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Prior studies have suggested there may be differences in reimbursement and practice patterns by gender. The purpose of this study was to comprehensively evaluate differences in reimbursement, procedural volume, and patient characteristics in total hip arthroplasty (THA) between men and women surgeons from 2013 to 2021. The Medicare Physician and Other Practitioners database from 2013 to 2021 was queried. Inflation-adjusted reimbursement, procedural volume, surgeon information, and patient demographics were extracted for surgeons performing over 10 primary THAs each year. Wilcoxon, t -tests, and multivariate linear regressions were utilized to compare men and women surgeons. Only 1.4% of THAs billed to Medicare between 2013 and 2021 were billed by women surgeons. Men surgeons earned significantly greater reimbursement nationally in 2021 compared to women surgeons per THA ($1,018.56 versus $954.17, P =.03), but no difference was found when assessing each region separately. Reimbursement declined at similar rates for both men and women surgeons (−18.3 versus −19.8%, P =.38). An increase in the proportion of women surgeons performing THA between 2013 and 2021 was seen in all regions except the South. In 2021, the proportion of all THAs performed by women surgeons was highest in the West (3.5%) and lowest in the South (1.0%). Women surgeons had comparable patient populations in terms of age, race, comorbidity status, and Medicaid eligibility to their men counterparts, but performed significantly fewer services per beneficiary (5.6 versus 8.1, P <.001) and fewer unique services (51.1 versus 69.6, P <.001). Average reimbursement per THA has declined at a similar rate for men and women physicians between 2013 and 2021. Women's representation in THA surgery nationwide has nearly doubled between 2013 and 2021, with the greatest increase in the West. However, there are notable differences in billing practices between genders. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) has increasingly been used by neonatal providers in neonatal intensive care units in the United States. However, there is a lack of literature addressing the complexities of POCUS coding and billing practices in the United States. This article describes the coding terminology and billing process especially those relevant to neonatal POCUS. We elucidate considerations for neonatal POCUS billing framework and workflow integration. Directions on image storage and supporting documentation to facilitate efficient reimbursement, compliance with billing regulations, and appeal to insurance claim denial are discussed. Key Points Code neonatal POCUS procedure precisely allows accurate reimbursement and reduced errors in billing. Document details to support medical necessity and reimbursement claims effectively. Adhere to regulations to avoid audits, denials, and ensure proper reimbursement. [ABSTRACT FROM AUTHOR]

Background With greater acceptance of postmastectomy breast reconstruction (PMBR) as a safe and reliable treatment option, the role of plastic surgeons in breast cancer management continues to rise. As Medicare reimbursements for surgical procedures decline, hospitals may increase charges. Excessive markups can negatively affect uninsured and underinsured patients. We aimed to analyze mastectomy and breast reconstruction procedures to gain insights into recent trends in utilization and billing. Methods We queried the 2013 to 2020 Medicare Provider Utilization and Payment Data with 14 Current Procedural Terminology (CPT) codes to collect service count numbers, hospital charges, and reimbursements. We calculated utilization (service counts per million female Medicare enrollees), weighted mean charges and reimbursements, and charge-to-reimbursement ratios (CRRs). We calculated total and annual percentage changes for the included CPT codes. Results Among the 14 CPT codes, 12 CPT codes (85.7%) with nonzero service counts were included. Utilization of mastectomy and breast reconstruction procedures decreased from 1,889 to 1,288 (−31.8%) procedures per million female Medicare beneficiaries from 2013 to 2020. While the utilization of immediate implant placements (CPT 19340) increased by 36.2%, the utilization of delayed implant placements (CPT 19342) decreased by 15.1%. Reimbursements for the included CPT codes changed minimally over time (−2.9%) but charges increased by 28.9%. These changes resulted in CRRs increasing from 3.3 to 4.4 (+33.3%) from 2013 to 2020. Free flap reconstructions (CPT 19364) had the highest CRRs throughout the study period, increasing from 7.0 in 2013 to 10.3 in 2020 (+47.1%). Conclusions Our analysis of mastectomy and breast reconstruction procedures billed to Medicare Part B from 2013 to 2020 showed increasingly excessive procedural charges. Rises in hospital charges and CRRs may limit uninsured and underinsured patients from accessing necessary care for breast cancer management. Legislations that monitor hospital markups for PMBR procedures may be considered by policymakers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate changes in regional and national variations in reimbursement to arthroplasty surgeons, procedural volumes, and patient populations for total hip arthroplasty (THA) from 2013 to 2021. The Medicare Physician and Other Practitioners database was queried for all billing episodes of primary THA for each year between 2013 and 2021. Inflation-adjusted surgeon reimbursement, procedural volume, physician address, and patient characteristics were extracted for each year. Data were stratified geographically based on the United States Census regions and rural–urban commuting codes. Kruskal–Wallis and multivariable regressions were utilized. Between 2013 and 2021, the overall THA volume and THAs per surgeon increased at the highest rate in the West (+48.2%, +20.2%). A decline in surgeon reimbursement was seen in all regions, most notably in the Midwest (−20.3%). Between 2013 and 2021, the average number of Medicare beneficiaries per surgeon declined by 12.6%, while the average number of services performed per beneficiary increased by 18.2%. In 2021, average surgeon reimbursement was the highest in the Northeast ($1,081.15) and the lowest in the Midwest ($988.03) (P <.001). Metropolitan and rural areas had greater reimbursement than micropolitan and small towns (P <.001). Patient age, race, sex, Medicaid eligibility, and comorbidity profiles differ between regions. Increased patient comorbidities, when controlling for patient characteristics, were associated with lower reimbursement in the Northeast and West (P <.01). Total hip arthroplasty (THA) volume and reimbursement differ between US regions, with the Midwest exhibiting the lowest increase in volume and greatest decline in reimbursement throughout the study period. Alternatively, the West had the greatest increase in THAs per surgeon. Patient comorbidity profiles differ between regions, and increased patient comorbidity is associated with decreased reimbursement in the Northeast and the West. This information is important for surgeons and policymakers as payment models regarding reimbursement for arthroplasty continue to evolve. [ABSTRACT FROM AUTHOR]

The paper designs and implements a fully customized and branded hospital billing and recordkeeping system. It is aimed at simplifying the medical billing process and minimizing the daily hassles encountered by hospitals and other healthcare facilities. The system captures patients' information such as demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal status like age and weight, and billing information electronically and stores them in a relational database for easy access, retrieval and processing. Structured system analysis and design methodology (SSADM) uses objects throughout the software development process. The programming languages and development tools used are HTML and CSS for interface design, MYSQL for database design, and PHP for server-side scripting that facilitates communication between the interface and the database. The expected result is an integrated patient billing and recordkeeping system that will keep track of all the transactions of patients with the hospital and associate all health information with specific patients. [ABSTRACT FROM AUTHOR]

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 (

If passed, the "Access to Genetic Counselor Services Act" will authorize genetic counselors to provide services under Medicare part B. We assert that Medicare policy should be updated through the enactment of this legislation to provide Medicare beneficiaries with direct access to genetic counselor services. In this article, we discuss the background, history, and some recent research relevant to patient access to genetic counselors to provide context and perspective regarding the rationale, justification, and potential results of the proposed legislation. We outline the potential impact of Medicare policy reform, including the effect on access to genetic counselors in high‐demand areas or underserved communities. Although the proposed legislation pertains only to Medicare, we argue that private systems will also be impacted by passage as this may lead to an increase in hiring and retention of genetic counselors by health systems, thereby improving access to genetic counselors across the US. [ABSTRACT FROM AUTHOR]

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 &num; 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

Coding for neurosurgical procedures is a complex process that is dynamically changing year to year, through the annual introduction and removal of codes and modifiers. The authors hoped to elucidate if publicly available artificial intelligence (AI) could offer solutions for neurosurgeons with regard to coding. Multiple publicly available AI platforms were asked to provide Current Procedural Terminology (CPT) codes and Revenue Value Units (RVU) values for common neurosurgical procedures of the brain and spine with a given indication for the procedure. The responses of platforms were recorded and compared to the currently valid CPT codes used for the procedure and the amount of RVUs that would be gained. Six platforms and Google were asked for the appropriate CPT codes for 10 endovascular, spinal, and cranial procedures each. The highest performing platforms were as follows: Perplexity.AI identified 70% of endovascular, BingAI identified 55% of spinal, and ChatGPT 4.0 with Bing identified 75% of cranial CPT codes. With regard to RVUs, the top performer gained 78% of endovascular, 42% of spinal, and 70% of cranial possible RVUs. With regard to accuracy, AI platforms on average outperformed Google (45% vs. 25%, P = 0.04236). The ability of publicly available AIs to successfully code for neurosurgical procedures holds great promise in the future. Future development of AI should focus on improving accuracy with regard to CPT codes and providing supporting documentation for its decisions. Improvement on the existing capabilities of AI platforms can allow for increased operational efficiency and cost savings for practices. [ABSTRACT FROM AUTHOR]

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.

Objective: The Relative Value Unit (RVU) system was initially developed to account for costs associated with clinical services and has since been applied in some settings as a metric for monitoring productivity. That practice has come under fire in the medical literature due to perceived flaws in determination of "work RVU" for different billing codes and negative impacts on healthcare rendered. This issue also affects psychologists, who bill codes associated with highly variable hourly wRVUs. This paper highlights this discrepancy and suggests alternative options for measuring productivity to better equate psychologists' time spent completing various billable clinical activities. Method: A review was performed to identify potential limitations to measuring providers' productivity based on wRVU alone. Available publications focus almost exclusively on physician productivity models. Little information was available relating to wRVU for psychology services, including neuropsychological evaluations, specifically. Conclusions: Measurement of clinician productivity using only wRVU disregards patient outcomes and under-values psychological assessment. Neuropsychologists are particularly affected. Based on the existing literature, we propose alternative approaches that capture productivity equitably among subspecialists and support provision of non-billable services that are also of high value (e.g. education and research). [ABSTRACT FROM AUTHOR]

Background: Although there is a substantial body of evidence regarding full practice authority's (FPA) effects on health care access and quality, very little research has examined how nurse practitioner (NP) licensure laws affect the status of NPs as clinicians, employees, and leaders in health care organizations. Purpose: This study examined whether states' implementation of FPA leads to higher pay, business ownership, assigned patient panel, and billing transparency for NPs' and whether NPs' gains from FPA increase over time in states where FPA has been in effect longer. Methodology: Data from a nationwide survey of licensed NPs (N = 5,770) were used to compare NPs' employment conditions between FPA and non-FPA states. After balancing the FPA and non-FPA groups on demographic characteristics (e.g., urbanicity, education), adjusted mean differences in outcomes between the groups were estimated using weighted multivariable regression. Results: Compared with NPs in non-FPA states, NPs in FPA states had higher mean earnings (p < .05), were more likely to be practice owners or shareholders (p < .01), and billed a greater percentage of their patient visits under their own National Provider Identifier (p < .001). Having FPA in place for ≥10 years was associated with greater improvements in conditions of employment compared with having FPA <10 years. Conclusions: States' adoption of FPA for NPs is associated with improved conditions of employment among NPs. Implications: Untethering NPs from physicians establishes a cascade of modest gains in income and practice ownership that may indicate changes over time. Additional research is needed to determine the trajectory of these increases and if they are consistent. [ABSTRACT FROM AUTHOR]

Objective: To determine bulk billing rates, and mean, median, and 10th and 90th centile fees for outpatient consultations with a psychiatrist in Australia in 2019, by state or territory. Method: Medicare claims data for bulk billing rates and the mean, median, and 10th and 90th centile for fees charged in Australia in 2019 were requested, for item numbers for initial and ongoing consultations. Results: There were high rates of bulk billing overall. Initial consultations were more likely to be bulk billed. There was variation in fees between states and territories. Fees were highest in the Australian Capital Territory. Conclusion: There is variation in fees and bulk billing rates for outpatient consultations with a psychiatrist. Fees tend to be higher in states or territories with higher median personal income. Psychiatrists were more likely to bulk bill for initial consultations, with the exception of the Northern Territory. High rates of bulk billing may indicate psychiatrists are absorbing increasing costs of service provision. [ABSTRACT FROM AUTHOR]

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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.

Introduction: Despite the increasing importance of coding and billing in healthcare as a whole and calls from the Accreditation Council for Graduate Medical Education (ACGME) to emphasize systems-based practice, many surgical training programs have not prioritized coding and billing within their curricula. We aim to evaluate the performance of surgical residents and early career surgeons in coding and billing and to appraise interventions to improve coding and billing abilities within this group. Methods: A literature search from conception to March 15th, 2022 utilizing PubMed, Google Scholar, and EMBASE was conducted to search for studies that evaluate surgical resident coding practices and interventions to improve practice management and financial competency. Results: Discrepancies in coding and billing ability are prominent between residents, surgeons, and professional coders. One study demonstrated coding accuracy of 76.5% for professional coders, 62.1% for surgical attendings, and 54.1% for surgical residents, whereas another study reported a 52.82% coding accuracy and residents. Resident performance in coding and billing was inferior to their more experienced surgical attending counterparts and professional coders. Surgical residents and fellows demonstrated significantly improved knowledge and confidence in coding following the administration of either individual or longitudinal educational interventions. Conclusion: Coding and billing discrepancies among students, residents, and surgeons persist due to a lack of formalized training. Integration of standardized and mandated medical coding curricula and interventions within residency programs has great potential to improve surgical coding practices and should be a mandatory component of graduate medical education. [ABSTRACT FROM AUTHOR]

Documentation by a healthcare provider is the key to capturing appropriate reimbursement for effort, expertize, and time given to patients. However, patient encounters are known to be under-coded; often describing a level of service that does not reflect the physician's labor. If there is deficient medical decision making (MDM) documentation, this will ultimately lead to a loss of revenue, as coders can only evaluate service levels from the documentation during the encounter. Physicians at the Timothy J. Harnar Regional Burn Center at Texas Tech University Health Sciences Center were experiencing below-average reimbursement for work performed in the burn center and theorized that deficiencies in documentation (particularly in the area of MDM) were the cause. They hypothesized that poor documentation by physicians was resulting in a substantial proportion of encounters being compulsorily coded at inadequate and imprecise levels of service. To improve the service levels of MDM in physician documentation at the Burn Center and consequently, increase the numbers and levels of billable encounters in the unit with an accompanying increase in revenue, two resources were created and employed with the purpose of providing increased documentation recall and thoroughness. These resources included a pocket card, designed to prevent missed details when documenting patient encounters, and a standardized EMR template that was mandated to be used by all BICU medical professionals rotating through the unit. After completion of the intervention period (July - October 2021), a comparison was made between the 4-month periods of July-October 2019 and 2021. Based on the encounters provided by residents and one fellow assigned to the BICU medical director, inpatient subsequent visit codes showed an average increase in billable encounters of 1500% amid the compared periods. Upon implementation of the intervention, subsequent visit codes 99231, 99232, and 99233 (higher-numbered codes indicating an increased level of service and accompanying reimbursement) raised by 142%, 2158%, and 2200%, respectively. An additional finding since the implementation of the pocket card and revised template, billable encounters have replaced the once-dominate global encounter, 99024 (associated with no reimbursement); realizing an increase in billable inpatient services due to complete and thorough documentation of non-global issues patients experienced throughout their hospital stays. Obtaining buy-in from physicians proved a significant challenge; consistent training and feedback allowed for an improved understanding of billing and coding processes within the BICU. The described findings indicate that a focused effort to improve documentation offers a promising method to yield potentially significant improvements in a unit's profitability. • Documentation is the key to capturing appropriate reimbursement. • Inadequate documentation leads to poorer billing. • Standardized materials and dedicated education can improve documentation. • Improving documentation leads to improved reimbursement. [ABSTRACT FROM AUTHOR]

The International Classification of Diseases-10 Procedure Code System (ICD-10-PCS) introduced oxidized zirconium (OxZi) and niobium procedural codes to the types of femoral head bearing surfaces in 2017. These codes aimed to increase procedural specificity in coding and improve data collection through administrative claims databases. This study aimed to assess the accuracy of ICD-10-PCS coding for femoral head bearing surfaces (cobalt chrome/metal, ceramic, and OxZi) in hip procedures. A retrospective analysis of 6,204 procedures utilizing femoral heads performed between October 1, 2017 and August 26, 2021 at a large, urban academic hospital was conducted. Operative reports and implant logs were queried to determine the femoral head bearing surface, which was used during the total hip arthroplasty. These results were then compared to the ICD-10-PCS codes in the billing records. Coding accuracy was subsequently determined and statistical differences between the three groups were evaluated. The ICD-10-PCS coding was accurate for 90.8% (5,634/6,204) of cases. Coding accuracy for ceramic femoral heads (95.4%, 4,171/4,371) was significantly greater than that of both cobalt chrome/metal (73.7%, 606/822; P <.001) and OxZi (84.8%, 857/1,011; P <.001) femoral heads. While coding for ceramic femoral heads was very accurate, OxZi and cobalt chrome/metal femoral heads were miscoded at a rate of approximately 20%. These inaccuracies call for further evaluation of the ICD-10-PCS coding process to ensure that conclusions drawn from clinical research performed through administrative claims databases are not subject to error. [ABSTRACT FROM AUTHOR]

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]

The alabaster wall monument to Robert Claudius Billing, Suffragan Bishop of Bedford, placed in the crypt of St Paul's Cathedral, commemorates the life and service of a Victorian cleric known for his work in the overcrowded parishes of east London. Supplied by Powell and Sons, a London-based glassmaking firm that made stained glass and mosaics as well as reredoses and tablets, the monument echoes the architectural style and decoration of the iconic building in which it is placed, as well as showcasing a new vitreous mosaic material known as opus sectile that the firm innovated and marketed as suitable for both wall and floor decoration. The striking opus sectile portrait of Billing preserves an image of the deceased, and together with the accompanying epitaph demonstrates the affection and high esteem in which he was held in the Diocese of London and beyond. [ABSTRACT FROM AUTHOR]

Nowadays, supermarkets are almost developed with much technological advancement. People purchase different items from the supermarkets and put them into a trolley because it's the simplest method employed in supermarkets to hold goods. However, throughout the entire process of shopping, customer must push the trolley manually by their own effort and when it involves the billing process customers must wait in long queues to pay their bills. this can be a time-wasting process because of the busy schedule of individuals. So, to avoid this our project presents development of the smart shopping trolley (SST) that may be integrated into the smart mall system. The SST can provide customers with the efficient interface so the shopping service are often effectively done. With the utilization of radiofrequency identification (RFID) tags, the SST can automatically detect the assorted products which are being added within the cart and show the related information on the computer program (LCD and webserver). Finally, the automated billing service is done by the SST and therefore the stored shopping data are going to be transmitted to the net or cloud server of mall through ESP8266. So, the proposed SST interacts with the customer and provides efficient shopping service. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to identify the trends in reimbursement for hand surgeons for new patient visits, outpatient consultations, and inpatient consultations from the years 2010–2018. In addition, we sought to investigate the influence of payer mix and coding level of service on physician reimbursement in these settings. The PearlDiver Patients Records Database was used to identify clinical encounters and their respective physician reimbursements for analysis within this study. This database was queried using Current Procedural Terminology codes to identify relevant clinical encounters for inclusion, filtered for the presence of valid demographic information and by physician specialty for the presence of a hand surgeon, and tracked by primary diagnoses. Cost data were then calculated and analyzed regarding the payer type and level of care. In total, 156,863 patients were included in this study. The mean reimbursement for inpatient consultations, outpatient consultations, and new patient encounters increased by 92.75% ($134.85 to $259.93), 17.80% ($161.33 to $190.04), and 26.78% ($102.58 to $130.05), respectively. When normalized to 2018 dollars to adjust for inflation, the percent increases were 67.38%, 2.24%, and 10.09%, respectively. Commercial insurance reimbursed hand surgeons to a greater degree than any other payer type. Mean physician reimbursement differed depending on the level of service billed, with the level of service V reimbursing 4.41 times more than the level of service I visits for new outpatient visits, 3.66 times more for new outpatient consultations, and 3.04 times more for new inpatient consultations. This study helps to provide physicians, hospitals, and policymakers with objective information regarding the trends in reimbursement to hand surgeons. Although this study indicates increasing reimbursements for consultations and new patient visits to hand surgeons, the margins shrink when adjusted for inflation. Economic Analysis IV. [ABSTRACT FROM AUTHOR]

Within the past decade, Medicare Part B reimbursements for various surgical procedures have been declining, whereas health care expenses continue to increase. As a result, hospitals may increase service charges to offset losses in revenue, which may disproportionately affect underinsured patients. Our analysis aimed to characterize Medicare billing and utilization trends across common vascular surgical procedures. The 2017 to 2021 Medicare Physician and Other Practitioners by Provider and Service dataset was queried for Current Procedural Terminology (CPT) codes for common vascular surgery procedures. The average charges, reimbursements, charge-to-reimbursement ratios, and service counts were calculated for the most common interventions performed by vascular surgeons. Data was stratified by care setting, facility (inpatient and outpatient hospital) vs non-facility locations. All monetary values were adjusted to the 2021 United States dollars to account for inflation. For facility settings, the mean charge billed to Medicare Part B increased from $3708 to $3952 (6.6%) from 2017 to 2021, with the average charge-to-reimbursement ratio increasing from 7.2 to 8.6. There were 17 of the 19 facility procedures that had a decline in reimbursements, decreasing from an average of $558 to $499 (−10.4%). Stab phlebectomy had the largest individual decrease in facility reimbursement (−53.5%), followed by above-knee amputation (−11.3%) and below-knee amputation (−11.0%). Both non-facility charges (−10.8%) and reimbursements (−12.2%) declined over the study period. Procedural utilization remained stable from 2017 to 2019. Tibial and femoral-popliteal atherectomy had increases of 45.9% and 33.7%, respectively, in overall procedural utilization when performed in non-facility settings from 2017 to 2019. Our analysis of vascular surgery procedures billed to Medicare Part B from 2017 to 2021 demonstrates an increase in charges, a decline in reimbursements, and a resultant increase in charge-to-reimbursement ratios for facility care settings. In contrast, non-facility charges have decreased in the face of declining reimbursements. These markups in submitted charges in facility locations may serve as an additional barrier to accessing care for patients who are underinsured. [ABSTRACT FROM AUTHOR]