Practice Management Alert

Question: A patient came in and announced that they’d gotten divorced and asked front desk staff if they could please change their name on our office records. My colleague said sure (the patient seemed happy/relieved, like they were eager to turn over a new leaf), but I’m worried about denials. Who’s right?

Maine Subscriber

Answer: You’ll be courting denials and audits if you change the name on the patient record without waiting for the patient’s new insurance card, if applicable, because a mismatch between the patient name as submitted on a claim and the payer’s member/enrollment record is a common reason for claim rejections and denials from payers — including Medicare.

For billing purposes, the name you submit should match the name on the patient’s insurance card and the payer’s enrollment record, including Medicare/Medicaid records when applicable. Also keep in mind that divorce does not always include or constitute a legal name change, and some organizations require legal documentation (for example, a court order or divorce decree, depending on the state) before updating the patient’s legal name in the medical record.

This is also an important reason to check government identification when enrolling a new patient, because the name a patient uses may not match their legal name.

Until the patient completes a legal name change and updates insurers, changing the name can create claim mismatches and denials. You can gently explain to the patient that they need to update their insurance carrier, if they haven’t already, and once they have an updated insurance card, you can adjust their records accordingly.

To honor the patient’s request without compromising your reimbursement and compliance, you can document a “preferred name” on the record, and make a note requesting office staff use it during interactions.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC