The misidentification

of patients is
typically considered
to be a safety
issue, but the
problem also
carries financial
ramifications.
BY LISA A. ERAMO, MA

The Untold
MPI Story
How ‘Dirty Data’ Affect a
Value-Based Revenue Cycle
W
hen most of us think about mas-
ter patient index (MPI) errors,
our minds immediately go to
the worst-case scenarios: A
patient prescribed a medication
to which they’re allergic expe-
riences a negative outcome. A patient undergoes the
wrong procedure. There are delays in a patient’s can-
cer diagnosis and treatment all because of a duplicate
record or overlay.
In fact, the ECRI Institute identified diagnostic
errors and the improper management of test results in
the EHR as the top patient safety challenge in 2019. It
isn’t a stretch to assume these errors and data mis-
management are largely due to an inability to match
records accurately.
But experts say negative patient safety–related out-
comes don’t tell the entire story of what can happen
when MPI errors occur. In fact, there are other impor-
tant implications that actually affect an organization’s
bottom line and perhaps its ability to remain profitable.
“There’s a lot of literature on how the MPI affects
patient safety, but not a lot of information on how the
MPI affects reimbursement and the revenue cycle,” says
Joe Lintz, DHA, RHIA, CHDA, HIM program director at
Parker University in Dallas, who researched the impact
of the MPI on revenue at three major hospitals as part of
his doctoral dissertation at Central Michigan University.
Lintz, who manually reviewed denials and error codes
at all three hospitals over a period of six months, found
that although MPI error rates were fairly low, there was
significant revenue loss due to improper tests, duplicate
testing, and inappropriate billing and coding.
For example, one hospital had approximately 8,500
discharges over six months with an MPI error rate of
0.14% (eg, only 12 records). However, using question-
naires completed by MPI staff, he gleaned that it took an
average of 10 hours per error to research and reconcile
the information. At a rate of $85 per hour (total of staff
and consultant time), this equates to $10,200. For organi-
zations with higher duplicate rates, this amount is even
more significant. This is in addition to revenue lost due
to the actual denials, Lintz says.
A recent survey conducted by BlackBook Research
found that 33% of all denied claims result from inaccu-
rate patient identification or information, costing the
average hospital $1.5 million in 2017 and the US health
care system more than $6 billion annually.
As if the patient safety issues weren’t enough, why
haven’t more hospitals cleaned up their MPIs, given
the operational burden and lost revenue associated
with these errors? One reason could be that providers
underestimate their number of duplicates, says Erin
Benson, senior director of market planning at Lexis-
Nexis Risk Solutions. It’s not uncommon for 10% to
20% of an organization’s records to be duplicates, and
the number may be even higher when mergers and
acquisitions occur, she says.
Another reason is that organizations tend to have
limited budgets, so they prioritize efforts that directly
affect patient care, such as new technologies and adding
staff. However, Benson says the tides are turning in light
of capitated payments.
“Organizations want an accurate count of overall
lives when they’re trying to make decisions,” she says,
adding that accurate information is also essential for
preventive care, social determinants of health (SDoH),
and population health management initiatives.
For example, it’s difficult to remind patients of pre-
ventive screenings and prevent readmissions when their
contact information is spread across multiple files with-
out a single source of truth. Likewise, it’s difficult to tar-
get SDoH interventions when ZIP codes and other data
are inaccurate.
All of these efforts affect value-based payments
either directly or indirectly, and it’s why organizations
are starting to focus more proactively on MPI mainte-
nance, Benson says.
Still, challenges remain. Mergers and acquisitions
introduce errors in the MPI, says Vince Vitali, CHCIO,
FCHIME, FHIMSS, vice president of strategy and
business development at NextGate. “The number
of registration points into a health system has
increased dramatically,” Vitali says. “You have
cancer centers, outpatient therapy areas, imaging
centers, reference laboratories—there are so many
more opportunities for error.”
A Blow to the Pocketbook
MPI errors can affect revenue in a variety of ways.
Consider this example: Mary Jones lives in Chicago but
moves to New York City for a few years, during which
time she gets married. When she returns to her pro-
vider, she is now Mary Kimmel living at a new resi-
dence. A registrar doesn’t realize it’s the same patient,
so a new record is created.
“In addition to her past medical history being
orphaned, there now exist two medical records for
Mary,” says Victoria Dames, senior director of prod-
uct management at Experian Health. “This situation
can happen very quickly with lifestyle changes such
as marriage and divorce or with user manual entry
error.” If the original record is used for billing pur-
poses, the patient’s name on the claim won’t match
with the name on the insurance card, leading to a
denial, Dames says.
This scenario can also lead to a coordination of
benefits issue, Vitali says. For example, if Mary has
coverage through her employer as well as additional
coverage through her spouse’s employer, the claim
may be denied.
Problems also occur when a lab or other test result is
sent to a duplicate record. When the provider can’t find
the results because they’re in the duplicate record, they
may ask the patient to repeat the lab or test, which could
cause a denial, Benson says.
MARCH 2020 • WWW.FORTHERECORDMAG.COM  23

MPI Errors and the Patient Experience
There’s also a patient satisfaction angle to all of this,
Benson says. When patients need to repeat labs and
other tests, they may rate their providers lower on a
Consumer Assessment of Healthcare Providers and
Systems (CAHPS) survey, which measures timely
access, care coordination, provider communication,
and more. These quality ratings ultimately affect an
organization’s ability to collect maximum reimburse-
ment, Benson says.
In addition, when patients need to redo labs and other
tests, delays in diagnosis and treatment can occur; this,
in turn, affects actual health outcomes and decreases
quality ratings, she says.
Organizations also need to think about MPI errors
in the context of high-deductible health plans, Vitali
says. “Patients are responsible for more and more of
the bills these days, and you’ve got to make sure you
have the correct patient information,” he says, adding
that it’s not uncommon for organizations to repeat-
edly send bills to a wrong address because registrars
fail to update the information. When the bills remain
unpaid, the organization may send them to a col-
lection agency, incurring additional costs. In some
cases, these late payments may even affect patients’
own credit scores, which can lead to lower satisfac-
tion ratings on CAHPS surveys.
Potential Solutions
Experts agree that solving the problem of dirty MPI
data requires a multiprong approach that includes
people, process, and technology. Consider the
following strategies:
Teach registrars about the revenue cycle. Vitali says
registrars need to understand the connection between
24  FOR THE RECORD • MARCH 2020
the MPI and reimbursement, including all of the ways
in which the data they input affect their organization’s
ability to collect payment.
Their role is critical because in most cases they
meet face to face with patients and can dig more
deeply when questions arise about identity, he says.
“After patients leave the hospital or clinic, it’s difficult
to get ahold of them and get information in a timely
fashion,” Vitali notes.
To prevent unnecessary duplicates, HIM directors
must provide registrars with thorough training not only
in terms of what data to capture—and how—but also on
how to conduct searches in the EHR and what processes
to follow when questions arise, he adds.
Focus on consistent data input enterprisewide. “Anything
you can do to make sure the initial data coming in are
entered in a standardized format will improve match
rates,” Benson says.
For example, standardizing patient addresses using
the United States Postal Service (USPS) format in
EHRs has been shown to improve match rates by up to
3%, according to a recent study published in the Jour-
nal of the American Medical Informatics Association.
Likewise, anyone entering patient data into
the EHR should populate as many name fields as
possible—first name, last name, nickname, alias, other
registered name, maiden name, and preferred name.
“That way, you can cover every angle when you search,”
says James Hoover, executive vice president and
cofounder of Medarcus. “Leveraging all the possible
name fields greatly increases your chance of finding
the right patient.”
Asking patients to spell their names is important, as
is spelling it back to them for confirmation, Hoover adds.
For patient lookup, Lintz says registrars should be
consistent in their approach. For example, a surgery
unit might use Social Security numbers to link patient
records while radiology and pharmacy collect infor-
mation from driver’s licenses. Ideally, all three depart-
ments would use the same look-up methodology since
many duplicate medical record errors can be traced to
small miscues and inconsistencies that arise during the
patient registration process.
According to Lintz, using consistent methods
for patient lookup not only ensures better care
coordination for patients who see multiple health care
providers but also ultimately reduces costs associated
with patient misidentification. Recommendations
include the following:
Make patient photos accessible to the registrars. This may
seem obvious, but Hoover says most organizations don’t
display patient photos in the EHR at the time of regis-
tration. “We’re losing our last best chance to verify a
patient,” he notes.
Establish a denial management strategy. Organizations
need an enterprisewide view of denials and the ability to
Registrars need to understand the connection
between the MPI and reimbursement, including all
of the ways in which the data they input affect their
organization’s ability to collect payment.
trace each denial to its root cause—specifically errors in
the MPI, Vitali says. Ideally, they should also use back-end
business analytics to correlate billing errors with patient
satisfaction scores. “It’s not an easy process, and most
organizations don’t have a handle on how to do it, but it’s
definitely something that gives good payback,” he says.
Implement an enterprisewide MPI (EMPI). An EMPI aggre-
gates information from multiple systems across an orga-
nization to create a single patient identity. Vitali says an
EMPI is critical because it enables organizations to inte-
grate outpatient clinics and physician practices, places
where patient information tends to be more accurate
because there are more frequent points of contact.
Capitalize on technology. Referential-matching technol-
ogy uses unique identifiers and third-party data (eg, data
from public records and other external agencies) to pro-
vide continuous updates to the MPI, handing registrars
the tools they need to be successful, according to Dames.
Why is this technology necessary? In theory, patients
should be able to give registrars all the information they
need to find the right record, but in reality, it doesn’t
always work that way, Vitali says. Patients forget infor-
mation or they simply may not be in the right frame of
mind, he says. “Patients are caught up in their own situa-
tions, and they just want to get in and see their provider,”
Vitali notes.
One limitation of referential data is that some people
may have only a few public records (eg, minors, undocu-
mented immigrants, those without a credit history),
though Benson says sophisticated linking algorithms
can often help overcome this hurdle.
Geocoding, a form of location intelligence that
converts addresses into geographic coordinates, is
an additional element that enables organizations
to authenticate address information in real time to
avoid duplicate record creation and identify fraud,
Vitali says.
Hoover says facial recognition and soft biometrics can
also help organizations match patients more effectively.
Soft biometrics, for example, measure the speed at which
someone signs their name as well as the pressure of the
pen—details that are nearly impossible to replicate.
In addition to these technologies, Hoover—
a trained computer scientist—says organiza-
tions can capitalize on “modern” search—which
converts text-based queries to mathematical-based
searches—to improve match rates. “You can do pre-
cision searches with unclean data either on input
or in the database and still find the exact match,”
he explains, adding that this technique is used by
Google and other search engines.
Modern search helps overcome instances of com-
pound errors—situations where there are multiple
errors either on input or during the patient look-up
process. This can easily occur with patients who use
a European date of birth format (ie, day then month
then year) or observe Chinese traditions (ie, first and
last names are reversed).
When registrars make errors with the name or
date of birth—as well as address or other identifying
information—the chances of finding the right patient
are slim, Hoover says. “These compound errors are where
EHRs fail miserably. They’re just not programmed for that
kind of uncertainty,” he says. “If we put modern search
in front of EHRs, we’ll prevent a significant number of
errors. This is what we, as an industry, need to do.”
Perform quarterly MPI audits. Even a rudimentary data
analysis of records with matching Social Security num-
bers is worthwhile, according to Hoover, who once
found 85,000 instances of two or more records sharing
the same number at one hospital, including 11 separate
records sharing a single number.
Other audit types focus on records with addresses
not in the USPS standardized format and records with a
middle initial rather than a middle name spelled out. “A
certain percentage of your data has errors in the spelling
or addresses, and that’s a proxy for how many other spell-
ing errors you have in other data fields,” Hoover says.
No Time to Waste
Experts agree that solving the problem of MPI errors will
be critical as organizations move forward with value-
based payment models. “We focus on patient safety
because that’s why health care organizations exist—to
help patients and keep them safe,” Benson says. “But the
revenue angle is critical as well.” n
Lisa A. Eramo, MA, is a freelance writer and editor in
Cranston, Rhode Island, who specializes in HIM, medical
coding, and health care regulatory topics.
MARCH 2020 • WWW.FORTHERECORDMAG.COM  25
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