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PubMedDate not supplied

Community and ambulatory pharmacy: evaluation of patient care services and billing patterns before implementation of Medicare part D.

OBJECTIVE: To provide a summary of community and ambulatory pharmacy practice and billing patterns for medication therapy management services before implementation of Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). DESIGN: Cross-sectional survey. SETTING: Ambulatory care and community pharmacy practice settings in the United States in January 2004. PARTICIPANTS: Members of the American College of Clinical Pharmacy Ambulatory Practice and Research Network, preceptors of the American Pharmacists Association (APhA) Community Pharmacy Residency Programs, and participants in the APhA Immunizing Pharmacist listserv. INTERVENTIONS: E-mail invitations to participate in a Web-based survey. MAIN OUTCOME MEASURES: Practice setting; pharmacy services performed; whether pharmacists were billing for pharmacy services; if billing, the billing technique used; if not billing, the reason for not billing. RESULTS: Of 349 respondents, 127 (36.4%) were practicing within a physician office, while 121 (34.7%) were practicing in community pharmacies. Diabetes, anticoagulation, dyslipidemia, hypertension, and smoking cessation management services were performed significantly more often in physician offices. Immunization delivery and diabetes, dyslipidemia, and osteoporosis screenings were performed significantly more often in community settings. A total of 190 (54.5%) pharmacists stated that they were billing for pharmacy services. More community pharmacists were billing for services compared with other combined practice settings (69.2% versus 46.7%, P < .001). Top reasons identified for not billing for services were salaried position, indigent population, and discomfort with the billing process. CONCLUSION: Valuable baseline data are provided regarding pharmacy services that have been successfully implemented in ambulatory and community practice settings and which billing techniques were used to receive reimbursement before the implementation of MMA.

Ambulatory Care↗

PubMed2001

Male bill colour and competition in zebra finches.

Several studies have assessed the role of bill colour in sexual selection and especially with respect to sexual preferences. Even though there are indications that bill colour is related to male quality, so far it has not been shown that bill colour influences male-male interaction. We used male zebra finches with artificially coloured bills in a competitive context to measure the effect of bill colour. In these tests the experimental bird could choose between two feeding sites, each near a stimulus bird with a different bill colour. We tested orange against red, no bird against orange/red and orange/red against green respectively. We found no difference in behaviour towards an orange compared to a red billed stimulus. However the birds spent relatively more time eating when alone compared to being close to a potential competitor. In addition, more time was spent eating than on other behaviours when the birds were close to the orange/red billed stimulus compared to the green billed stimulus. So, although no effect was found in the orange against red test, the results suggest that bill colour may play some role in male-male interaction.

Journal Article↗

PubMed2004

Billing and reimbursement for pediatric surgical services: a unique assessment of a complex process.

BACKGROUND/PURPOSE: Billing and reimbursement for pediatric surgical services is a complicated process that has not been rigorously evaluated. This study evaluates pediatric surgery billing and reimbursement and compares the process between third party payors. METHODS: The authors tracked all noncapitated bills from submission to final payment for all cases performed during 1 month. Data included operation, insurance type, amount billed, and amount collected. If payments were denied, the reasons were ascertained and the appropriateness verified. Chi-square and Student's t tests were used for comparisons. RESULTS: The billing process for all noncapitated pediatric surgical cases during May 2000, was reviewed (n = 136). The majority of bills (79%) were paid outright. Of the rejected bills, 76% were denied inappropriately. Inappropriate denial of payment was most frequent among patients insured by Medicaid. Mean time to complete payment was longest among patients insured by managed care groups. Percent of total charges reimbursed for surgical services was significantly lower for patients insured by Medicaid and Health Maintenance Organizations (HMO). CONCLUSIONS: A significant number of bills for pediatric surgical services are rejected inappropriately. Careful analysis of one's rejected bills can recoup up to 20% of revenue. HMO's and Medicaid are more likely to deny payment inappropriately, take longer to make payments, and reimburse less for pediatric surgical services.

Costs and Cost Analysis↗

PubMed2001

The impact of longer-than-average anesthesia times on the billing of academic anesthesiology departments.

UNLABELLED: Academic anesthesiology departments provide clinical services for surgical procedures that have longer-than-average surgical times and correspondingly increased anesthesia times. We examined the financial impact of these longer times in three ways: 1) the estimated loss in revenue if billing were done on a flat-fee system by using industry-averaged anesthesia times; 2) the estimation of incremental operating room (OR) sites necessitated by longer anesthesia times; and 3) the estimated potential gain in billed units if the hours of productivity of current anesthesia time were applied to surgical cases of average duration. Health Care Financing Administration average times per anesthesia procedure code were used as industry averages. Billing data were collected from four academic anesthesiology departments for 1 yr. Each claim billed with ASA units was included except for obstetric anesthesia care. All clinical sites that do not bill with ASA units were excluded. Base units were determined for each anesthesia procedure code. The mean commercial conversion factor (US$45 per ASA unit) for reimbursement was used to estimate the impact in dollar amounts. In all four groups, anesthesia times exceeded the Health Care Financing Administration average. The loss per group in billed ASA units if a flat-fee billing system were used ranged from 18,194 to 31,079 units per group, representing a 5% to 15% decrease (estimated billing decrease of US$818,719 to US$1,398,536 per group). The number of excess OR sites necessitated by longer surgical and anesthesia times ranged from 1.95 to 4.57 OR sites per group. The potential gain in billed units if the hours of productivity of current anesthesia time were applied to surgical cases of average duration was estimated to be from 13,273 to 21,368 ASA units. Longer-than-average anesthesia and surgical times result in extra hours or additional OR sites to be staffed and loss of potential reimbursement for the four academic anesthesiology departments. A flat-fee system would adversely affect academic anesthesiology departments. IMPLICATIONS: We examined the economic impact of longer-than-average anesthesia times on four academic anesthesiology departments in three ways: the estimated loss in revenue under a flat-fee system, the excess operating room sites staffed, and the potential gain in revenue if the surgeries were of average length. These results should be considered both in productivity measurements and strategies for operating room management.

Accounting↗

PubMedDate not supplied

Social networks and best practices in public health: the example of regional billing groups.

OBJECTIVE: Rising health care costs, increased demand for clinical services, and reimbursement difficulties created a funding shortage among local health departments in the state of Kansas. This intervention established regional billing groups to provide professional support and increase third-party reimbursement. DESIGN: Through feedback sessions, billing clerks provided qualitative responses about training needs. These informed the process of establishing billing groups in each state health district. SAMPLE: All billing clerks in the state's 6 regional health districts were invited to participate, as were insurance and billing software representatives. INTERVENTION: Between April 2002 and September 2004, 6 collaborative groups were established. Billing clerks received professional support and training from peers, insurance representatives, and software providers. An interagency billing advisory team was established to coordinate training activities between groups. RESULTS: These groups have allowed local health departments to increase reimbursement revenue by 50%-75%, allowing for the provision of expanded health services to client populations. CONCLUSIONS: These methods can serve as a model for other states, particularly those with considerable rural populations or decentralized health care systems. Still, funding shortages persist, and public health billing clerks will continue to need ongoing training in the most current and effective billing methods.

Accounting↗

PubMed1996

Ultrastructure, number, distribution and innervation of electroreceptors and mechanoreceptors in the bill skin of the platypus, Ornithorhynchus anatinus.

The platypus is presently the only mammal demonstrated to use electroreception to obtain food. The electroreceptive system of the platypus is far more complex than that of its close relative the echidna. This paper presents an anatomical study of the basis of electroreception in the platypus. The innervation of the bill by the trigeminal nerve is described, as are three sensory structures, associated with food gathering, within the bill skin. There are 40,000 mucous gland electroreceptors found in the bill skin of the platypus. The papillary portion of each of these sensory mucous glands is modified to accommodate electrosensory nerve terminals. In contrast to fish electroreceptors, the electrosensory terminals of the platypus are not associated with a sensory cell. These mucous gland electroreceptors are arranged in a series of parasagittal stripes on the bill. This array suggests a basis for the ability of the platypus to quickly and accurately locate the origin of an electrical stimulus. A push-rod mechanoreceptor, similar in morphology to Eimer's organ of the mole, and bill-tip organs in birds, was also found in the bill skin. The slightly differing morphology of these mechanoreceptors when compared to their avian and talpid counterparts suggests that this is another example of convergent evolution, with the common need to provide a solution to increasing tactile sensitivity on bare rhinarial skin. These push-rods are found to be most dense around the labial margins of the bill, with a marked decrease in density towards the middle and caudal portions of the bill. The distribution of the push-rods is similar to the distribution of the third sensory structure found on the bill, the sensory serous gland. Although less numerous than the mechanoreceptors (46,500 mechanoreceptors compared with 13,500 sensory serous glands), these sensory serous glands have a similar distribution and similar changes in density. These concurrent distributions argue for some functional correlation of these two sensory structures. The papillary region of the serous gland is modified in a manner similar to that of the mucous gland electroreceptor to accommodate sensory input. The sensory terminals of the serous glands are very similar to those of the mucous gland electroreceptors, and so it is presumed that these sensory serous glands are a type of electroreceptor that might be involved in detection of electrical signals at close quarters where the mechanoreceptors are also engaged.

Animals↗

PubMed1995

Balance billing under Medicare: protecting beneficiaries and preserving physician participation.

Medicare's experience with balance billing provides valuable lessons for policy making for national or state health care reform. Medicare developed several policies to encourage physicians to become participating providers who accept Medicare-allowed charges as payment in full. Only nonparticipating physicians are permitted to bill for additional amounts beyond that paid by Medicare, and there are limits on the amount of balance billing per claim. As shown by the analysis of claims presented in this article, Medicare has successfully provided financial protection to beneficiaries. In 1986, more than 60 percent of expenditures for physician services were on assigned claims for which there could be no balance billing; by 1990, 80 percent of expenditures were on assigned claims. Balance billing decreased by about 30 percent during the same period. Although these policies have been successful in reducing total expenditures for balance billing, they may not provide financial protection to the most economically vulnerable beneficiaries. Using survey and claims data, we found that the poor have lower balance billing expenditures for services provided by primary care physicians, but that there is no relationship between poverty status and balance billing expenditures for services of nonprimary care physicians. In addition, most low-income beneficiaries are liable for balance bills. Under health care reform, adoption of Medicare's incentive-based approach with mandatory assignment for the poor would allow for some choice based on price and would provide financial protection for all consumers.

Aged↗

PubMed2000

C3: A comprehensive physician activity and billing tool

Purpose: The Clinical Charge Capture system (C3) was developed at the University of Michigan to increase the efficiency and accuracy with which information about physician activity and billing is tracked in academic medical centers. Description: This Oracle-based, Visual Basic system integrates the operating room scheduling system, transcription database, clinical data repository, referring physician database, and IDX to allow physicians and staff to perform paperless and on-line standard tasks such as preauthorizing procedures; creating a bill which describes the charges for procedures performed along with their supporting diagnoses; identifying inpatient daily care and consult charges; dictating, editing, signing, and providing attestations for procedural and inpatient notes (menu-driven boilerplate notes are used for common procedures); submitting of charges on-line to IDX; and downloading of payment data from IDX. A messaging system between physicians and billing specialists allows questions to be posed regarding coding issues and options. Summary information about charges is presented and the status of the bill as it progresses through the internal review and billing process is demonstrated. Any missing data are flagged such that delivery of a bill is accurate, timely, and complete. Outpatient clinic visit charges are acquired on line using bar code technology with direct download of clinic charges to IDX. Generation of charges and referral letters may be performed immediately following the performance of a procedure or patient encounter or subsequently in the office. Resident activity is also tracked. Finally, search functions are provided which allow the program to serve as a clinical information research database. Results: The time to bill submission for operative procedures in fiscal year 1996 (Pre-C3) when compared to 1999 (Post-C3) decreased in each individual surgical division (See figure)as well as for the overall Department (Total: mean Pre-C3=40 days, mean Post-C3=8 days). The average bill was increased by 9% for each primary charge submitted. Conclusions: We conclude that this system has the potential to enhance the efficiency, accuracy, and organization of routine physician documentation, billing, and data collection activities.

Journal Article↗

PubMed2001

Coding and billing in the pediatric intensive care unit.

Physicians need to be proficient in their use of CPT codes and ICD-9 codes. They must participate actively and be knowledgeable of their billing process. An organized approach to coding and billing has been suggested by the American Academy of Pediatrics, as outlined in the following box. Physicians are ultimately responsible for any bill submitted in their name. Therefore, close scrutiny of the coding and billing procedures is paramount. Even if mistakes are made in the billing process beyond physicians' input, physicians still may be held responsible. If physicians do their own coding, the bills become more accurate, which can result in higher reimbursement. Physicians also should have a functional compliance plan in place, whether practicing in a large faculty group practice or practicing solo, with the ability to audit the coding and billing process and respond to variances if they are found. By being more involved in the process, physicians can have a more efficient billing system that avoids the potential for fraud and abuse and improves collections.

Forms and Records Control↗

PubMed1998

U.S. Senate Bill 422: the Genetic Confidentiality and Nondiscrimination Act of 1997.

On March 11, 1997, Senator Pete Domenici introduced U.S. Senate Bill 422, the Genetic Confidentiality and Non-Discrimination Act of 1997. The bill specifies that "existing legal protections for genetic information are inadequate to ensure genetic privacy and to prevent genetic discrimination." The first stated purpose of the bill is "to define the circumstances under which DNA samples may be collected, stored, and analyzed and genetic information may be collected, stored, analyzed, and disclosed." The bill reinforces statutes already passed in 19 states that guarantee patients certain rights of control over their own personal genetic information (Congressional Record, S2141). This bill fundamentally changes the mechanism whereby molecular biologists acquire tissue, and defines new obligations between researchers and human subjects. Even if this bill is not passed in its present form, it appears inevitable that legislation with a similar intent will soon emerge. Any such legislation will carry the full weight and penalties of law. Because many current research practices may violate these proposed new regulations, researchers should understand the provisions of S. 422. Furthermore, it is crucial that researchers understand the bill now, before it becomes law, because this may be their last opportunity to lobby for any modifications of the bill.

Confidentiality↗

PubMed2004

Factors associated with bulk billing: experience from a general practitioners' survey in New South Wales.

OBJECTIVE: To assess whether some demographic and practice characteristics of general practitioners (GPs) are associated with the use of bulk billing. METHODS: A cross-sectional postal survey was conducted in late 2002 with a 15% stratified random sample, based on sex and area of practice, of currently practising GPs in New South Wales. Multinomial logistic regression was used to look at GPs' characteristics associated with their self-reported use of bulk billing. RESULTS: Of the 494 GPs who participated in the study, 44% bulk billed for all patient consultations, 34% for selective patients, while 22% did not bulk bill for any patient. Multivariate analysis revealed that GPs practising in metropolitan areas were six times more likely to bulk bill for all patients compared with GPs in rural areas (OR 6.7, 95% CI 3.8-11.9). Overseas-trained GPs were twice as likely to bulk bill for all patients compared with locally trained GPs (OR 2.3, 95% CI 1.2-4.3). The likelihood of bulk billing for all patients also increased with an increase in GPs' caseload. CONCLUSIONS: This paper discusses some of the policy and programmatic implications of the changing pattern of bulk billing. Special efforts are needed to provide increased practice support for GPs in rural and remote areas in order to ensure affordable and accessible GP services.

Adult↗

PubMed1993

Are psychoanalytic billing practices ethical?

The changing climate of "health care reform" and increased third-party intrusion into psychotherapy are raising challenges over the ethics of traditional psychoanalytic practices such as billing for missed sessions. The practice of billing for missed sessions is an integral part of some analytic psychotherapies and forms the basis of the field of operation of many therapies. When used in this way, the billing practices are unique in medicine in that only these therapies use billing as a part of treatment. This practice is used for a variety of practical reasons but especially to emphasize to patients that the therapy occurs in their internal lives and addresses the symbols they use in organizing their world view. The symbolic use of a time commitment and the obligation to pay for that commitment are necessary so as not to present the patient with a contaminated field of operation. In this way the practice is similar to many other areas of medicine, such as surgeries that are viewed as global procedures whose billing allows for time that is not actually spent in contact with patients. This paper discusses the clinical rationale for the ability to bill for missed sessions and its ethics in terms of the newer language of utilization review. By laying down the principle of billing as a practice parameter for an open-ended bundled service that is billed globally the author translates the practice into more modern utilization-review terminology.

Adult↗

PubMed1991

Accuracy of patient encounter and billing information in ambulatory care.

BACKGROUND: This study examined the degree of accuracy of billing data in an academically affiliated family practice. METHODS: The progress notes from 1253 consecutive visits were independently reviewed by two family physicians, and the diagnoses, use of procedures, and level of service were determined for each visit. Discrepancies between the reviewers were resolved by consensus. These data were compared with the data on the corresponding billing form that had been completed by the care providers (ie, physicians on the faculty, physicians in training, family nurse practitioners, and nurses). RESULTS: There was poor agreement between the billing form and progress note on level of service and number of diagnoses (kappa = 0.37 and kappa = 0.28, respectively). The progress note usually indicated that a higher level of service should have been billed for a visit than actually was billed. Underreporting of the number of diagnoses was substantial; the billing forms listed only 69% of the diagnoses identified in the progress notes. In 60% of visits, each diagnosis on the billing form had a matching diagnosis in the progress note. This could be improved to 78% of visits if broad categories of disease were used. Residents were similar to faculty in the accuracy of reported level of service and types of diagnoses, but were more likely to underreport the number of diagnoses. CONCLUSIONS: Ambulatory care data from computerized billing files may not be sufficiently accurate for proper reimbursement of physician services or for use in research.

Abstracting and Indexing↗

PubMed2006

Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services.

PURPOSE: Some pediatric surgeons rarely document nonoperative services, believing that the reimbursement provided for such care is negligible. We evaluated the impact of comprehensive documentation and billing for nonoperative, pediatric surgical care. METHODS: All bills submitted for inpatient, nonoperative care for 1 year were reviewed. Total receipts for documented admissions, consultations, critical care, and daily care were determined. The Evaluation and Management code billed for each service was recorded, and the total and average payments attributable to each Evaluation and Management code were calculated. RESULTS: Fifty-six percent of services were covered by Medicaid and 26% by a commercial insurer. There were 607 billed admission history and physical exams for which reimbursement totaled 43,493 dollars. Critical care services were provided to 49 patients and yielded 8964 dollars in payments. Six hundred thirty-nine inpatient consultations were performed with a reimbursement of 42,830 dollars. Daily care services were billed 1044 times and produced 71,579 dollars in payments. Overall reimbursement for documented, nonoperative services was 166,866 dollars. This represented 16.2% of total, noncontracted income for the practice. CONCLUSION: Despite a payer mix heavily weighted toward Medicaid, comprehensive documentation and billing for nonoperative services increased total, noncontracted reimbursement by almost 20% over what it would have been had only operative services been billed. The yield from properly documented, nonoperative care can be substantial.

Child↗

PubMed1998

Genetic variation and bill size dimorphism in a passerine bird, the reed bunting Emberiza schoeniclus.

In passerine birds morphological differentiation in bill size within species is not commonly observed. Bill size is usually associated with a trophic niche, and strong differences in it may reflect the process of genetic differentiation and, possibly, speciation. We used both mitochondrial DNA (mtDNA) and nuclear microsatellites to study genetic variation between two subspecies of reed bunting, Emberiza schoeniclus schoeniclus and E.s. intermedia, along their distributional boundary in western Europe. These two subspecies are characterized by a high dimorphism in bill size and, although breeding populations of the two subspecies are found very close to each other in northern Italy, apparently no interbreeding occurs. The observed morphological pattern between the two subspecies may be maintained by geographically varying selective forces or, alternatively, may be the result of a long geographical separation followed by a secondary contact. MtDNA sequences of cytochrome b and ND5 (515 bp) showed little variation and did not discriminate between the two subspecies, indicating a divergence time of less than 500 000 years. The analysis of four microsatellite loci suggested a clear, although weak, degree of genetic differentiation in the large- and small-billed populations, as indicated by FST and RST values and genetic distances. The correlation between bill size and genetic distance between populations remained significant after accounting for the geographical distances between sampling localities. Altogether, these results indicate a very recent genetic differentiation between the two bill morphs and suggest that a strong selection for large bills in the southern part of the breeding range is probably involved in maintaining the geographical differentiation of this species.

Alleles↗

PubMedDate not supplied

Is sepsis accurately coded on hospital bills?

OBJECTIVE: To examine whether sepsis is accurately coded on hospital bills. METHODS: Hospital inpatient uniform bills (UB-92) for 122 patients with clinically documented severe sepsis of presumed infectious origin were retrospectively examined. Final UB-92 hospital bills were obtained for all study subjects. ICD-9-CM diagnosis codes from these bills were then reviewed to ascertain the number of subjects for whom one or more diagnostic codes for septicemia and/or bacteremia were present. RESULTS: A total of 92 hospital bills (75.4%) contained one or more ICD-9-CM diagnostic codes for septicemia and/or bacteremia. Of the 30 that did not, 15 (12.3%) had codes for major systemic infection and organ failure. No diagnoses indicative of sepsis (i.e., organ failure and major infection) were present on the remaining 15 (12.3%) bills. CONCLUSIONS: Our findings suggest that use of ICD-9-CM codes for identifying patients with sepsis using hospital bills is only moderately sensitive. Strict reliance on administrative data sources for sepsis surveillance or research planning may therefore be prone to substantial error.

Database Management Systems↗

PubMed2003

Billing for inpatient hospital care.

Pharmacy personnel billing patients for services rendered is discussed. Billing for services is a critical function for maintaining the financial viability of health care institutions. Poor understanding of the system can lead to incorrect documentation, which can result in a claim rejection. The UB-92 provides hospitals with the proper format to request reimbursement for services provided. To ensure proper reimbursement, appropriate coding of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for diagnosis, procedures, and services provided is necessary. Ancillary services, such as pharmacy, play a crucial role in the completion of the bill by ensuring that the charge-master accurately represents the service provided. This information includes identification, charge, cost, and revenue codes. Hospital billing agents must also account for any outpatient visits that may have occurred within three days of admission, since these charges may need to be included on the hospital bill. In order for the billing process to be effective, it is important that all personnel have a thorough understanding of the billing process and be able to effectively communicate with each other.

Fees, Pharmaceutical↗

PubMed2007

Automated documentation error detection and notification improves anesthesia billing performance.

BACKGROUND: Documentation of key times and events is required to obtain reimbursement for anesthesia services. The authors installed an information management system to improve record keeping and billing performance but found that a significant number of their records still could not be billed in a timely manner, and some records were never billed at all because they contained documentation errors. METHODS: Computer software was developed that automatically examines electronic anesthetic records and alerts clinicians to documentation errors by alphanumeric page and e-mail. The software's efficacy was determined retrospectively by comparing billing performance before and after its implementation. Staff satisfaction with the software was assessed by survey. RESULTS: After implementation of this software, the percentage of anesthetic records that could never be billed declined from 1.31% to 0.04%, and the median time to correct documentation errors decreased from 33 days to 3 days. The average time to release an anesthetic record to the billing service decreased from 3.0+/-0.1 days to 1.1+/-0.2 days. More than 90% of staff found the system to be helpful and easier to use than the previous manual process for error detection and notification. CONCLUSION: This system allowed the authors to reduce the median time to correct documentation errors and the number of anesthetic records that were never billed by at least an order of magnitude. The authors estimate that these improvements increased their department's revenue by approximately $400,000 per year.

Anesthesia↗