In a recent blog post, we introduced the issue of dirty orders for labs, radiology and other services. In this post we will dig deeper into the costs associated with dirty orders. Several types of errors contribute to this problem:
- Missing or inaccurate patient identification or contact information
- Missing or inaccurate information necessary for billing
- Missing or inappropriate test codes
- Mismatches between the ordered tests and the specimens that were obtained
- Missing clinical information that is needed for medical necessity checking, preauthorization or correct interpretation of the test results
In some cases, errors in the data in the electronic health record (EHR) or billing system (such as date of birth) can be propagated to the order. This results in additional staff time at the lab as well as in the practice to confirm or modify this information.
In other cases, information may be omitted by the staff person placing the order. Most EHRs as well paper ordering systems require that the staff person be intimately familiar with the ordering requirements for the lab or service provider. Since most practices deal with multiple labs and a variety of other service providers, it is unrealistic to expect that they won’t make errors.
The most obvious impact of these ordering errors is the additional staff time on both ends, to supply additional required information and correct errors. But additional and potentially much more significant costs can occur as a result of dirty orders:
- Medical liability due to missing test results, incorrectly interpreted test results or delayed diagnoses
- Decreased patient satisfaction if additional tests are required and/or additional visits are needed
- Denial of claims due to missing or inaccurate demographics data or medical necessity justification, and the staff costs involved with getting contested claims paid
- Increased no-shows at the patient service center due to the inability to contact and follow up with patients
Labs and other service providers are recognizing that these costs can be significant, and that once a dirty order is received there is little that can be done other than low-tech interaction with the ordering practice, via phone, fax and email.
So why are these costs hidden? The costs are hidden because doctors continue to use paper orders because that’s easier for them. And the errors that result from transcribing paper order really add up with the volume of labs.
The key to avoiding the costs of dirty orders is to improve the order validation process at the source. Labs can help facilitate this by educating their customers about the mutual costs of dirty orders, and by helping to provide technical solutions that can work within the practice’s EHR and existing order processes.