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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 These efforts identified inactive providers and out of date information.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.

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