the rate of clean claim submissions. ⁽⁶⁾

 References:

1. https://www.suntecindia.com/patient-demographics-entry-registration-services.html
2. http://sidsoft.in/entry.aspx
3. https://mindsea.com/patient-demographics/
4. https://www.flatworldsolutions.com/healthcare/patient-demographic-entry-services.php
5. https://www.eclaimstatus.com/blog/what-is-patient-demographics/
6. https://www.accesshealthcare.com/services/revenue-cycle/patient-registration-patient-demographics
7. https://www.medicalbillingwholesalers.com/services/patient-demographics-entry