Physicians may be penalized for poor utilization.

BACKGROUND AND OBJECTIVES: Our objectives were to determine the distribution of errors and estimate the magnitude of the burden of delayed payments in a large physician group practice. METHODS: A 25% random sample (n=775) was taken from all billed records of a physician group practice in the Pacific Northwest that were delayed 6 months or more as of June 30, 2001. The source and specific reasons for payment delays, as well as the amount of each unpaid invoice, were determined by electronic documentation or telephone calls to the payor. Analysis of variance was used to determine whether the amount of the invoice was associated with the source and reason of error. RESULTS: The source of delayed payments due to provider, payor, patient, and technical error were 36.1%, 28.1%, 14.5%, and 21.3%, respectively. The most-frequent reasons for delayed payment were that the provider incorrectly set up the account (15.2%), the provider did not follow up on denial (12.9%), and the payor incorrectly processed the invoice (11.6%). Analysis of variance suggested that the invoice amount was not significantly associated with the source but was significantly different across reasons for delayed payment. The potential financial impact of earlier recovery of payment was $262,270. CONCLUSIONS: In these data, provider and payor errors accounted for almost two thirds of delayed payments. The most promising avenue for providers to reduce delayed payments is by reducing their own errors. Eliminating the two most common errors would result in a more timely recovery of nearly $70,000 in revenues.

Insurance, Health, Reimbursement↗

PubMed2002

Quality control in nucleic acid testing--where do we stand?

Quality control has been playing an increasingly important role in the implementation of nucleic acid amplification techniques (NATs) for clinical diagnosis since the introduction of these methods in the early 1990s. Initial multicenter studies involving hepatitis B virus (HBV), hepatitis C virus (HCV), Mycobacterium tuberculosis, and human immunodeficiency virus type 1 (HIV-1) revealed serious problems in specificity (false-positive rates of ca. 40%) and sensitivity, large variations in quantitative results, and a plethora of units (largely not comparable between assays). The problem areas identified included the need for standardized reagents and common units, contamination control mechanisms, inhibition control mechanisms, genotype-independent detection and quantitation, facilitated nucleic acid isolation procedures, clinically relevant dynamic ranges, and internal run controls. Progress made in each of these areas will be discussed. In addition to the above-mentioned problem areas, the value of external quality control of existing and evolving NATs was recognized. To this end, the European Union Quality Control Concerted Action for Nucleic Acid Amplification in Diagnostic Virology was established in May 1998. During its three-and-a-half years of existence, a total of 14 proficiency panels containing 8-13 well-characterized, simulated clinical samples of various viral loads and genotypes were prepared for herpesviruses (herpes simplex virus, human cytomegalovirus), blood-borne viruses (HBV, HCV, HIV-1), enteroviruses, and Chlamydia trachomatis, distributed to up to 20 different countries, and tested by up to 97 different laboratories. The results show dramatic improvement in specificity (false-positive rates <3% for most panels), presumably due to a generally greater expertise of participating laboratories, more frequent use of enzymatic or mechanical contamination control mechanisms, and increased utilization of standardized reagents (commercial kits). However, considerable problems with sensitivity remain (false-negative rates up to 50%), reflecting the high detection limits of some commercial viral load kits still on the market as well as inadequate standardization of quantitation controls between assay systems. In conclusion, although considerable progress has been made, quality control of NATs in clinical diagnosis remains an ongoing challenge.

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