How a 300 Bed Hospital Unlocked $1.6M in Financial Gains & Boosted Its CMS Star Rating by Fixing Patient Identity

A 300 bed nonprofit hospital in the Southeastern U.S., serving mostly rural and underserved populations, was struggling with a silent but expensive issue. Fragmented records, duplicate charts, and overlays were leading to billing confusion, delayed care, and a surge in denied claims. Their legacy MPI system flagged hundreds of potential duplicates each month, but staff lacked the tools and confidence to resolve them efficiently.

In one case, a patient’s MRI was documented under one chart but the treating physician unknowingly opened a duplicate record that didn’t include the imaging results. Believing the test hadn’t been performed, they ordered it again. The insurer rejected the duplicate claim, costing the hospital both the reimbursement and the resources spent on the unnecessary scan.

But the issue wasn’t limited to insured patients. For uninsured individuals, repeat tests triggered by fragmented records meant the hospital absorbed the full cost. Overlays and mismatched demographic data exposed them to HIPAA liability, such as sending clinical results or billing statements to the wrong address. There were also growing concerns about fraud. Without centralized identity verification, it was possible for bad actors to exploit intake gaps and receive treatment or prescriptions under false identities. Each faulty record didn’t just distort care; it introduced financial risk, skewed quality metrics, and threatened regulatory compliance.

The cumulative impact was financial, operational and reputational and it was growing.

The SynchroLink AI Solution

SynchroLink AI modernized the hospital’s identity resolution approach using three core technologies that collectively paid for themselves in just a few months.

Identity Assurance at Registration

At registration, patient data was instantly compared against Beacon, SynchroLink AI’s proprietary database of over 300 million verified identities. When similarities were found, the system returned a confidence score, and verification questions were generated based on trusted identity data, such as past cities, phone numbers, or birth dates (answers a real patient would know) but an impersonator likely wouldn’t. This empowered staff to stop duplicates and questionable registrations at the source, without slowing down intake.

Precision Pairing for Manual Review

When staff suspected two charts belonged to the same patient but lacked clear indicators, SynchroLink AI provided an evidence based confidence score showing how similar the records were across key fields like name, date of birth, address, and phone number. This gave HIM teams clarity to confidently link records or escalate them when necessary, avoiding unnecessary delays and improving the accuracy of each merge.

Bulk Identification for System Wide Cleanup

Each night, SynchroLink AI scanned the EHR’s MPI to identify existing duplicates and overlays. These matches were grouped and staged for review, allowing HIM teams to perform safe and auditable merges. This significantly reduced the backlog of unresolved identity issues and freed up valuable administrative time.

Results: Financial Return and Strategic Lift

In just six months, the hospital:

• Reconciled over 3,000 fragmented records
• Recovered $920,000 in delayed or denied claims
• Saved $220,000 in administrative overhead by reducing manual stewardship
• Avoided $110,000 in unnecessary testing costs especially for uninsured patients

The investment paid for itself many times over delivering more than $1.6 million in value, or over 5x the cost of implementation.

More importantly, these identity improvements led to a measurable increase in quality scores. The hospital’s CMS Star Rating improved from 2 to 3 stars, driven by gains in data integrity, timely access to care, and fewer documentation errors, which are core components of CMS quality metrics.

By resolving identity overlays and duplicates at scale, the hospital not only improved operational efficiency but also proactively prepared for federal mandates like the MATCH IT Act. This positioned them to qualify for health equity-linked value-based reimbursement programs and future interoperability standards. With clean, structured identity data, the hospital launched two research data-sharing partnerships that brought in $150,000 to $300,000 annually in unrestricted revenue.

When Identity Works, Everything Works: From Denials to Stars to Equity

Hospitals often assume their MPI is working until it isn’t. The system is only as reliable as the data within it. Staff don’t always know if two charts belong to the same patient, and guessing wrong can affect billing, lead to repeated tests, or result in clinical errors.

SynchroLink AI removes that uncertainty by acting as a verified answer key. Its confidence scoring system supports staff judgment with real time clarity, helping prevent mistakes before they happen and clean up the ones already in the system. Whether it’s stopping fraud, catching a mistyped birth date, or preventing a redundant test, SynchroLink AI converts identity resolution from a liability into a financial asset.

If your organization is losing money to denials, absorbing the cost of unnecessary testing, or burning hours on manual chart reviews, this is the kind of investment that pays for itself and keeps paying.