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At least 19 recordsLinked to original sources
PubMed1998

High-billing general practitioners and family physicians in Ontario: how do they do it? An analysis of practice patterns of GP/FPs with annual billings over $400,000.

BACKGROUND: To better understand the reasons why some fee-for-service physicians have high billing levels, the authors compared the practice and demographic characteristics of general practitioners and family physicians (GP/FPs) who submitted over $400,000 in annual Ontario Health Insurance Plan (OHIP) fee-for-service claims in 1994-95 with those of GP/FPs who billed between $35,000 and $400,000. METHODS: The authors describe the OHIP billing and physician characteristic data for fiscal year 1994-95. They used multivariate logistic regression to determine factors independently associated with high billing status. RESULTS: A total of 219 GP/FPs (2.5% of the GP/FPs in Ontario) billed over $400,000 in 1994-95. Of these, 14 had billing patterns similar to those of specialists, and 27 billed predominantly for diagnostic and therapeutic procedures (particularly physiotherapy). The remaining 178 (81.3%) billed for a mix of services similar to that of other GP/FPs but on average had 2.6 times the volume of patient assessments and a greater share of their total billings derived from diagnostic and therapeutic procedures (9.1% v. 5.6%). Multivariate analysis indicated that these high-volume GP/FPs were less likely than GP/FPs who billed between $35,000 and $400,000 to be 60 years of age or older (odds ratio [OR] 0.09, p < 0.05) and female (OR 0.21) and were more likely to be foreign graduates (OR 1.85) and practising in a region with low physician supply (OR 0.45 for each increase of 1 physician per 1000 population). Metropolitan Toronto was an outlier to the latter relation and was more likely to have high-volume GP/FPs (OR 16.89). INTERPRETATION: High-billing GP/FPs attained their high billing levels by maintaining large numbers of patient visits and by performing procedures. Further research is needed to determine the time spent per patient and the quality of care delivered by these physicians as well as the appropriateness of the procedures that they perform.

Adult↗
PubMed2002

Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1977

The mutual relations of structures in the growing bill of chick (Gallus domesticus L.) and duck (Anas platyrhynchos L.) Embryos. IV. The size, shape, and position of the upper and lower bills in unilaterally microphthalmic duck embryos.

Unilaterally microphthalmic duck (DUM) embryos studied in stage 39 were obtained by damaging the right eye in stage 17. The development between stages 19 and 39 was observed in samples. After prolonged incubation, one duck hatched and reached adulthood. In DUM embryos partial crossbeak develops. Both the upper and lower bills deviate lateralwards, the upper bill more than the lower. In stage 39 a small orbit is present on the treated side. In stained and cleared heads most of the elements of the skull (the bones surrounding the orbit, the brain-case, and the upper and lower bill elements) are translated in the direction of the rudimentary orbit on the treated side. The bills are twisted around each other at the tip. Measurements of external dimensions as well as those made in stained and cleared stage-39 DUM heads show elongation of the left part of the lower bill. Except for the crossed bills, the changes found in the embryos persisted in the adult. The findings support a hypothesis concerning the mutual influence of bills during morphogenesis. The coherence of the functional cranial components in the embryo is discussed.

Animals↗
PubMed1998

Billing for physician services: a comparison of actual billing with CPT codes assigned by direct observation.

BACKGROUND: Little is known about the accuracy of family physicians' use of the Current procedural Terminology (CPT) coding scheme for office visits, despite increased administrative oversight of Medicare billing practices. In addition, the patient and visit characteristics that are associated with over- and undercoding are not well understood. METHODS: This study compared coding for evaluation and management (E&M) services billed for 3791 visits to 138 family physicians with the codes assigned by trained research nurses using direct observation. We calculated the degree to which the codes for E&M were concordant with the observer-assigned codes. Analysis of variance and logistic regression were used to examine the association of visit and patient characteristics with discordance between billed and observer-assigned CPT codes. RESULTS: Billing codes were concordant for 55% of encounters. Discordance was evenly distributed between under- and overcoding. Concordance of billed and observed codes was greatest for patients with indemnity insurance. Undercoding increased with longer visit length and a smaller percentage of the visit spent planning treatment. Overcoding was more common during visits with a greater percentage of time spent chatting, planning treatment, and delivering preventive services. CONCLUSIONS: Family physicians are generally accurate in their billing procedures. The findings on patient and visit characteristics associated with over- or undercoding may be used by practicing clinicians to enhance the accuracy of their coding and billing procedures.

Adult↗
PubMed1998

Conducting physician mail surveys on a limited budget. A randomized trial comparing $2 bill versus $5 bill incentives.

OBJECTIVES: The effects of incentive size on physicians' response rates to a mail survey were determined. METHODS: One thousand US primary care physicians were assigned randomly to receive a survey with either a $5 bill or a $2 bill as an incentive. For each of the two incentive groups, the overall response rate for three mailing waves, the total cost, and the total cost per usable response were measured. RESULTS: The response rate among those receiving the $5 bill (61%) was 32% higher than the response rate among those receiving the $2 bill (46%); overall costs were slightly higher in the $5 group, but the cost per response for each group was similar ($15.46 versus $14.93). For the same cost, a higher response rate could have been achieved in the $2 group if costs saved from foregoing the third mailing were instead used to increase the incentive for a portion of the subjects. CONCLUSIONS: A $5 bill incentive yielded a higher response rate among the physicians in this study than did a $2 bill incentive. Moreover, the powerful effect of the incentive size, combined with the consequent decline in the costs of subsequent mailing waves, suggests that resources in a fixed survey budget are allocated more efficiently to increasing the initial incentive rather than to providing a third wave to nonresponders.

Budgets↗
PubMed1991

Billing tactics. Advantages of a professional billing service in radiation oncology.

An efficient billing system for your professional services must include the following items: 1. A significant amount of personal involvement by the physician in the origination of the patients' charges. 2. Friendly, courteous, and helpful personnel for patient interaction. 3. Timely and accurately posting of accounts. 4. An absolute separation of receipt of payments and account reconciliation. 5. A personal interest by the physician in the accounts receivable balance as well as monthly financial summaries of the ongoing business of your practice. 6. Knowledge of the patient's credit history and ability to pay for services. 7. Dedication to serving you in the most efficient cost-effective manner. 8. A method for remaining absolutely current on any changes occurring in the healthcare reimbursement sector. 9. Frequent meetings between the radiation oncologist and the service responsible for professional billing. 10. Timely review and management of all past due accounts making decisions toward collection or adjustment. 11. A method for tracking referral physician identification and disease categories which are now a part of Medicare billing requirements and should allow you to be able to graphically demonstrate trends in your practice referrals.

Commerce↗
PubMed2000

Improved inpatient billing metrics by physician-directed billing software.

Billing may not be prominent on academic physicians' lists of priorities because of other demands and commitments for their time. The authors developed and examined the use of an electronic inpatient billing tool that also facilitated physician rounding responsibilities. The results show that use of an electronic tool was more acceptable to physicians than their original card system, and it significantly decreased charge-processing lag time.

Academic Medical Centers↗
PubMed1984

[Biomechanics of the skull and the bill in Ramphastos (Ramphastidae, Aves). II. Analysis of the conditions of movement of the bill].

As all the anatomical conditions are not present to permit any movement between the cranial segments, the bill aperture and closure by the rotation on the quadrato mandibular joint is, in Ramphastos , the only action studied in relation to muscles organization and bone architecture by torques analysis. From a mechanical advantage viewpoint, the beginning of the closure seems to be performed by velocity muscles, while the action is ended by power muscles. The stresses issued by the muscles actions are balanced by bone trabeculae and other muscles, and may be considered as responsible of the mechanical stiffness of the whole bill system.

Animals↗