Case
Study - Integrated Healthcare System
Multiple Provider Databases
National Provider Identifier Implementation
Situation
A mid-Atlantic seven hospital integrated healthcare system had
grown in the past largely by acquisition. As a result it had acquired
a network of hospitals, home health care agencies, and urgent care,
oncology, and rehab clinics. Operating systems differed for many
of these organizations. An internal analysis identified nine separate
provider databases in fourteen different units. The provider databases
differed in their individual file structures, in the fields of information
maintained, in the completeness of information for each provider,
in the use (or non use) of internal identifiers to differentiate
records, and in their overall accuracy. Despite the many differences
in the provider databases, information about providers was transmitted
to a centralized billing system.
Problem
The network had to prepare for the regulatory implementation of
the National Provider Identifier that would assign one new unique
number to each provider; however, because of disparities in the
separate databases it was not possible to uniquely identify physicians
throughout the network. More troubling was a recognized deterioration
in accounts receivable days outstanding and an increase in the re-working
of claims because of provider data errors resulting from separate
inputs from the different organizations within the network.
Folio Problem Solving
Folio was chosen to integrate the disparate databases into a workable
centralized system.
Folio’s solution consisted of a number of steps:
- Folio reformatted and standardized the data elements for each
provider database.
- Using a variety of proprietary software tools, new ‘virtual’
identifiers were assigned to records by matching with known external
databases.
- Record comparisons were created using the identifiers and Folio
created a crosswalk across all databases that linked the same
provider in multiple files and identified redundant and duplicate
records.
- Folio used automated techniques to highlight variances in information
about providers in the separate databases and reconciled the variances
into one consolidated master file that combined separate inputs
from the different databases. These efforts identified inactive
providers and out of date information.
- The final result was a consolidated and current database that
eliminated all duplicate and inactive records, reconciled all
data variances, and provided a crosswalk identifier to each existing
provider database.
Benefits
The Health System was able to implement the National Provider Identifier
across the multiple entities without cash flow delays or increases
in claim denials.
More importantly the project identified the impact of provider
data errors on increasing accounts receivable days outstanding,
billing re-work, claims reprocessing and denials. Processes and
workflows were put in place that had a measurable effect on lowering
costs and increasing cash flows.
Quantify the financial impact of
inaccurate and incomplete provider information with the Folio Analyzer
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