FDA Commissioner Urges Insurers to Support Biosimilar Competition

Rheumatology Practice Management April 2018 Vol 6 No 2 - Biosimilars
Sophie Granger


FDA Commissioner Urges Insurers to Support Biosimilar Competition

Although addressing patient needs must remain the top priority of any physician practice, it is also imperative that members of your staff consider the quality of the data they enter into your patients’ electronic health rec­ords. This article will discuss some of the ways in which data quality can affect the clinical, administrative, and financial aspects of your practice.

It is essential that the information in your patients’ medical charts is successfully tied to their demographic information in the practice management system. To accomplish this goal, each patient’s name must be entered in a consistent manner. For example, if a patient’s middle initial is used in one section but not in another, the system will identify the patient as 2 separate individuals, which can lead to confusion and administrative errors.

Similarly, if your practice sends a billing statement to a patient but the address was not accurately entered in your system—perhaps the street number or zip code was typed incorrectly or the patient is no longer at that location—the statement will most likely be returned and a member of your staff will need to take the time to find the error and resend the statement. This is wasted time that could have been spent earning revenue.

The quality of the data entered into the system will also affect the accuracy of the reports you run. These reports can range from determining the frequency of a certain procedure that your team members perform to forecasting trends in insurance reimbursement to calculating bonus amounts for members of your staff.

The quality of the data you submit to insurance companies is of paramount importance because it determines how much your practice will be reimbursed for the services you provide. Insurance companies also rely on these data to create benchmarks and determine trends in healthcare. Benchmarks are used to measure the quality of care—as well as the cost of care—that you provide to your patients relative to that of your peers. The results of these comparisons help determine the contracted rates for reimbursement that insurance companies set for each of their in-network providers. The data you provide may also be used to calculate the rates for various health insurance products you purchase for your own staff.

With the introduction of the Merit-Based Incentive Payment System (MIPS), the quality of the data you generate is key to earning points in each of the 4 performance categories. For example, as the measures in MIPS weigh more heavily on the use of the patient portal, it will be even more critical that the e-mail addresses of your patients are documented accurately.

Each member of your team must be involved in taking the necessary steps to ensure the quality of the data in your system. Your front desk staff must use care when entering patient demographic information. In addition, your providers need to be cognizant of the data they enter into patients’ charts to document the care that has been provided, and your billing staff must be skilled at determining the accuracy of the procedure and diagnosis codes and units of measure they use when submitting patient claims to insurance companies, which can prevent denials and requests for more information.

The quality of the care you give your patients is paramount to their health and well-being. In the same manner, the quality of the data you generate is essential for accurately measuring the quality of care you provide. Careless errors will cost you time and money, which will directly affect your bottom line.

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Last modified: May 30, 2018
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