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Introduction: Recent reports suggest rising intensity of emergency department (ED) billing practices, sparking concerns that this may represent up-coding. However, it may reflect increasing severity and complexity of care in the ED population. We hypothesize that this in part may be reflected in more severe manifestations of illness as indicated by vital sign abnormalities.Methods: Using 18 years of data from the National Hospital Ambulatory Medical Care Survey, we conducted a retrospective secondary analysis of adults (>18 years). We assessed standard vital signs using weighted descriptive statistics (heart rate, oxygen saturation, temperature, and systolic blood pressure [SBP]), as well as hypotension and tachycardia. Finally, we evaluated for differing effects stratifying by subpopulations of interest, including age (

Abdelrahman M Elhusseiny,1,2 Muhammad Z Chauhan,1 Ahmed B Sallam1,3 1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, the University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Ain Shams University, Cairo, EgyptCorrespondence: Ahmed B Sallam, Department of Ophthalmology, Jones Eye Institute, the University of Arkansas for Medical Sciences, 4301 W Markham Street # 523, Little Rock, AR, 72205, USA, Email ahmedsallam11@yahoo.comPurpose: Many physicians charge more than the Medicare insurance program pays. Current charge-to-payment ratios in ophthalmology and trends over the years are unknown. In this work, we examined physician charge-to-payment ratios in ophthalmology across procedures and consultations.Methods: We utilized data from 100% final-action physician/supplier Part B Medicare fee-for-service (FFS) population from 2015 to 2020. We retrieved data on ophthalmic procedures and consultations, both facility-based and non-facility-based, conducted by ≥ 50 ophthalmologists. We analyzed median charge-to-payment ratios, which were calculated as submitted charges divided by the Medicare-allowed payments, between ophthalmic procedures and consultations to assess for trends over the study period.Results: We find that the median charge-to-payment ratio for all current procedural terminology (CPT) codes in 2020 was 2.23 (Interquartile range (IQR): 1.54– 3.27) as compared to 2.00 (IQR: 1.39– 2.92) in 2015, an overall 2.76% average annual growth rate from 2015– 2020. For ophthalmic procedures, the median charge-to-payment ratio in 2020 was 3.03 (IQR: 2.13– 4.41) compared to 2.79 (IQR: 1.96– 3.97) in 2015, corresponding to a 2.01% AAGR from 2015– 2020. For consultations, those rates were 2.06 (IQR: 1.48– 2.96), 1.85 (IQR: 1.33– 2.59), and 2.71%, respectively.Conclusion: We found that the submitted charge-to-Medicare payment ratios among ophthalmic procedures and consultations have steadily increased since 2015. However, there was a relatively low rate of excess charges for ophthalmology services compared to other surgical-based specialties with minimal variation among providers.Keywords: medicare excess charge, ophthalmology services, billing, trends, allowed medicare payments

The management of the technical reserve in Empresas Promotoras de Salud (EPS) in Colombia demonstrates adequate financial capacity to ensure the effective delivery of healthcare services. Nevertheless, the reserve's inherent nature and the unpredictability it engenders in planning engender financial risks that impair the long-term viability of such companies. The study aims to examine how filed invoices, unsubmitted authorizations, and estimated unknown debts affect the technical reserve of EPSs in Colombia from 2016 to 2021 using statistical methods like Online Linguistic Support, Autoregressive Moving Average, Autoregressive Conditional Heteroscedasticity, and Vector Autoregression. A descriptive and correlational study was conducted, considering current regulatory policies and the health insurance industry. Time series data were analyzed and revealed an inverse correlation between the explanatory and response variables. The method permits the assessment of two variables that impact technical reserve management: an increase in filed invoices and undetected claims results in decreased reserves, and filed authorizations have the opposite effect. Technical term abbreviations are explained upon their initial use in the text. Citations follow a consistent footnote style and formatting features. Similarly, we forecasted the impulse response function for the effect of technical reserves and suggested developing a predictive methodology to manage, regulate, or eradicate financial management vulnerabilities linked to HPC in Colombia. We emphasize the significance of precise authorizations for medical services since undiscovered debts may lead to financial losses for health care providers. A systematic approach is necessary to adhere to applicable regulations, including Law 100 of 1993 and associated resolutions and decrees. Healthcare providers can enhance their financial performance by ensuring accurate authorization and billing practices, thereby avoiding financial penalties. [ABSTRACT FROM AUTHOR]

The current billing system can only be done at the cashier by relying on human resources. So that it can increase the number of queues when consumers increase and purchase more than one product. Longer queues can waste time and energy so that it can reduce customer satisfaction. The billing process that can only be done at the cashier can also be an obstacle for customers in knowing the total bill when shopping. This can trigger an over budget so that customers have to increase their expenses. This research proposes an automatic billing system on a smart cart that can support the billing process, especially reading the total bill in real time. This system uses a Radio Frequency Identification (RFID) passive label attached to each product as a unique identification code. In the shopping cart there is an RFID reader that functions to read the label. The products that have been added to the cart will be displayed on the application intended for customers and the web server for the cashier. Information on the website includes product name, price per product unit, product quantity, and total bill.

Abstract Aim This study developed a set of competency evaluation indicators for billing nurses in China. Background In clinical practice, nurses often take up billing responsibilities that are accompanied by certain risks. However, the competency evaluation index system for billing nurses has not been established in China. Methods This study consisted of two main phases of research design: the first phase included a literature review and semi-structured interviews. Individual semi-structured interviews were conducted with 12 nurses in billing departments and 15 nurse managers in related departments. Concepts distilled from the literature review were linked to the results of the semi-structured interviews; this phase produced the first draft of indicators for assessing the professional competence of nurses in billing departments. In the second phase, two rounds of correspondence were conducted with 20 Chinese nursing experts using the Delphi method to test and evaluate the content of the index. The consensus was defined in advance as a mean score of 4.0 or above, with at least 75% agreement among participants. In this way, the final indicator framework was determined. Results Using the iceberg model as a theoretical foundation, the literature review identified four main dimensions and associated themes. The semi-structured interviews confirmed all of the themes from the literature review while generating new themes, both of which were incorporated into the first draft of the index. Then two rounds of the Delphi survey were conducted. The positive coefficients of experts in the two rounds were 100% and 95%, respectively, while the authority coefficients were 0.963 and 0.961, respectively. The coefficients of variation were 0.00–0.33 and 0.05–0.24, respectively. The competency evaluation index system for billing nurses consisted of 4 first-level indicators, 16 s-level indicators, and 53 third-level indicators. Conclusion The competency evaluation index system for billing nurses, which was developed on the basis of the iceberg model, was scientific and applicable. Implications for nursing management The competency assessment index system for billing nurses may provide an effective practical framework for nursing administration to evaluate, train, and assess the competency of billing nurses.

Study Design: Retrospective Cohort Study. Objectives: Using natural language processing (NLP) in combination with machine learning on standard operative notes may allow for efficient billing, maximization of collections, and minimization of coder error. This study was conducted as a pilot study to determine if a machine learning algorithm can accurately identify billing Current Procedural Terminology (CPT) codes on patient operative notes. Methods: This was a retrospective analysis of operative notes from patients who underwent elective spine surgery by a single senior surgeon from 9/2015 to 1/2020. Algorithm performance was measured by performing receiver operating characteristic (ROC) analysis, calculating the area under the ROC curve (AUC) and the area under the precision-recall curve (AUPRC). A deep learning NLP algorithm and a Random Forest algorithm were both trained and tested on operative notes to predict CPT codes. CPT codes generated by the billing department were compared to those generated by our model. Results: The random forest machine learning model had an AUC of.94 and an AUPRC of.85. The deep learning model had a final AUC of.72 and an AUPRC of.44. The random forest model had a weighted average, class-by-class accuracy of 87%. The LSTM deep learning model had a weighted average, class-by-class accuracy 0f 59%. Conclusions: Combining natural language processing with machine learning is a valid approach for automatic generation of CPT billing codes. The random forest machine learning model outperformed the LSTM deep learning model in this case. These models can be used by orthopedic or neurosurgery departments to allow for efficient billing. [ABSTRACT FROM AUTHOR]

Recently, California (CA) pharmacists' scope of practice has expanded to include independently prescribing self-administered hormonal contraceptives, nicotine replacement therapy medications, travel health medications, routine vaccinations, naloxone hydrochloride, and HIV preexposure and postexposure prophylaxis. However, previous reports indicate that practicing within this expanded scope has remained limited. Therefore, a 26-item, web-based survey was emailed to CA community pharmacists to assess pharmacists' knowledge, intent, and barriers to prescribing and billing for these patient care services. A total of 216 chain, supermarket-based, independent, mass merchant, and health-system outpatient pharmacists were included. The primary services provided and medications prescribed are for vaccinations and naloxone. Most pharmacists agree that engagement in and implementation of new strategies to enhance patients' access to care is important. Common barriers include patient unawareness of pharmacist-provided services, lack of payment for services, and difficulty incorporating services within pharmacy workflow. Pharmacists are confident in their ability to provide patient care services but are less knowledgeable and confident about billing for them. Enhancing promotion of pharmacist-provided services to patients, developing strategies to efficiently incorporate them into the workflow, and payment models can help overcome barriers to providing these services.

Background: Health policy knowledge is critical in today's healthcare environment; efforts to understand dermatology residents' health policy literacy and education on policy reforms pertaining to dermatology practice are limited. Methods: A 25-question electronic survey was administered to current U.S. dermatology residents in ACGME-accredited residencies to assess health policy education/experiences, career goals, and familiarity with current issues in health policy and dermatology. Results: There were 46 respondents of equal gender and training stage distribution. Of these, 67% and 30% reported health policy instruction in medical school and residency, respectively; 17% reported no prior instruction. Additionally, 50% and 31% intended to pursue academic medicine and private practice, respectively. Although most believed dermatology careers to be compatible with non-clinical endeavors (organized medicine leadership, policy reform, political/legislative advocacy, elected office), few intended to pursue such endeavors. Fewer than 50% of respondents reported familiarity with health legislation, reimbursement models, and the American Academy of Dermatology Association's 2018 advocacy priorities. Conclusions: Although some dermatology residents have prior health policy education and/or receive training in residency, there remain gaps in their knowledge and preparation to face current healthcare issues. Medical schools and residencies should address such gaps and provide health policy opportunities to ensure trainees' future success.

Point-of-care ultrasound (POCUS) is widely used for both diagnostic and therapeutic purposes. With its many advantages, including ease of use, real-time multisystem assessment, affordability, availability, and accuracy, it has been adopted by all medical specialties. Despite its advantages, the lack of standard workflow and automated billing solutions makes it difficult to launch a comprehensive POCUS program. In this work, we describe how we created and implemented an efficient standardized EHR-based workflow for POCUS that has been used across multiple division and settings within our organization. [ABSTRACT FROM AUTHOR]

Retail customers often wait to complete their purchases during the checkout process. Prior research suggests that long checkout lines and service delays negatively affect customers’ evaluation of store services. The present study investigates the potential customer and in-store distractions and their implication for emotional discomfort due to crowding stress. This study employed a cross-sectional research design and surveyed 385 respondents visiting the target retail outlets in Bengaluru, India. Correlation analysis explored the relationship between self-distraction, in-store distractions, and emotional discomfort. The study found that self-distraction negatively correlates with discomfort while in the queue (r = –0.119) and discomfort during the billing (r = –0.119). In contrast, in-store distractions (r = –0.161) and video displays near the checkout area (r = 0.116) effectively reduce emotional discomfort while in the queue. Additionally, point-of-purchase (POP) display (r = –0.265) and availability of refreshments near the billing counter (r = –0.175) are effective in reducing emotional discomfort during the billing. This study thus offers viable and affordable methods of improving the customer’s waiting experience while contributing to store profits.

Background: Point‐of‐care ultrasound (POCUS) is a central component of emergency medical care. However, clinicians often fail to adequately document their examinations, causing problems for downstream clinicians and quality assurance processes as well as loss of revenue. The objective of this study was to evaluate the impact of a user‐centered POCUS documentation workflow system for examination ordering, documentation, selective archival, and billing on POCUS documentation in a large academic emergency department (ED). Methods: In this quasi‐experimental study, we examined POCUS documentation 22 months before and 12 months after implementation of a user‐centered, automated ultrasound workflow (October 2018–July 2021). The workflow allows for electronic health record (EHR) order entry to populate a virtual ultrasound worklist, automatic demographic information retrieval to ultrasound machines, selective image storage to a hospital picture archive and communications system and/or POCUS archive Ultralinq, generation of an EHR report, and integrated billing triggers. Data were retrieved using Current Procedural Terminology codes for billed POCUS examinations during the study period. We also collected monthly hospital registry data to quantify ED visits to control for volume. We compared the number and per‐visit rate of POCUS documented using descriptive statistics and segmented linear regression before and after implementation of the workflow. Results: In the 22‐month preimplementation period, 209,725 ED visits occurred. During this period, POCUS was completely documented in 13,514 or in 6.4% of ED visits. There were an average of 614 scans documented per month. In the 12‐month postimplementation period, 97,418 ED visits occurred. During this period, POCUS was completely documented in 10,001 visits, or 10.3% of ED visits. There were an average of 833 scans documented per month. Linear regression analysis showed a significant increase in average monthly POCUS documentation of 265.34 scans/month (95% CI 150.60–380.09, p < 0.001) at the time of the intervention. Conclusions: In this single‐center study, POCUS documentation increased by more than 60% following the implementation of a user‐centered POCUS workflow that reduced the burden on the clinician by automating data entry, improving data flow between ultrasound machines and the EHR and integrating billing. [ABSTRACT FROM AUTHOR]

Introduction Residents often feel unprepared for independent practice, citing an unfamiliarity with billing as a common cause. Gamification has been well studied as a means to engage learners but not as a way to improve resident knowledge of outpatient billing guidelines. Methods We delivered a session to incoming PGY 1 residents with a goal of improving billing proficiency. The session included a pretest and posttest questionnaire, a prerecorded PowerPoint lecture, and Billing Bonanza, a game with instructions and rules that used gamification to reinforce billing concepts. Results Residents demonstrated improvement in percentage of correctly answered questions from 42% on the pretest to 67% on the posttest, which resulted in a statistically significant increase of 0.24 questions correct. Discussion This session led to improvement in baseline billing knowledge.

Purpose: Few examples of hospital-wide transition programs have been presented in the literature and to date, we have no data on the clinical and financial operations of such services. Design and methods: A transition clinic, guided by Got Transition’s Six Core Elements, was created for youth with moderate-to-high medical and psychosocial complexity (per Bob’s Levels of Social Support scale). The clinic visit and transition readiness assessment (UNC TRxANSITION Index) were billed fee-for-service or under a bundled payment managed care model. We present data on patient characteristics, clinic operations, finances, and patient/parent satisfaction (online survey) in the clinic’s first year of operation (March 2021-February 2022). Results: In Year 1, the clinic completed 115 appointments (113 unique patients). Most patients were older adolescents/young adults (M = 19.7 ± 1.8 years) and nearly half were Latinx. Patients presented with several complex medical needs including coordination of care across multiple subspecialties, high health care utilization, decision-making determinations, behavioral and mental health concerns, and resource needs. Implementation of the Six Core elements was high (range 99.1%−100%). The average billed per patient was $498 (in 2021–2022 USD). Considering paid and unpaid office visits, we collected an average of 31.6 cents on the dollar. Almost 80% of office visit claims and 21.9–33.3% of transition readiness assessments were paid by insurers. Patient/parent satisfaction was high, with over 90% of families reporting that they learned something, knew one thing they could do to improve transition readiness, and were able to get their questions asked and answered. Conclusions: Transition clinics may never be fully self-sustainable given low collection rates and inability to capture extra charge codes related to chronic care management and transitional care. However, our collection rate was on-par with the collection rate for our hospital’s subspecialty clinics and we show it is possible to receive some funding from insurers.

Abstract Objective Discrepancies in medical coding can negatively impact institutional revenue and result in accusations of medical fraud. The objective of the present study was to prospectively assess the utility of a dynamic feedback system for otolaryngology providers in improving the coding/billing accuracy of outpatient clinic encounters. Methods A billing audit of outpatient clinic visits was performed. Dynamic billing/coding feedback, consisting of a virtual lecture and targeted e‐mails, was provided at distinct intervals by the institutional billing and coding department. χ2 was used for categorical data, and the Wilcoxon test was used to compare changes in accuracy over time. Results A total of 176 clinic encounters were reviewed. Prior to feedback, 60% of encounters were inaccurately billed by otolaryngology providers, requiring upcoding and representing a potential 35% work relative value unit (wRVU) loss of E/M generated productivity. After 1 year of feedback, providers significantly increased the accuracy of their billing from 40% to 70% (odds ratio [OR]: 3.55, p

In order to reduce the operational energy consumption in the heating and cooling of buildings, the building industry is exploring methods of combining district heating and cooling networks where tenants’ premises are equipped with individual water source heat pumps. This has the potential to create an ambient loop where tenants can exchange heat with each other, and a main source of heating or cooling can top up the energy demand of the loop. A challenge that arises in such a system is how the landlord can accurately bill tenants when energy is shared between tenants via the landlord's services loop. This study takes a theoretical approach on one potential solution where the billing model is developed to use data from energy meters and electricity meters, analyze the operational modes of the components in the system and proportion the energy usage accordingly.

Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the impact of Medicare and Medicaid fraud to determine the magnitude of upcoding inpatient and outpatient claims throughout reimbursements. The methodology for this study utilized a literature review. The literature review analyzed physician upcoding throughout present on admission infections, diagnostic related group upcoding, emergency department, and clinic upcoding. It was found that upcoding has had an impact on Medicare payments and fraud. Medicare fraud has been reported to be the magnitude of upcoding inpatient and outpatient claims throughout Medicare reimbursements. In addition, fraudulent activity has increased with upcoding for ambulatory inpatient and outpatient charges for patients with Medicare and Medicaid. [ABSTRACT FROM AUTHOR]

Abstract Background The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. Despite a robust evidence base, real world implementation of Collaborative Care has been limited and very slow. The goal of this analysis is to better describe and understand the progression of implementation in the largest state-led Collaborative Care program in the nation—the New York State Collaborative Care Medicaid Program. Data are presented using the RE-AIM model, examining the proportion of clinics in each of the model’s five steps from 2014 to 2019. Methods We used the RE-AIM model to shape our data presentation, focusing on the proportion of clinics moving into each of the five steps of this model over the years of implementation. Data sources included: a New York State Office of Mental Health clinic tracking database, billing applications, quarterly reports, and Medicaid claims. Results A total of 84% of clinics with which OMH had an initial contact [n = 611clinics (377 FQHCs and 234 non-FQHCs)] received some form of training and technical assistance. Of those, 51% went on to complete a billing application, 41% reported quarterly data at least once, and 20% were able to successfully bill Medicaid. Of clinics that reported data prior to the first quarter of 2019, 79% (n = 130) maintained Collaborative Care for 1 year or more. The receipt of any training and technical assistance was significantly associated with our implementation indices: (completed billing application, data reporting, billing Medicaid, and maintaining Collaborative Care). The average percent of patient improvement for depression and anxiety across 155 clinics that had at least one quarter of data was 44.81%. Training and technical assistance source (Office of Mental Health, another source, or both) and intensity (high/low) were significantly related to implementation indices and were observed in FQHC versus non-FQHC samples. Conclusions Offering Collaborative Care training and technical assistance, particularly high intensity training and technical assistance, increases the likelihood of implementation. Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care.

The customer experience encompasses all aspects of a company's partnership: excellence in support services, promotion, packaging, product and service features, ease of use and adaptability. Customer Experience the consumer's internal and personal reaction to any direct or indirect interaction when using a business. The purpose of this study was to measure customer experience in Khorasan Razavi Telecommunication Company. In this study 384 customers of Telecommunication Company in Mashhad city participated, which was done during the first 3 months of year 1398. The research tool was a questionnaire and partial least squares analysis was used to analyze and test the research hypotheses. The results of the research hypotheses showed that brand image, service, network and customer support, billing, shop and self-service influenced the customer experience.

Cloud computing constant evolution requires dynamic adjustments to service pricing and billing terms, considering provider infrastructures, customer requirements, and discount policies, among others. In this context, Customer Agreements (CA) are used to regulate the service provision including, among other information, the agreed service level in SLAs, pricing, and billing terms. Although many existing proposals and industrial tools support the definition of pricing and billing of cloud services, there is a lack in terms of customisation and automated monitoring tools integrated with the billing process. In this article, we provide a flexible billing proposal supporting CA that considers not only SLA terms but also customisable pricing and billing terms, possibly including compensations (i.e. discounts or overcharges) that apply when specified conditions are met. In addition, we developed an automated monitoring and analysis tool that we validate in a real-world industrial scenario. Moreover, we analyse and compare more than 50 existing industrial tools with our proposal, highlighting the advantages of its rule-based approach.

From a practical point of view, no power system is free of losses. Power system losses, especially in distribution systems are usually high and result in increasing the cost of operations to the electric utilities and the price tag of electricity to the consumers. Aggregate Technical, Commercial and Collection (ATC&C) losses is a reliable parameter that reveals the true energy and revenue loss conditions of distribution systems. In this paper, mathematical models were developed for the determination of billing efficiency, collection efficiency, and ATC&C losses using Life Camp Area Office’s network of Abuja Electricity Distribution Company Plc Nigeria, as a case study. The average billing efficiency, collection efficiency and ATC&C losses for the period under review were found to be 89.73%, 84.80%, and 23.79% respectively. An understanding of appraisal of these losses is important to the power system Engineers, energy policy makers, and the power firms as it enables areas of high losses in the network to be identified, which will give room for credible investment plans and subsequent monitoring of the losses.

Incidental hepatic tissue obtained via cholecystectomy has yet to be fully characterized. Our objective was to demonstrate that this incidental hepatic tissue can be very large, can harbor clinically significant hepatopathology, and can increase billing. We retrospectively reviewed 20 specimens from cholecystectomy that contained hepatic tissue that was very large or that harbored clinically significant hepatopathology. For each case, we assigned theoretical variables corresponding to billing generated for the gallbladder, the liver, and cytochemistry, and compared this billing to standard billing generated if hepatic tissue and cytochemistry were ignored. Five specimens contained prominent wedge-like pieces of liver measuring 0.8 cm to 2.2 cm long and 0.3 cm to 1.8 cm wide, and 15 specimens contained microscopic pieces of liver. Diagnoses included nonalcoholic fatty liver disease or steatohepatitis (17 specimens), de novo α1-antitrypsin deficiency (2 specimens), de novo amyloidosis (1 specimen), hemosiderosis (1 specimen) and necrosis (1 specimen). Theoretical billing generated by including hepatic tissue and cytochemistry was triple the billing generated if hepatic tissue and cytochemistry were ignored. Incidental hepatic tissue obtained via cholecystectomy represents a potentially robust source of diagnostic hepatopathology and billing, and could minimize morbidity by detecting clinically occult hepatic diseases early. Microscopy of incidental hepatic tissue obtained via cholecystectomy should always be performed.

BackgroundHealth care delivery in the United States has evolved in many ways over the past century, including the development of the specialty of Emergency Medicine (EM). With the creation of this specialty, many positive changes have occurred within hospital emergency departments (EDs) to improve access and quality of care of the nation's de facto "safety net." The specialty of EM has been further defined and held to high standards with regard to board certification, sub-specialization, maintenance of skills, and research. Despite these advances, problems remain.ObjectiveThis review discusses the history and evolution of for-profit corporate influence on EM, emergency physicians, finance, and demise of democratic group practice. The review also explores federal and state health care financing issues pertinent to EM and discusses potential solutions.DiscussionThe monopolistic growth of large corporate contract management groups and hospital ownership of vertically integrated physician groups has resulted in the elimination of many local democratic emergency physician groups. Potential downsides of this trend include unfair or unlawful termination of emergency physicians, restrictive covenants, quotas for productivity, admissions, testing, patient satisfaction, and the rising cost of health care. Other problems impact the financial outlook for EM and include falling federal, state, and private insurance reimbursement for emergency care, balance-billing, up-coding, unnecessary testing, and admissions.ConclusionsEmergency physicians should be aware of the many changes happening to the specialty and practice of EM resulting from corporate control, influence, and changing federal and state health care financing issues.

Accurate documentation of patient care and acuity is essential to determine appropriate reimbursement as well as accuracy of key publicly reported quality metrics. We sought to investigate the impact of standardized note templates by inpatient advanced practice providers (APPs) on evaluation and management (E/M) charge capture, including outside of the global surgical package (GSP), and quality metrics including case mix index (CMI) and mortality index (MI). We hypothesized this clinical documentation initiative as well as improved coding of E/M services would result in increased reimbursement and quality metrics. A documentation and coding initiative on the heart and vascular service line was initiated in 2016 with focus on improving inpatient E/M capture by APPs outside the GSP. Comprehensive training sessions and standardized documentation templates were created and implemented in the electronic medical record. Subsequent hospital care E/M (current procedural terminology codes 99231, 99232, 99233) from the years 2015 to 2017 were audited and analyzed for charge capture rates, collections, work relative value units (wRVUs), and billing complexity. Data were compared over time by standardizing CMS values and reimbursement rates. In addition, overall CMI and MI were calculated each year. One year following the documentation initiative, E/M charges on the vascular surgery service line increased by 78.5% with a corresponding increase in APP charges from 0.4% of billable E/M services to 70.4% when compared with pre-initiative data. The charge capture of E/M services among all inpatients rose from 21.4% to 37.9%. Additionally, reimbursement from CMS increased by 65% as total work relative value units generated from E/M services rose by 78.4% (797 to 1422). The MI decreased over the study period by 25.4%. Additionally, there was a corresponding 5.6% increase in the cohort CMI. Distribution of E/M encounter charges did not vary significantly. Meanwhile, the prevalence of 14 clinical comorbidities in our cohort as well as length of stay (P =.88) remained non-statistically different throughout the study period. Accurate clinical documentation of E/M care and ultimately inpatient acuity is critical in determining quality metrics that serve as important measures of overall hospital quality for CMS value-based payments and rankings. A system-based documentation initiative and expanded role of inpatient APPs on vascular surgery teams significantly improved charge capture and reimbursement outside the GSP as well as CMI and MI in a consistently complex patient population. [ABSTRACT FROM AUTHOR]

The problem of delays in returning library books is common to all categories of library users at the University of Zambia. However, little is known about what causes the delay in returning the borrowed books. To address this gap, the authors investigated circulation policies at Zambia's leading academic library. The objective was to establish the effect of library regulations on the return of library books. Using a survey method, the study targeted 90 full-time students who were randomly selected. Quantitative data were analyzed using the statistical package for social sciences while qualitative data were coded and analyzed thematically. The results revealed that circulation policies have an effect on returning the borrowed books by users. These findings provide a useful contribution to the dearth of literature on this subject and offer valuable information to inform future planning. [ABSTRACT FROM AUTHOR]

Background: The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. Despite a robust evidence base, real world implementation of Collaborative Care has been limited and very slow. The goal of this analysis is to better describe and understand the progression of implementation in the largest state-led Collaborative Care program in the nation-the New York State Collaborative Care Medicaid Program. Data are presented using the RE-AIM model, examining the proportion of clinics in each of the model's five steps from 2014 to 2019.Methods: We used the RE-AIM model to shape our data presentation, focusing on the proportion of clinics moving into each of the five steps of this model over the years of implementation. Data sources included: a New York State Office of Mental Health clinic tracking database, billing applications, quarterly reports, and Medicaid claims.Results: A total of 84% of clinics with which OMH had an initial contact [n = 611clinics (377 FQHCs and 234 non-FQHCs)] received some form of training and technical assistance. Of those, 51% went on to complete a billing application, 41% reported quarterly data at least once, and 20% were able to successfully bill Medicaid. Of clinics that reported data prior to the first quarter of 2019, 79% (n = 130) maintained Collaborative Care for 1 year or more. The receipt of any training and technical assistance was significantly associated with our implementation indices: (completed billing application, data reporting, billing Medicaid, and maintaining Collaborative Care). The average percent of patient improvement for depression and anxiety across 155 clinics that had at least one quarter of data was 44.81%. Training and technical assistance source (Office of Mental Health, another source, or both) and intensity (high/low) were significantly related to implementation indices and were observed in FQHC versus non-FQHC samples.Conclusions: Offering Collaborative Care training and technical assistance, particularly high intensity training and technical assistance, increases the likelihood of implementation. Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care. [ABSTRACT FROM AUTHOR]

Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the impact of Medicare and Medicaid fraud to determine the magnitude of upcoding inpatient and outpatient claims throughout reimbursements. The methodology for this study utilized a literature review. The literature review analyzed physician upcoding throughout present on admission infections, diagnostic related group upcoding, emergency department, and clinic upcoding. It was found that upcoding has had an impact on Medicare payments and fraud. Medicare fraud has been reported to be the magnitude of upcoding inpatient and outpatient claims throughout Medicare reimbursements. In addition, fraudulent activity has increased with upcoding for ambulatory inpatient and outpatient charges for patients with Medicare and Medicaid. [ABSTRACT FROM AUTHOR]

BackgroundThe purpose of this study was to propose a new crosswalk using the resource-based relative value system (RBRVS) that preserves the time unit component of the anesthesia service and disaggregates anesthesia billing into component parts (preoperative evaluation, intraoperative management, and postoperative evaluation). The study was designed as an observational chart and billing data review of current and proposed payments, in the setting of a preoperative holing area, intraoperative suite, and post anesthesia care unit. In total, 1,195 charts of American Society of Anesthesiology (ASA) physical status 1 through 5 patients were reviewed. No direct patient interventions were undertaken.ResultsSpearman correlations between the proposed RBRVS billing matrix payments and the current ASA relative value guide methodology payments were strong (r=0.94-0.96, P

Introduction: Documentation and billing for laceration repair involves a description of wound length. We designed this study to test the hypothesis that emergency department (ED) personnel can accurately estimate wound lengths without the aid of a measuring device.Methods: This was a single-center prospective observational study performed in an academic ED. Seven wounds of varying lengths were simulated by creating lacerations on purchased pigs’ ears and feet. We asked healthcare providers, defined as nurses and physicians working in the ED, to estimate the length of each wound by visual inspection.  Length estimates were given in centimeters (cm) and inches. Estimated lengths were considered correct if the estimate was within 0.5 cm or 0.2 inches of the actual length. We calculated the differences between estimated and actual laceration lengths for each laceration and compared the accuracy of physicians to nurses using an unpaired t-test.Results: Thirty-two physicians (nine faculty and 23 residents) and 16 nurses participated.  All subjects tended to overestimate in cm and inches.  Physicians were able to estimate laceration length within 0.5 cm 36% of the time and within 0.2 inches 29% of the time. Physicians were more accurate at estimating wound lengths than nurses in both cm and inches. Both physicians and nurses were more accurate at estimating shorter lengths (5.0 cm).Conclusion: ED personnel are often unable to accurately estimate wound length in either cm or inches and tend to overestimate laceration lengths when based solely on visual inspection. Abstract [West J Emerg Med. 2014;15(7):–0.]

ABSTRACT Introduction: to assess the efficiency of management by a Social Health Organization (Organização Social de Saúde - OSS) compared with the private sector; to verify if there are savings for the State Health Secretariat (SES) in management contracts for financing the production of a public hospital versus its production values billed by private methods; and to establish if the amounts billed by the Unified Health System (SUS) table would finance the same procedures. Methods: we compiled and tabulated all procedures performed and the materials and drugs dispensed in the Euryclides Jesus Zerbini Transplant Hospital (HTEJZ), managed by the OSS Associação Paulista Para o Desenvolvimento da Medicina (SPDM), in September, October, and November 2018, according to the Brasíndice® table for drugs, the Simpro® table for materials, the CBHPM® table for medical fees, and tables SIGTAP SUS and SIA SUS. We then compared the average values obtained in the private billing with the costing amount reimbursed by the State Health Secretariat and the billing calculated in the SIA-SUS. Results: the average SUS revenue was R$ 2,774,086.91; the monthly reimbursement by the SES was R$ 13,055,700.00; and the average private revenue was R$ 25,084,440.31. Conclusions: the management by the OSS SPDM in the Euryclides de Jesus Zerbini Transplant Hospital was more efficient in the financing / production ratio than it would be to a private hospital. The economy of public funds was significant. The current SUS table reimbursement values would not meet the need for funding for an overly complex hospital.

Despite years of recognition that many physicians are woefully unprepared to face challenges regarding the business of medicine, marginal progress has been made. In this piece, we aim to provide the contemporary reproductive medicine physician with an understanding of billing, coding, and, most importantly, cost containment for a typical fertility practice. It is critical for modern practices to not forego hard-earned revenue to insurance companies or not be aware of critical rules and regulations. While running a successful fertility practice requires good medical care, a profitable practice is necessary for overall long-term success. This article provides a brief history of medical insurance and billing, explains the process of updating billing codes, and reviews the revenue cycle, cost containment, and contract negotiations with insurance companies. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials. No other disclosures were reported.

Cet article examine l’indemnisation des forces de l’ordre par les organisateurs d’événements musicaux, en particulier de festivals, en France. La gestion de l’ordre public y est marquée par la prééminence de l’État, ainsi que de la police nationale et la gendarmerie. L’indemnisation des services de ces dernières témoigne du pouvoir discrétionnaire du préfet, représentant de l’État, dans l’établissement (ou non) de la facturation, laquelle fait l’objet de fortes résistances de la part des organisateurs de festivals. En variant les dispositifs de sécurité ainsi que les montants de l’indemnisation, les préfets influent sur les relations entre forces de l’ordre et administrés. Dans le cas de l’indemnisation des forces de l’ordre par les organisateurs d’événements musicaux, sur qui s’exerce ce pouvoir discrétionnaire, et avec quels effets ? Et que révèle la mise en oeuvre de « droits », mais aussi de « passe-droits » par l’autorité préfectorale au sujet des relations entre État, police et société ? Une enquête qualitative, combinant entretiens, observations et sources documentaires variées, permet de répondre à ces questions. L’examen du recours différencié à l’indemnisation des forces de l’ordre par les préfets témoigne de la centralité des caractéristiques des territoires concernés, ainsi que des représentations préfectorales des événements musicaux et de leurs publics, prises en compte dans la définition du dispositif de sûreté. De surcroît, la définition des territoires professionnels et du monopole de l’État dans l’exercice de la violence légitime freine la concertation entre organisateurs et préfets sur la mise en oeuvre des dispositifs de sûreté.

Objetivo: la investigación pretende validar una herramienta de auditoría para la validación de cuentas médicas y la gestión de glosas en los procesos de auditoría con el fin de evaluar, controlar y mejorar los estándares de calidad y gestión en las instituciones de salud. Metodología: se optó por un estudio de corte exploratorio mixto. La investigación se realizó en tres fases: primero, se identificaron las principales causas por la que las EPS glosan las facturas a las IPS; posteriormente, se diseñó una herramienta que permite la auditoría interna de las facturas, previo envío a las EPS y la gestión de las glosas recibidas y; finalmente, se sometió la herramienta a validación por medio de un panel de expertos. Resultados: se diseñó una herramienta incorporando criterios de validación de facturas para los conceptos de tarifas y soportes, se incorporaron seis módulos que permiten parametrizar contratos EPS – IPS, registrar facturas, auditar soportes y tarifas, cargar facturas de forma masiva, gestionar glosas y generar indicadores y soportes del proceso de gestión. La herramienta fue validada con un panel de expertos, conformado por cinco miembros, quienes valoraron la usabilidad, claridad, facilidad y factibilidad de aplicación de la herramienta en el sector salud. Conclusiones: la investigación propone una herramienta constituida por diferentes módulos de acuerdo con el proceso y se valoraron criterios de claridad, cumplimiento de normatividad y factibilidad de aplicación en las IPS del país. El panel de expertos coincidió en la importancia del desarrollo de estas herramientas que entregan información de cumplimiento normativo y de la gestión hospitalaria ya que benefician la toma de decisiones acertada y oportuna en la gestión de glosas y los procesos de recuperación de cartera en las IPS.

A cloud of geographically distributed data centers developed by ITMO University (ifmo.ru) is presented.To increase reliability, as well as to collect statistical data, a special monitoring system is created that monitors the state of systems and the utilization of hardware resources. In addition to building a map of statistical data, information on resource utilization is suggested for the provider to perform a billing. An approach to monitoring system with asynchronous communication is proposed. An option with message broker implementation is shown. Out of two basic billing models, billing by quotas and billing by actual usage, we propose a model for organizing a dialogue between the administrator and the monitoring system in order to obtain data on resource utilization by actual usage. The use of a database for storing requests and responses is proposed, as well as the asynchronous dialogue using queues technology and message broker. Approbation was carried out on testing equipment with an actual infrastructure simulation. Unique asynchronous multi-agent system was obtained for statistics gathering on data center resources utilization. RabbitMQ message broker, PostgreSQL database and Zabbix monitoring system implementations are shown. The dialogue system was optimized with the help of Python code. The designed model can be recommended for implementation aimed at utilization of data obtained in different data centers, including distributed ones. Suggested model can be used in high-loaded systems providing virtual resources as a service.

Objective: The healthcare chart is becoming ever more complex, serving clinicians, patients, third party payers, regulators, and even medicolegal parties. The purpose of this study was to identify our emergency medicine (EM) resident and attending physicians’ current knowledge and attitudes about billing and documentation practices. We hypothesized that resident and attending physicians would identify billing and documentation as an area in which residents need further education.Methods: We gave a 15-question Likert survey to resident and attending physicians regarding charting practices, knowledge of billing and documentation, and opinions regarding need for further education.Results: We achieved a 100% response rate, with 47% (16/34) of resident physicians disagreeing or strongly disagreeing that they have adequate training in billing and documentation, while 91% (31/34) of residents and 95% (21/22) of attending physicians identified this skill as important to a resident’s future practice. Eighty-two percent (28/34) of resident physicians and 100% of attending physicians recommended further education for residents.Conclusion: Residents in this academic EM department identified a need for further education in billing and documentation practices. [West J Emerg Med. 2010;11(2): 116-119.]

Background: Health policy knowledge is critical in today's healthcare environment; efforts to understand dermatology residents' health policy literacy and education on policy reforms pertaining to dermatology practice are limited. Methods: A 25-question electronic survey was administered to current U.S. dermatology residents in ACGME-accredited residencies to assess health policy education/experiences, career goals, and familiarity with current issues in health policy and dermatology. Results: There were 46 respondents of equal gender and training stage distribution. Of these, 67% and 30% reported health policy instruction in medical school and residency, respectively; 17% reported no prior instruction. Additionally, 50% and 31% intended to pursue academic medicine and private practice, respectively. Although most believed dermatology careers to be compatible with nonclinical endeavors (organized medicine leadership, policy reform, political/legislative advocacy, elected office), few intended to pursue such endeavors. Fewer than 50% of respondents reported familiarity with health legislation, reimbursement models, and the American Academy of Dermatology Association's 2018 advocacy priorities. Conclusions: Although some dermatology residents have prior health policy education and/or receive training in residency, there remain gaps in their knowledge and preparation to face current healthcare issues. Medical schools and residencies should address such gaps and provide health policy opportunities to ensure trainees' future success. [ABSTRACT FROM AUTHOR]

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Background: Physician reimbursement laws for diagnostic interpretive services require that only those services provided contemporaneously and /or contribute directly to patient care can be billed for. Despite these regulations, cardiologists and radiologists in many hospitals continue to bill for ECG and plain film diagnostic services performed in the emergency department (ED). The reimbursement value of this care, which is disconnected in time and place from the ED patient encounter, is unknown. In a California community ED with a 32,000 annual census, the emergency physicians (EPs) alone, by contract, bill for all ECG readings and plain film interpretations when the radiologists are not available to provide contemporaneous readings.Objectives: To determine the impact of this billing practice on actual EP reimbursement we undertook an analysis that allows calculation of physician reimbursement from billing data.Methods: An IRB-approved analysis of 12 months of billing data cleansed of all patient identifiers was undertaken for 2003. From the data we created a descriptive study with itemized breakdown of reimbursement for radiograph and ECG interpretive services (procedures) and the gross resultant physician income.Results: In 2003 EPs at this hospital treated patients during 32,690 ED visits. Total group income in 2003 for radiographs was $173,555 and $91,025 for ECGs, or $19/EP hour and $6/EP hour respectively. For the average full-time EP, the combined total is $2537/month or $30,444 per annum, per EP. This is $8/ED visit (averaged across all patients).Conclusion: As EP-reimbursement is challenged by rising malpractice premiums, uninsured patients, HMO contracts, unfunded government mandates and state budgetary shortfalls, EPs are seeking to preserve their patient services and resultant income. They should also be reimbursed for those services and the liability that they incur. The reimbursement value of ECGs and plain film interpretations to the practicing EP is substantial. In the ED studied, it represents $30,444 gross income per full-time EP annually. Plain film interpretation services produce three times the hourly revenue of ECG reading at the hospital studied.[WestJEM. 2009;10:178-183.]

Dynamic wireless charging (DWC) is a promising technology to charge Electric Vehicles (EV) using on-road charging segments (CS), also known as DWC pads. In order to ensure effective utilization of this on-the-road charging service, communication and coordination need to be established between the EVs and the different network entities, thereby forming an Internet of Electric Vehicles (IoEV). In an IoEV, EVs can utilize different V2X communication modes to enable charging scheduling, load management, and reliable authentication and billing services. Yet, designing an authentication scheme for dynamic EV charging presents significant challenges given the mobility of the EVs and the short contact time between the EVs and the charging segments. Accordingly, this work proposes a fast, secure and lightweight authentication scheme that allows only authentic EVs with valid credentials to charge their batteries while ensuring secure and fair payments. The presented scheme starts with a key pre-distribution phase between the charging service company (CSC) and the charging pad owner (PO), followed by a hash chain and digital signature-based registration and authentication phase between the EV and the CSC, before the EV reaches the beginning of the charging lane. These preliminary authentication phases allow the authentication between the EVs and the charging segments to be performed using simple hash key verification operations prior to charging activation, which reduces the computational cost of the EVs and the CS. Symmetric and asymmetric key cryptography are utilized to secure the communication between the different network entities. Analysis of the computational and transmission time requirements of the proposed authentication scheme shows that, for an EV traveling at 60 km/h to start charging at the beginning of the charging lane, the authentication process must be initiated at least 1.35 m ahead of the starting point of the lane as it requires ≃81 ms to be completed.

This study aims to determine and explain the simultaneous and partial effects of service quality components consisting of reliability, responsiveness, assurance to customer satisfaction in PT. Terminal Petikemas Surabaya, аnd to know аnd explаin which between the three service quаlity vаriаbles thаt hаve а dominаnt effect on customer sаtisfаction. The type of reseаrch used is explаnаtory reseаrch with populаtion or census method with quаntitаtive аpproаch. Sаmples taken were 35 Billing Service users registered in PT. Terminal Petikemas Surabaya. Dаtа collection method used is questionnаire. The result of multiple lineаr regression аnаlysis shows thаt the three independent vаriаbles reliability, responsiveness, аssurаnce hаve significаnt influence on the dependent vаriаble thаt is customer sаtisfаction.