Inaccurate or incomplete provider data is a significant challenge that impacts the entire healthcare ecosystem. It can have serious consequences, such as delayed or denied payments, compromised patient safety, and difficulties with compliance and regulatory reporting. Addressing this issue requires a concerted effort across key entities - healthcare organizations, providers, and the technology used. Recognizing and discussing common myths about provider roster data is one way to begin implementing data quality initiatives. This will help streamline data management and promote greater transparency between providers and data users.
Myth 1: It is not necessary to update roster data regularly.
Reality: Regular updates to roster data are crucial for maintaining accurate and up-to-date information about healthcare providers. Outdated data may lead to obstacles in patient access and have financial implications.
Myth 2: Roster data updates are only important for billing purposes.
Reality: Provider roster data is important for reasons beyond billing. This includes provider credentialing, quality reporting, and population health management.
Myth 3: Providers can opt out of roster data sharing.
Reality: Opting out of provider roster data sharing may impact the ability to participate in certain programs or receive certain benefits. Providers are required by law to participate in roster data sharing. In some rare cases where rosters are not required, significant implications result. That’s because sharing provider roster data benefits patients and the entire healthcare system - provided it is accurate and reliable.
Myth 4: Provider roster data is always accurate.
Reality: Provider roster data is only as accurate as the information provided by the healthcare providers themselves. It is important for everyone involved in the provider roster data process to ensure that the information is up-to-date and accurate. Orderly Health has found that, on average, 40% of provider roster data may contain errors at the source.
Myth 5: Provider roster data contains protected health information (PHI).
Reality: Unlike patient and clinical data, provider rosters are typically constrained to demographic data for providers, including contact information, specialties, entity affiliations, etc. They do not include medical record information or data pertaining to patient records. However, it’s important to make sure provider roster data is safeguarded appropriately since they can contain sensitive personally identifiable information (PII) related to age, unique identification numbers, and other personal fields that may be used to better match patients and clinicians.
Debunking provider roster data myths:
It is important to promote greater transparency and communication around provider roster data - and its uses throughout the entire healthcare ecosystem. One way is to educate each stakeholder about the importance of accurate and up-to-date data, providing clear guidelines for data sharing and usage.