Health records could have positive effect on insurance data validation

Health records were shown to be useful in confirming patient information against other sources.

A study that recently appeared in the Journal of the American Informatics Association explored the way electronic health records (EHRs) could make confirming insurance data more effective. The results show that EHR information taken from Oregon community health centers corresponded successfully with both Medicaid and reimbursement data, suggesting its possible usefulness in important patient-related insurance processes.

The study looked at more than 69,000 patients from 96 clinics in the state. The EHR information tested originated from the Oregon Community Health Information Network (OCHIN), and excluded those with private insurance to focus on the systems for which full data was available. EHR coverage data had a more than 86 percent rate of agreement with reimbursement figures and a Medicaid agreement rate that was even higher (more than 94 percent).

The authors of this study concluded that EHRs could be a valuable tool for confirming insurance details.

"If replicated in other studies, EHR data could be used to inform clinic staff and patients about insurance coverage status and could be incorporated into EHR-based tools aiming to improve the stability of insurance coverage for publicly insured Americans," they wrote.

Part of the impetus behind the study was, as they noted, that "there is no established method for validating EHR insurance data." It was also important to determine a way to validate data in real time, and said that their findings could inspire the use of tools that capitalize on EHR data.

Incorporating health records systems into other areas shows a possible way to increase efficiency and speed up health payment processes. For operational advisory tasks, the staff of healthcare consulting firms can contribute varied and custom-selected forms of assistance, so practices are responding to the latest industry needs and feel like they are putting their current systems to good use. 

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