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PubMed2001

Impact of a compliance program for billing on internal medicine faculty's documentation practices and productivity.

PURPOSE: Academic health centers and faculty practice plans have implemented programs to comply with Office of Inspector General (OIG) billing regulations. This study measured the impact of such a program on physicians' billing practices, faculty productivity, and operating revenues. METHOD: A prospective two-year study of departmental billing activities was carried out in 1997-98 and 1998-99 in the department of internal medicine at the Saint Louis University School of Medicine and its faculty practice plan. Compliance with inpatient evaluation and management (E/M) coding and Health Care Financing Administration (HCFA) billing was evaluated by an independent staff of experts. Beginning in 1998-99, the department provided detailed monthly reports of and education in billing and compliance performance to divisional managers and individual faculty. RESULTS: Inpatient admission profiles, practice patterns, and payer mixes of the faculty practice plan and department did not differ during the study. The gross collection rates for the practice and the department rose by 7.3% and 9.5%, respectively, and all divisions increased in their gross collection rates in 1998-99. All but one division increased E/M services in 1998-99 (range -4% to +151%). All divisions decreased their rates of unbillable E/M services in 1998-99. The two divisions with the highest unbillable rates in 1997-98 (gastroenterology and cardiology) significantly reduced their unbillable service rates in 1998-99 (-7.74% and -7.17%, respectively). Medical oncology and geriatrics recorded the greatest reductions in 1998-99 (-63% and -52%, respectively). All but two divisions increased the percentages of complex inpatient E/M services in 1998-99 (average = +27.4%), with commensurate reductions in less complex visits (p < 0.05), and there was an inverse correlation (R = -0.85; p < 0.01) between the relative increases in the division's inpatient encounters and the service complexity charged. A modest inverse correlation (R = -0.50; p < 0.05) existed between the reduction of relative percentages in divisions' unbillable rates (averaging -34%) and the increase in their gross collection rates (averaging + 31%). CONCLUSION: Implementation of a billing compliance program at the departmental level enhances physician productivity and billing compliance for inpatient E/M services, potentially increasing departmental revenues while reducing the institutional risk of an OIG audit.

Academic Medical Centers↗

PubMed1976

Economic analysis of an automated billing system for physicians' services.

An on-line Medicaid billing system for physicians' services was implemented and tested during a two and one-half year period in 100 offices throughout the State of +0.50,Alabama. Participating physicians represented 17% of all physicians in the state. The monthly volume of Medicaid claims entered through the system represented more than 50% of the statewide load processed by the Medicaid carrier. Users entered claims data on standard Touch Tone telephones equipped with Carddialers, and received instructions and data confirmation from the central computer facility via voice answer-back. Input time for the average claim billing for two separate services was less than one and one-half minutes and resulted in a reduction of clerical labor required for manual input by at least 50%. After a fee-for-service was inaugurated, the system workload remained at 86% of its load level before fee for service. Those physicians willing to pay for the billing service were high-volume users who had come to depend on the system and who appreciated the economics that the system had achieved for them in their office billing practices. An average claim consisting of two items of service could be billed at a cost of $0.50,, exclusive of user terminal rental ($6 per month per office) and the cost of data entry personnel (between $0.05 and $0.10 + 0.05 and $.10 per claim). Various algorithms have been offered for use in estimating an annual budget for an on-line billing system given alternative system configurations, methods of financing, annual volume of units of service, and the geographical nature of the population to be served. The tasks of preparing, processing, and storing insurance claims information have placed a costly and time-consuming burden on both providers of medical services and fiscal intermediaries. The unfortunate result is that the cost of submitting an insurance claim for professional medical services is a disproportionate fraction of the amount paid for providing the service. For general practitioners, who provide the largest number of individual services, this share may be more than one-fourth of the payment for most common services. Similarly, for the Medicaid or Medicare intermediary or for the insurance carrier, the cost of preparing and recording data from source documents is a large part of total processing costs. The objective of the On-Line Medicaid Billing System project was to demonstrate that it is possible to reduce the costs of submitting claims from the physician's office as well as to reduce the costs of data preparation in the carrier's system. This publication focuses on an economic analysis of cost effectiveness. Readers interested in system design, development, and on-line operation will find detailed descriptions in previously published reports.

Accounting↗

PubMedDate not supplied

Practice-based electronic billing systems and their impact on immunization registries.

Many providers rely on electronic billing systems to report information to immunization registries. If billing data fail to capture some administered immunizations, the registry will not reflect a child's true immunization status. Our objective was to assess differences between immunizations administered and immunizations reported to a registry from electronic billing systems. Philadelphia's Department of Public Health conducted chart audits in 45 providers serving 50 or more children aged 7-35 months and using electronic billing systems to report data to Philadelphia's immunization registry in 2001-2003. Chart records were compared to registry records to identify immunizations administered in these practices but not reported to the registry. The study practices administered 256,969 immunizations to 20,611 children. Of these 256,969 administered immunizations, 62,213 (24%) were not in the registry. The electronic billing systems submitted data for all administered immunizations for 69% of immunization visits, some but not all for 11% of visits, and none for 20% of visits. Immunizations administered but not billed cost these providers up to $980,477 in lost revenue from administrative fees alone. Improvement of billing data quality would result in more complete registries, higher reported immunization coverage rates, and recovered revenue for immunization providers.

Accounts Payable and Receivable↗

PubMed2004

Comparison of responses to a US 2 dollar bill versus a chance to win 250 US dollars in a mail survey of emergency physicians.

OBJECTIVES: To evaluate whether small monetary incentives improve physicians' responses to surveys. To the best of the authors' knowledge, no one has evaluated emergency physicians' response rate and cost per participant of a small monetary incentive relative to a chance to win a more substantial sum. The authors compared emergency physicians' responses and per-participant costs between a US 2 dollar bill and a 250 US dollars lottery. METHODS: Two groups of 288 emergency physicians were randomly selected and mailed a survey. Within each group of 288, half received a US 2 dollar bill and the other half received an offer that respondents would be entered into a drawing to win 250 US dollars. Nonresponders received a reminder postcard one week later, and persistent nonresponders received a second mailing of the survey three weeks after the initial mailing. RESULTS: Of the 576 surveys that were mailed, nine (2%) subjects were ineligible or undeliverable, leaving 567 eligible subjects, of whom 301 (53%) participated in the survey. The US 2 dollar bill had a substantially higher response rate: 170 (56%) of those receiving a US 2 dollar bill participated versus 131 (44%) of those receiving a chance to win 250 US dollars (95% confidence interval = 5% to 22%; p < 0.001). The US 2 dollar bill offer was less expensive per participant than the 250 US dollars offer. The cost of postage and incentives was 997.33 US dollars for 170 participants, or 5.87 US dollars per participant, for the US 2 dollar bill and 979.29 US dollars for 131 participants, or 7.48 US dollars per participant, for the chance to win 250 US dollars. CONCLUSIONS: Mailing a US 2 dollar bill incentive produces a better response rate with lower cost per participant than offering a chance to win 250 US dollars.

Awards and Prizes↗

PubMed2004

The sensitivity of Medicare billing claims data for monitoring mammography use by elderly women.

Mammography use is monitored through Medicare billing claims; however, the sensitivity of this data source has not been previously described. This study included 10,852 Colorado women ages 65 and older with a mammogram in 1998 as registered by the Colorado Mammography Project who were Medicare fee-for-service (FFS) enrollees. These records were matched to Medicare billing data to assess the proportion of those mammograms submitted for payment to Medicare. The overall sensitivity of the FFS Medicare billing data for screening mammography was 85 percent. Medicare billing claims were less sensitive for younger women, African Americans, women with some college education, and women with supplementary private insurance. In Colorado, the Medicare FFS billing claims understates mammography usage by 15 percent. Care must be taken when comparing mammography use derived from Medicare billing claims, as the sensitivity of billing data can vary substantially by age, race, and socioeconomic status.

Aged↗

PubMed2005

Strengthening Medicare: will increasing the bulk-billing rate and supply of general practitioners increase access to Medicare-funded general practitioner services and does rurality matter?

BACKGROUND: Recent increases in the bulk-billing rate have been taken as an indication that the Federal government's Strengthening Medicare initiative, and particularly the bulk-billing incentives, are 'working'. Given the enduring geographic differences in the supply of general practitioners (GPs) it is timely to reconsider the impact that this increase in the provision of 'free care' will have on access to Medicare-funded GP services in rural and urban areas of Australia. Utilisation has been modelled as two different stochastic processes: the decision to consult and the frequency of consultation. RESULTS: In the decision to consult model the supply of FFS GPs is a more important predictor of utilisation than the bulk-billing rate. Paradoxically the modelling predicts that ceteris paribus increases in either GP supply or the bulk-billing rate appear to have perverse effects in some areas by decreasing utilisation. In the frequency of consultation model, GP density is not a predictor and increasing the bulk-billing rate will unambiguously increase the frequency of consultation across all areas. In both models, the positive impacts associated with changes in supply and cost are constrained outside the inner metropolitan area by reduced geographic accessibility to Medicare-funded GP services. The modelling also shows that people are more likely to consult a GP in areas of high socioeconomic disadvantage, although socioeconomic status is not a predictor of frequency of consultation. CONCLUSION: Bulk-billing rates and the supply of FFS GPs are important features of the Australian health care system that are, potentially, amenable to policy manipulation. The implications of this research are that government policies designed to achieve similarity in these characteristics across geographic areas will not result in equity of access because they fail to address problems caused by geographic inaccessibility in rural and remote areas. Attempting to increase bulk-billing rates in some of these areas may, in fact, reduce access to FFS GP services.

Journal Article↗

PubMed2000

Billing for cognitive services: understanding Québec pharmacists' behavior.

BACKGROUND: There is growing evidence that pharmacists' interventions to solve drug-related problems are effective and cost-saving. Since 1978, under the Quebec provincial drug plan, payment for two cognitive services, the pharmaceutical opinion and the refusal to dispense a prescription, has been disbursed to community pharmacists. However, the number of claims for these services lags far behind expectations. OBJECTIVE: To identify factors influencing Quebec community pharmacists in the billing for a pharmaceutical opinion or for a refusal to dispense. METHODS: Questions on predisposing, enabling, and reinforcing factors potentially related to pharmacists' behavior were included in a self-administered questionnaire sent to all 3517 community pharmacists practicing in the province of Quebec during 1996. Using multivariate logistic regression, models were built to explain billing for an opinion and billing for a refusal. RESULTS: According to our models, the typical pharmacist who billed for opinions or refusals in Quebec is <45 years of age, has attended a continuing education program on this topic, and believes that billing for interventions is important. This typical pharmacist handles a mean daily volume of 100-250 prescriptions, uses a decision-support computer program, and has sufficient technical staff assistance. This pharmacist believes that interventions can be billed rapidly and are consistently paid by the province's drug plan. CONCLUSIONS: In order to increase the billing of pharmaceutical care in community pharmacies, tailored educational programs should be offered to pharmacists. There is also a need to improve working conditions in pharmacies.

Adult↗

PubMed2003

Pulmonary function testing: coding and billing issues.

Clinicians who conduct pulmonary function tests should understand the principles and rules of the coding and billing system for pulmonary function testing. Certain billing codes will not be paid by most insurance payers. To ensure that your pulmonary function tests are appropriately coded, billed, and paid: (1) obtain a Current Procedural Terminology (CPT) coding book and an International Classification of Diseases 9th Revision (ICD-9) diagnosis book, and understand how they are used in setting coding and billing strategies, (2) know the people in your facility who do the billing and work with them to produce an appropriate coding and billing strategy, (3) make sure the physicians are involved in developing and implementing your coding and billing strategy, and (4) assure that your laboratory is set up properly to follows the Medicare rules for participation, that you have the appropriate testing supervision, that the appropriate administrative structure is in place to assure compliance with all regulations, and that you meet American Thoracic Society testing standards.

Fees and Charges↗

PubMed2006

"The future of the midwife depends on her power to relieve pain". The rise and fall of the Analgesia in Childbirth Bill (1949).

The Analgesia in Childbirth Bill (1949) remains the only attempt in British history to give mothers the legal right to pain relief in childbirth. It provides a useful introduction to the major themes in the history of British obstetric anaesthesia and analgesia under the National Health Service. This paper places the bill in the dual contexts of long-standing concern over the status of British midwives and persistent governmental squabbling over the cost of the National Health Service. For its sponsors, the National Birthday Trust Fund, the bill provided an opportunity both to improve the availability of analgesia to mothers in childbirth and to reassert their dominance as leaders in the field of analgesia research. For the Ministry of Health under a Labour Minister, Aneurin Bevan, however, the bill represented both a (concealed) Conservative attack on the newly socialized British medical system and a further burden on the already overtaxed coffers of the National Health Service. Bevan's opposition to, and eventual defeat of, this enormously popular bill found its roots in the bill's economic implications rather than its clinical or humanitarian consequences.

Analgesia, Obstetrical↗

PubMed2000

The impact of direct and extra billing for medical services: evidence from a natural experiment in British Columbia.

This paper examines the impact of direct and extra billing on patient demand for medical services as well as physicians' responses to changing patient demand. These issues are examined in the context of a "natural experiment" in British Columbia, Canada where, in 1992, 81 general practitioners and specialists "opted-out" of the provincial Medical Services Plan (MSP) and began direct and extra billing their patients. These opted-out physicians are compared to a matched sample of physicians who remained within the MSP. Switching costs for patients were relatively low because of the availability of non-direct/extra billing physicians. The data consists of the more than 140,000 patient visit claims over a 2-year time period, one year immediately prior to the opting-out date and one year immediately following. The results of this study show that, on average, female visits to opted-out general practitioners (GPs) dropped approx. 9% after direct/extra billing. There was no concurrent drop for male patient visits. On average, patient visits to opted-out specialists dropped approx. 6%. Within the observed timeframe, opted-out physicians' billing patterns changed; somewhat offsetting this demand decrease. On average, opted-out GPs' payments per remaining patient increased by 10% following direct/extra billing (the post period), while opted-out specialists' payments per patient increased by 7%. There were no corresponding changes in payments per patient for the control group of physicians who remained opted-in.

British Columbia↗

PubMed2002

Coding and billing for gastrointestinal endoscopy.

The complexities associated with the coding, billing, and reimbursement process seem to increase daily. Keeping abreast of the changes in this environment is, to say the least, a challenge. To succeed in today's billing environment the gastroenterologist should surround his or her practice with staff, resources, and education. Experienced skilled staff, preferably a certified professional coder should be employed. Certified coders bring advanced coding skills to ones practice, which allows increased proficiency with the coding and billing process. Provide the necessary resources for staff. Current coding material is crucial to the financial success of the practice. CPT-4, ICD-9, and Correct Coding Guide are the bare basics of the resource material available to staff. Maintaining a library of resource material (i.e., Medicare bulletins, managed care newsletters, and so forth) aids the staff with the necessary tools to carry out their duties. In addition, specific gastroenterology coding subscriptions are available to assist in staying ahead of the ever-changing billing and coding environment. Continuing education in the billing and coding process for both the physician and staff is essential. Numerous workshops are offered periodically. It is imperative that staff attends all Medicare-sponsored workshops in addition to gastroenterology-specific coding seminars. More and more physicians are now aware of their responsibility in the billing process and have begun to participate in the coding education along with their staff. This is a significant indicator of a physicians' intent to have a compliant and financially successful practice.

Cost-Benefit Analysis↗

PubMed1989

Responses of electroreceptors in the platypus bill to steady and alternating potentials.

1. This is a report of further observations on the response characteristics of electroreceptors in the bill of the platypus, Ornithorhynchus anatinus, first described by Gregory, Iggo, McIntyre & Proske (1987). 2. The main finding is that, with the bill immersed in water, applying a potential difference between large plate electrodes on either side of the bill, produced detectable responses in a population of electroreceptors to field strengths as low as 4 mV cm-1. Threshold for individual receptors lay between 4 and 25 mV cm-1. 3. An electric dipole placed in the water close to the receptive field could also elicit responses, threshold being lowest when the cathode was near the centre of the field. On several occasions the most sensitive spot was seen, under the microscope, to correspond to the mouth of a mucous sensory gland (Andres & Von Düring, 1984). Response intensity fell when the dipole was moved further away, the drop being less steep in a direction over the top of the bill towards the mid-line. 4. For individual receptors the latency of the first impulse initiated by supramaximal voltage pulses was 1.1-1.8 ms. Latencies tended to be shorter when the site of the receptor lay closer to the recording electrodes. Plotting each latency against conduction path length for eleven receptors gave an approximately linear relation from which was calculated an average axonal conduction velocity of 56 m s-1. The plot yielded an estimate of impulse initiation time of 0.8 ms. It is argued that this is too short to include a synaptic delay. A peripheral synapse is found in all non-mammalian electroreceptors. 5. Electroreceptors responded to both steady and rapidly changing potential gradients. For ramp-shaped gradients of 1-50 V s-1 peak firing rate was approximately proportional to log stimulus velocity. In response to sinusoidal potential changes a 1:1 relation between each afferent impulse and the peak of the stimulating waveform could be obtained over the range 12-300 Hz. Threshold was at its lowest at 50-100 Hz. Tuning curves measured with the bill immersed in water were little different from those obtained by focal stimulation with the bill in air. 6. It is concluded that platypus electroreceptors, supplied by the trigeminal nerve, and which are therefore not part of the acoustico-lateralis system as in non-mammalian electroreceptors, are also unique in not having a peripheral synapse. Furthermore, they are able to respond to both steady and rapidly changing voltage gradients.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

PubMed2003

Clinical integration of billing for a pediatric nephrology and transplant program.

PURPOSE: To develop and implement a billing process that fully integrates all activities of a pediatric nephrology and transplant program, by facilitating and coordinating data from patients, physicians, hospitals, and third-party billing services to maximize revenues. METHODS: Financial operations were analyzed via a randomized audit of patient charts that focused on office procedures and revenue collection. Results based on monthly reports documenting revenue received and outstanding, procedures billed, and patient registration accuracy. RESULTS: The combination of improvements in patient registration, chart documentation, new billing sheets with procedure and diagnosis codes, physician in-service education, upgraded charges, and the recredentialing of all practice physicians realized an increase in revenue collections from 18% in 2000 to 89% in 2001. CONCLUSION: The need to integrate and coordinate information is vital for both billing accuracy and revenue collections. Integration of clinical services and billing procedures has maximized performance, profitability, and accuracy while decreasing administrative time and costs.

Child↗

PubMed1991

A study of patients receiving no billed nursing care.

Although home health care traditionally is conceptualized as nursing care, in today's environment care at home may be delivered by a myriad of professional and nonprofessional practitioners. In fact, many patients who receive home care do not receive billed nursing visits. We studied a group of patients (n = 200) who received no billed nursing care, but rather received billed care from therapists, social workers and home health aides. This cohort of patients differed from patients who received billed nursing care in several ways: they were more frequently referred to home care from the community, their prognoses on admission to home care were significantly better, and their outcomes from home care services were considerably more favorable. Clearly patients not receiving billed nursing care have service and resource needs different from those of the population receiving billed nursing care. Therefore, new perspectives must be used when considering how to assess, deliver and perhaps pay for the requirements of these patients.

Home Care Services↗

PubMed1997

Billing Medicare for investigational devices: what's OK, what's not.

In 1993-1994, the Office of Inspector General (OIG) conducted an investigation of allegations that numerous hospitals had fraudulently billed the Medicare program for investigational cardiac devices. OIG found evidence of fraud related to these devices as well as to certain investigational procedures. Partly as a result of this probe, Senate hearings were held in 1996 to ascertain whether fraud and abuse in Medicare billing was a widespread problem. Investigational devices and procedures received particular attention during these proceedings. Hospitals involved in the 1993-1994 OIG investigation maintained that the Federal government previously sanctioned billing for the use of some investigational or experimental devices, that the devices and procedures in question had already been proven to be safe and effective, and that the devices or procedures resulted in better patient care or shorter lengths of stay. For these and other reasons, the hospitals contended, billing Medicare for these devices was appropriate. Although HCFA has allowed the Medicare program to pay for the use of some investigational devices and procedures since November 1995, Federal fraud and abuse investigators continue to scrutinize the billing practices of hospitals engaged in clinical trials. Financial managers in healthcare organizations that use investigational devices--even those not engaged in clinical trials--need to carefully review their organizations' compliance with Medicare billing requirements.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1999

[Automated anesthesia billing by electronic anesthesia record keeping system].

There has been loss of anesthesia fee by errors of filling out billing sheets manually. A large loss of anesthesia fee was pointed out by the audit during the past several years. In order to prevent these billing error, we have developed an automated anesthesia billing system combined with an electronic anesthesia record keeping (EARK) system. The system derives all the anesthesia cost-related parameters from the EARK database and calculates anesthesia fee according to the logic of the Japanese health care insurance system. After implementing the system, anesthesiologists and circulating nurses became free from filling out billing sheets. The accuracy of the automated billing was proved by the comparison with hand filled sheets. The survey showed that the system prevented 2.5 million yen of billing loss in a month. Such an economic impact of the system proves the rationale of an EARK as a cost containment tool.

Anesthesia↗

PubMedDate not supplied

A rational solution to billing problems.

For many practices, billing is a back-office task to be completed when the patient leaves the office. Historically, medical offices have placed their least experienced personnel at the front desk while the experienced staff remain hidden behind the scenes handling claims. Today's emphasis on customer service, however, has pushed the pendulum so that seasoned personnel are among the first with whom patients interact. Billing is a process that begins at the front desk when the appointment is made. Understanding the billing pipeline and how every action in a practice can contribute to the successful submission of "clean" claims and improved cash flow can encourage the physician and staff to think "billing" during each step of a patient's visit. This article will take you through the steps involved in the billing pipeline from patient registration to final payment or collection agency referral. For each step, we will point out how the actions of the staff affect billing and what can be done to assure accurate, clean claims are submitted promptly.

Deductibles and Coinsurance↗

PubMed1978

Family planning: sudden infant death syndrome bills.

Family planning, sudden infant death syndrome (SIDS) bills approved by the Senate Child Health and Human Development Subcommittee authorize $2.5 billion over 1979-1983 for family planning and $49 million over the same period for SIDS. The Human Resources Committee is expected to mark-up both bills May 3, 1978. The SIDS bill includes funds for expansion of counseling and information services, improving reporting requirements, and upgrading the SIDS unit in the Office of Maternal and Child Health. A total of $7 million is autorized for 1979. The Administration's SIDS bill includes only $3 million for 1979 and "such sums as necessary" for 1980-1981. The family planning bill authorizes $169 million for 1979, $197 million for 1980, $228 million for 1981, $263 million for 1982, and $300 million for 1983 to expand basic family planning services to adults and adolescents. It authorizes $42.5 million for 1979, $72 million for 1980, $105 million for 1981, $142 million for 1982, and $183 million for 1983 to provide services specifically to sexually active adolescents, plus $5 million in 1979, $7.5 million in 1980, $10 million in 1981, $12.5 million in 1982, and $15 million in 1983 for demonstration programs in infertility and to increase research in the biomedical, contraceptive development, and behavioral fields. The measure also provides $100 million in 1979, $125 million in 1980, $150 million in 1981, $175 million in 1982, and $200 million in 1983 for population research and reemphasizes the administrative functions of the deputy assistant secretary for population affairs and the Office of Population Affairs. The Department of Health, Education, and Welfare is currently looking for someone to fill the post, the duties of which are now performed by Deputy Assistant Secretary for Health Programs J. Lashof. The Administration's family planning bill requests $145 million for 1979 and "such sums as necessary" for 1980 and 1981.

Americas↗