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MEDICAL BILLING – PATIENT DEMOGRAPHICS

PATIENT DEMOGRAPHICS – AN OVERVIEW

• What is Patient Demographics and what does it contain?

Patient Demographics sheet contains all the basic demographic information about an individual or patient. Patient demographics ( PD ) include Patient name, Date of birth, Address, Phone number, Doctor information, Social security number (SSN) and Sex. Patient Demographic also contains Guarantors or emergency contact information, Health insurance information. Each piece of information is important because correct and quality entry of such information will directly impact physician’s monthly revenue. This sheet is also called as face sheet of a charge or claim.

A good patient demographic form is the key to obtaining accurate information which is required for claim submission. Providing as much information as possible will reduce the insurance company’s need to contact billing office. Avoiding unnecessary contact will reduce the costs of claims processing and delay in payments. Obtaining all the required demographic information will often determine how willing the patient is to complete the form. If the request is firm and professional without being offensive, we have great chances of getting the information’s which we need to settle a claim.

Ideally a patient’s insurance coverage should be verified before any service is rendered with the common exception of emergency treatment. This policy shouldn’t apply exclusively to new patients. Established patients may have changed employers, gotten married or divorced or are no longer covered by the policy which was in effect during their last visit. Photocopy of insurance cards is always a help.

• How Patient demographics originate and reach us ?

Patient Demographic sheets also known as face sheet are distributed to patients when they visit physician’s office for treatment. Before the services are rendered, front office staff ensures that patient demographic sheets are filled in by the patient or some one in patient’s family. This process ensures that all necessary patient’s demographic information are gathered accurately which would facilitate in timely reimbursement of physicians charges. In most of the physician’s front office, copies of insurance identification card are also taken. This is to ensure that all the information’s available in insurance identification card are captured. Insurance ID card contains very valuable information which would be very helpful in settling the claim.

These patient demographics are batched together at physician’s office and are forwarded to our office for patient demographics entry.

• For our easy understanding now let us see each of the information found in patient demographics. Information found in patient demographics have been classified into five major headings.
They are:

I. Patient Information.
II. Patient Employer Information.
III. Patient Guarantor Information.
IV. Physician Information.
V. Insurance Information.

I. Patient Information:


This segment in face sheet consists of basic demographic information.

They are:

1. Account #
2. Patient Name
3. Patient Sex
4. Patient Date of Birth
5. Marital Status
6. Patient Address
7. Patient phone number

Each patient record is assigned a patient account number. This is how a patient is identified in the system. Before filing any claim we would need to obtain clear, accurate information from the patients. A good patient information sheet is the key to this aspect of claims submission. Let us now see few more things about items listed below.

1. Account Number [Visit Number]: In case of a New Patient this field in almost all the Medical Billing software’s is updated automatically. In cases where it does not get updated automatically the billing office enters the Medical Record Number/Account Number as on the Encounter Form submitted by the Hospital/Provider.
In case of an Established Patient the Billing Office runs a query to search for the patient record with the help of the Medical Record Number/Account Number or using the Last Name or using the Date of Birth of the patient. If the software has a Visit Number concept then a new visit with the same Account number and the next visit number is created if not then the same Account is edited with the new details as on the Encounter Form.
This number is for the internal purpose of the Billing Office and the Hospitals. This field is usually in numeric format but may differ from software to software. This number does not form part of the HCFA-1500 claim form.
Example:
Account #: 24584951, 3205215 …
Account # and Visit #: 24584951-01, 24584951-02 …

2. Patient Name: This field is entered in the Last Name, First Name Middle Initial format. However in some software’s this field is split as Last Name First Name and Middle Initial fields. The patient name may also contain title (Junior, Senior, I, II, III …) and suffix (M.D. …) this information also needs to be entered along with the name. The title must be entered with the last name and the suffix should be entered with the first name or after the middle initial. The Name on the Encounter Form may not be given in above said format but still it should be entered as per the Billing Software specifications. Checking the spelling of patient name is a very important step. Simple errors such as transposition of letters or misspelled names can result in denial or suspension of the claim.
Patient name is printed in the 2nd field of the CMS1500 form in Last Name, First Name Middle Initial format.

Example:
Patient Name: Jones, Brenda K; Brenda K Jones; Miller John Jr.; …

3. Date of Birth: This field contains the Date of Birth of the patient. It is entered in the MM/DD/YYYY or MMDDYYYY as per the Billing Software specification.
This field is printed in the 3rd field of the CMS-1500 claim form in MM DD YY format. If Date of Birth detail is not available then generic DOB format have to be entered i.e., 01/01/1901.

Example:
Date of Birth: 02/12/1979; 02/12/79; 02-Dec-1979 …

4. Sex: This field contains the Gender of the patients. i.e., M for Male, F for Female, and U for Unknown when the gender of the patient is not specified on the patient encounter Form.
This field is printed in the 3rd field of the CMS-1500 claim form along with the Date of the Birth.

Example:
Sex: Male; Female; M; F.

5. Social Security Number: This field contains a 9 digit number which is allotted to the patient by the Social Security Administration. If SSN is missing from patient encounter form then this field is usually left blank or any 9 digit dummy number (000-00-0000/999-99-9999) is entered as per the Billing Software specifications.
This number is for the internal purpose of the Billing Office and the Hospital. It is mainly helpful to follow-up with the patients or insurance on their outstanding balances. This number does not appear on the CMS-1500 claim form.

Example:
SSN: 245-19-0124; 245190124

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