Journal articles: 'Hospital Billing'

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SoRelle, Ruth. "Hospital ED Billing." Emergency Medicine News 29, no. 3 (March 2007): 38. http://dx.doi.org/10.1097/01.eem.0000264690.65513.fa.

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Welton, John M., and Kathy Harris. "Hospital Billing and Reimbursement." JONA: The Journal of Nursing Administration 37, no. 4 (April 2007): 164–66. http://dx.doi.org/10.1097/01.nna.0000266846.77178.23.

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Mitchell, Colby L., Ernest R. Anderson, and Leeann Braun. "Billing for inpatient hospital care." American Journal of Health-System Pharmacy 60, suppl_6 (November 1, 2003): S8—S11. http://dx.doi.org/10.1093/ajhp/60.suppl_6.s8.

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Merritt-Myrick, Samirah, and David Harris III. "Successful Billing Strategies in the Hospital Industry." International Journal of Human Resource Studies 11, no. 1 (January 15, 2020): 85. http://dx.doi.org/10.5296/ijhrs.v11i1.18212.

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This paper explores the negative impact of changing Medicare regulations have on hospital profitability. Findings indicate that the successful strategies billing managers could use to ensure Medicare reimbursement and profitability include remaining up to date with Medicare changing compliance regulations, enhancing communication with staff, multiple departments, and Medicare, and adopting a robust billing system and other systems that compliment billing. Since the implementation of changes, hospitals continued to foster criterion to ensure successful Medicare reimbursement, thereby remaining in operation to continue to support the healthcare needs of families in the local communities. The biggest obstacle for hospitals is the ever-revolving Medicare reform and the effects it has on lowering reimbursement for the hospital industry. Hospitals that are affected by reform report issues that relate to the Medicare Prospective Payment System (PPS), payment for performance, and value-based payments.

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Labrèche, France, Tom Kosatsky, and Raymond Przybysz. "Childhood Asthma Surveillance using Administrative Data: Consistency between Medical Billing and Hospital Discharge Diagnoses." Canadian Respiratory Journal 15, no. 4 (2008): 188–92. http://dx.doi.org/10.1155/2008/412809.

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BACKGROUND: The absence of ongoing surveillance for childhood asthma in Montreal, Quebec, prompted the present investigation to assess the validity and practicality of administrative databases as a foundation for surveillance.OBJECTIVE: To explore the consistency between cases of asthma identified through physician billings compared with hospital discharge summaries.METHODS: Rates of service use for asthma in 1998 among Montreal children aged one, four and eight years were estimated. Correspondence between the two databases (physician billing claims versus medical billing claims) were explored during three different time periods: the first day of hospitalization, during the entire hospital stay, and during the hospital stay plus a one-day margin before admission and after discharge (‘hospital stay ± 1 day’).RESULTS: During 1998, 7.6% of Montreal children consulted a physician for asthma at least once and 0.6% were hospitalized with a principal diagnosis of asthma. There were no contemporaneous physician billings for asthma ‘in hospital’ during hospital stay ± 1 day for 22% of hospitalizations in which asthma was the primary diagnosis recorded at discharge. Conversely, among children with a physician billing for asthma ‘in hospital’, 66% were found to have a contemporaneous in-hospital record of a stay for ‘asthma’.CONCLUSIONS: Both databases of hospital and medical billing claims are useful for estimating rates of hospitalization for asthma in children. The potential for diagnostic imprecision is of concern, especially if capturing the exact number of uses is more important than establishing patterns of use.

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Murray, Marilyn K., and John J. Matchulat. "Hospital Charity Care and Billing Practices." JONA: The Journal of Nursing Administration 35, no. 6 (June 2005): 286???292. http://dx.doi.org/10.1097/00005110-200506000-00004.

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Buppert, Carolyn. "8 Things About Billing Hospital NP Services." Journal for Nurse Practitioners 10, no. 3 (March 2014): 207–8. http://dx.doi.org/10.1016/j.nurpra.2013.12.006.

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Cobaito, Francisco. "Faturamento Hospitalar Sob a Lente da Qualidade Total Hospital Billing Under the Lens of Total Quality." Revista de Gestão em Sistemas de Saúde 5, no. 1 (June 1, 2016): 52–61. http://dx.doi.org/10.5585/rgss.v5i1.167.

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Teufack, Sonia G., Peter Campbell, Pascal Jabbour, Mitchell Maltenfort, James Evans, and John K. Ratliff. "Potential financial impact of restriction in “never event” and periprocedural hospital-acquired condition reimbursement at a tertiary neurosurgical center: a single-institution prospective study." Journal of Neurosurgery 112, no. 2 (February 2010): 249–56. http://dx.doi.org/10.3171/2009.7.jns09753.

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Object The Centers for Medicare and Medicaid Services (CMS) have moved to limit hospital augmentation of diagnosis-related group billing for “never events” (adverse events that are serious, largely preventable, and of concern to the public and health care providers for the purpose of public accountability) and certain hospital-acquired conditions (HACs). Similar restrictions may be applied to physician billing. The financial impact of these restrictions may fall on academic medical centers, which commonly have populations of complex patients with a higher risk of HACs. The authors sought to quantify the potential financial impact of restrictions in never events and periprocedural HAC billing on a tertiary neurosurgery facility. Methods Operative cases treated between January 2008 and June 2008 were reviewed after searching a prospectively maintained database of perioperative complications. The authors assessed cases in which there was a 6-month lag time to allow for completion of hospital and physician billing. They speculated that other payers would soon adopt the present CMS restrictions and that procedure-related HACs would be expanded to cover common neurosurgery procedures. To evaluate the impact on physician billing and to directly contrast physician and hospital billing impact, the authors focused on periprocedural HACs, as opposed to entire admission HACs. Billing records were compiled and a comparison was made between individual event data and simultaneous cumulative net revenue and net receipts. The authors assessed the impact of the present regulations, expansion of CMS restrictions to other payers, and expansion to rehospitalization and entire hospitalization case billing due to HACs and never events. Results A total of 1289 procedures were completed during the examined period. Twenty-five procedures (2%) involved patients in whom HACs developed; all were wound infections. Twenty-nine secondary procedures were required for this cohort. Length of stay was significantly higher in patients with HACs than in those without (11.6 ± 11.5 vs 5.9 ± 7.0 days, respectively). Fifteen patients required readmission due to HACs. Following present never event and HAC restrictions, hospital and physician billing was minimally affected (never event billing as percent total receipts was 0.007% for hospitals and 0% for physicians). Nonpayment for rehospitalization and reoperation for HACs by CMS and private payers yielded greater financial impact (CMS only, percentage of total receipts: 0.14% hospital, 0.2% physician; all payers: 1.56% hospital, 3.0% physician). Eliminating reimbursement for index procedures yielded profound reductions (CMS only as percentage of total receipts: 0.62% hospital, 0.8% physician; all payers: 5.73% hospital, 8.9% physician). Conclusions The authors found potentially significant reductions in physician and facility billing. The expansion of never event and HACs reimbursement nonpayment may have a substantial financial impact on tertiary care facilities. The elimination of never events and reduction in HACs in current medical practices are worthy goals. However, overzealous application of HACs restrictions may remove from tertiary centers the incentive to treat high-risk patients.

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Erna Permanasari, Adhistya, Silmi Fauziati, and Argi Kartika Candri. "Development of a Web-Based Convergent Hospital Billing System." MATEC Web of Conferences 248 (2018): 02001. http://dx.doi.org/10.1051/matecconf/201824802001.

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Given the large volume of data generated in hospitals, the usage of hospital information system (HIS) that may ease the hospital’s workload on managing patient bills is critical. Thus, this paper presents the development of a web based hospital billing system which allows the staffs to manage and store patient bills in such a way that it can integrate bills from various departments. In addition to that, the system has additional features to allow down payments, automatically generate accounting reports, as well as integrate some features of the registration and the pharmacy system. The system design followed the Waterfall approach and was done using the use case diagram, activity diagram, sequence diagram, and entity relationship diagram. The data processed was actual data from the hospital and dummy data for the pharmacy system. The system’s functionality was tested using the black-box method and then evaluated by the hospital staffs using the SUS (System Usability Scale) method. From there, we obtained a score of 77.5 out of 100 from the SUS evaluation and 100% success rate from 102 features tested with the black-box testing method. Therefore, we can conclude that the new system works well and has good usability.

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Kawai, Alison Tse, Michael S. Calderwood, Robert Jin, Stephen B. Soumerai, Louise E. Vaz, Donald Goldmann, and Grace M. Lee. "Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections." Infection Control & Hospital Epidemiology 36, no. 8 (April 24, 2015): 871–77. http://dx.doi.org/10.1017/ice.2015.86.

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BACKGROUNDThe 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.OBJECTIVETo examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).STUDY POPULATIONAdult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.DESIGNWe used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.RESULTSBefore the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11–1.23]; for CAUTI, 1.19 [1.16–1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69–0.81]; for CAUTI, 0.87 [0.79–0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97–0.99]; for CAUTI, 0.99 [0.97–1.00]).CONCLUSIONSThe Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.Infect. Control Hosp. Epidemiol. 2015;36(8):871–877

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Ellis, Elizabeth Fuselier, Thomas A. Mackey, Carolyn Buppert, and Kenneth E. Klingensmith. "Acute Care Nurse Practitioner Billing Model Development." Clinical Scholars Review 1, no. 2 (November 2008): 125–28. http://dx.doi.org/10.1891/1939-2095.1.2.125.

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As hospitals face increasing practice management challenges, as in decreased staffing, decreased reimbursement, increased malpractice, rising costs, and increased quality and safety demands, many hospitals today have turned toward increased use of nurse practitioners (NPs). Utilization of NPs within hospitals has been safe, effective, and profitable and is increasingly accepted. Hospitals are now developing defined clinical leadership roles to oversee the daily practice management of advanced practice providers. A doctor of nursing practice (DNP) is the ideal clinical leader to develop and implement such innovative practice solutions for hospital-based NP programs. This article will address the basic principles of building a practice billing model for acute care NPs at a major medical center in Houston, Texas. Creating new models requires comprehensive analysis and continued evaluation as the complexities in providing health care continuously shift. The direct benefit of NP utilization will become evident through direct reimbursement or practice improvement.

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Dan, Bernard. "Challenges in using hospital billing databases for epidemiology." Developmental Medicine & Child Neurology 57, no. 1 (September 5, 2014): 7–8. http://dx.doi.org/10.1111/dmcn.12568.

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Mendenhall, S. "USING BILLING DATA TO IMPROVE HOSPITAL DRUG USE." International Journal for Quality in Health Care 3, no. 4 (December 1, 1991): 267–75. http://dx.doi.org/10.1093/intqhc/3.4.267.

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Korb, Pearce J., Serena J. Scott, Amy C. Franks, Anunta Virapongse, and Jennifer R. Simpson. "Coding and billing issues in hospital neurology compensation." Neurology: Clinical Practice 6, no. 6 (August 23, 2016): 487–97. http://dx.doi.org/10.1212/cpj.0000000000000290.

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Stryker, Louis S., Susan M. Odum, and Thomas K. Fehring. "Variations in Hospital Billing for Total Joint Arthroplasty." Journal of Arthroplasty 29, no. 9 (September 2014): 155–59. http://dx.doi.org/10.1016/j.arth.2014.03.052.

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Tu, K., T. Mitiku, H. Guo, D. S. Lee, and J. V. Tu. "Myocardial infarction and the validation of physician billing and hospitalization data using electronic medical records." Chronic Diseases and Injuries in Canada 30, no. 4 (September 2010): 141–46. http://dx.doi.org/10.24095/hpcdp.30.4.06.

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Objective Population-based identification of patients with a myocardial infarction is limited to patients presenting to hospital with an acute event. We set out to determine if adding physician billing data to hospital discharge data would result in an accurate capture of patients who have had a myocardial infarction. Methods We performed a retrospective chart abstraction of 969 randomly selected adult patients using data abstracted from primary care physicians on an electronic medical record in Ontario, Canada, as the reference standard. Results An algorithm of 3 physician billings in a one-year period with at least one being by a specialist or within a hospital or emergency room plus one hospital discharge abstract performed with a sensitivity of 80.4% (95% CI: 69.5-91.3), specificity of 98.0% (95% CI: 97.1-98.9), positive predictive value of 69.5% (95% CI: 57.7-81.2), negative predictive value of 98.9% (95% CI: 98.2% to 99.6%) and kappa statistic of 0.73 (95% CI: 0.63-0.83). Conclusion Using a combination of hospital discharge abstracts and physician billing data may be the best way of assessing trends of MI occurrence over time since it increases the capture of MI beyond those patients who have been hospitalized.

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Hemmer, Edgar. "Improving Hospital Billing and Receivables Management: Principles for Profitability." Hospital Topics 70, no. 1 (January 1992): 10–13. http://dx.doi.org/10.1080/00185868.1992.10545233.

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Herr, Daniel L., Gilles Clermont, and Derek C. Angus. "GENERATING TISS-28 SCORES DIRECTLY FROM HOSPITAL BILLING DATA." Critical Care Medicine 26, Supplement (January 1998): 66A. http://dx.doi.org/10.1097/00003246-199801001-00155.

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Ma, Xing Cheng, Yu Hua Liu, and Pei Hua Bao. "Interface-Based Medicare Billing Software Design." Applied Mechanics and Materials 666 (October 2014): 333–39. http://dx.doi.org/10.4028/www.scientific.net/amm.666.333.

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Medical institutions and health care billing system is mostly independent of the hospital information system software, such as the presence of a heavy workload and inconsistent information due to the Hospital Information System would like to produce a secondary entry problems. Design of Medicare billing software based on the interface, is the fundamental solution to the problem. This paper describes a specific Medicare interface specification, implementation of information exchange with the medical center by the dynamic link library functions, including the structure and format of the input and output parameters of the library function call, as well as medical insurance information processing flow. Select Delphi as a development tools, the definition of the interface specification stored in arrays, Achieve various Medicare functions of the Medicare interface specification with custom functions. A Medicare billing software system is completed with Medicare directory information management, Medicare card information management, Medicare fee settlement management, and the other Medicare functions.

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Hall, Brett M., Susan M. Odum, Thomas K. Fehring, and Louis S. Stryker. "Differences in Hospital Billing for Total Joint Arthroplasty Based on Hospital Profit Status." Journal of Arthroplasty 31, no. 9 (September 2016): 37–40. http://dx.doi.org/10.1016/j.arth.2016.02.067.

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Evanoff, Bradley A., Jeanne H. Button, and Laurie D. Wolf. "Effects of an Ergonomics Intervention among Hospital Billing Department Employees." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 44, no. 6 (July 2000): 700–703. http://dx.doi.org/10.1177/154193120004400643.

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McCue, Michael J., and Preethy Nayar. "Hospital billing for blood processing and transfusion for inpatient stays." Transfusion 49, no. 7pt2 (July 2009): 1517–19. http://dx.doi.org/10.1111/j.1537-2995.2009.02260.x.

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Zunta, Raquel Silva Bicalho, and Valéria Castilho. "Billing of nursing procedures at an intensive care unit." Revista Latino-Americana de Enfermagem 19, no. 3 (June 2011): 573–80. http://dx.doi.org/10.1590/s0104-11692011000300017.

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This study aimed to: estimate the billing of nursing procedures at an intensive care unit and calculate how much of total ICU revenues are generated by nursing. An exploratory-descriptive, documentary research with a quantitative approach was carried out. The study was performed at a general ICU of a private hospital in the city of Sao Paulo. The sample consisted of 159 patients. It was concluded that the nursing procedures were responsible for 15.1% of total ICU revenues, which breaks down to an average 11.3% of revenues coming from nursing prescriptions and 3.8% from medical prescriptions. Demonstrating how much nursing contributes to hospital revenues is essential information for nursing managers, as it is an important argument to obtain resources and guarantee safe care.

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Webber, Elaine, and Jean Benedict. "Billing for Professional Lactation Services: A Collaborative Practice Approach." Clinical Lactation 6, no. 2 (May 2015): 60–65. http://dx.doi.org/10.1891/2158-0782.6.2.60.

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Studies indicate support following discharge is a key component to improved breastfeeding outcomes. Many women do not have access to professional lactation support because of financial constraints. Until direct insurance reimbursement for lactation consultant services is consistent and universal, creative solutions are needed. A collaborative practice model between lactation consultants and medical healthcare providers is one approach. A community hospital implemented an outpatient lactation clinic coordinated by lactation consultants working in conjunction with in-hospital pediatricians and nurse practitioners. Patients are seen jointly by both the lactation consultant and medical care provider, with services billed to commercial and state insurances through the medical practice. The outcome is increased access to care, improved breastfeeding outcomes with greater patient satisfaction, and increased revenues for the facility.

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Jacoby, Melissa B. "Not-for-Profit Hospital Billing and Collection: Resisting Quick Legal Fixes." American Heart Hospital Journal 3, no. 1 (January 2005): 36–38. http://dx.doi.org/10.1111/j.1541-9215.2005.03929.x.

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Chern, Mary Anne. "Sudden scrutiny of hospital billing and collections: Managing the oppositional crisis." New Directions for Philanthropic Fundraising 2005, no. 49 (2005): 135–47. http://dx.doi.org/10.1002/pf.122.

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Pilkinton, Marjorie, and Lois Brustman. "A Survey of Physician Knowledge and Attitudes on Hospital Billing Costs." Obstetrics & Gynecology 123 (May 2014): 20S—21S. http://dx.doi.org/10.1097/01.aog.0000447278.43379.a5.

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Cooper, Zack, Hao Nguyen, Nathan Shekita, and Fiona Scott Morton. "Out-Of-Network Billing And Negotiated Payments For Hospital-Based Physicians." Health Affairs 39, no. 1 (January 1, 2020): 24–32. http://dx.doi.org/10.1377/hlthaff.2019.00507.

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Rohajawati, S., P. Rahayu, H. Akbar, S. Indria, and D. I. Sensuse. "Implementing DSDM and OO Method to Develop Billing in Mental Hospital." Journal of Physics: Conference Series 1566 (June 2020): 012059. http://dx.doi.org/10.1088/1742-6596/1566/1/012059.

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Lavoie-Gagne, Ophelie, Matthew Siow, William E. Harkin, Alec R. Flores, Carey S. Politzer, Brendon C. Mitchell, Paul J. Girard, Alexandra K. Schwartz, and William T. Kent. "Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)." Trauma Surgery & Acute Care Open 6, no. 1 (January 2021): e000634. http://dx.doi.org/10.1136/tsaco-2020-000634.

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BackgroundElectric scooters (e-scooters) have become a widespread method of transportation due to convenience and affordability. However, the financial impact of medical care for sustained injuries is currently unknown. The purpose of this study is to characterize total billing charges associated with medical care of e-scooter injuries.MethodsA retrospective review of patients with e-scooter injuries presenting to the trauma bay, emergency department or outpatient clinics at an urban level 1 trauma center was conducted from November 2017 to March 2020. Demographic and clinical data were collected. Primary outcomes of interest were total billing charges and billing to insurance (hospital and professional). Multivariable models were used to identify preventable risk factors associated with higher total billing charges.ResultsA total of 63 patients were identified consisting of 42 (66.7%) males, average age 40.19 (SD 13.29) years and 3.2% rate of helmet use. Patients sustained orthopedic (29%, n=18), facial (48%, n=30) and cranial (23%, n=15) injuries. The average total billing charges for e-scooter clinical encounters was $95 710 (SD $138 215). Average billing to insurance was $86 376 (SD $125 438) for hospital charges and $9 334 (SD $14 711) for professional charges. There were no significant differences in charges between injury categories. On multivariable regression, modifiable risk factors independently associated with higher total billing charges included any intoxication prior to injury ($231 377 increase, p=0.02), intracranial bleeds ($75 528, p=0.04) and TBI ($360 898, p=0.006).DiscussionMany patients sustain high-energy injuries during e-scooter accidents with significant medical and financial consequences. Further studies may continue expanding the financial impact of e-scooter injuries on both patients and the healthcare system.Level of evidenceIII

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de Freitas Moura Souza, Ana Maria, Saulo Barbará de Oliveira, and Emílio Possidente Daher. "Mapping the Hospital Billing Process: The Case of the a Federal Hospital in Rio de Janeiro." Procedia Computer Science 100 (2016): 671–76. http://dx.doi.org/10.1016/j.procs.2016.09.210.

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Beck da Silva Etges, Ana Paula, Ricardo Bertoglio Cardoso, Milena S. Marcolino, Karen Brasil Ruschel, Ana Paula Coutinho, Elayne Crestani Pereira, Fernando Anschau, et al. "The Economic Impact of COVID-19 Treatment at a Hospital-level: Investment and Financial Registers of Brazilian Hospitals." Journal of Health Economics and Outcomes Research 8, no. 1 (April 16, 2021): 36–41. http://dx.doi.org/10.36469/jheor.2021.22066.

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Background: The economic impact associated with the treatment strategies of coronavirus disease-2019 (COVID-19) patients by hospitals and health-care systems in Brazil is unknown and difficult to estimate. This research describes the investments made to absorb the demand for treatment and the changes in occupation rates and billing in Brazilian hospitals. Methods: This research covers the initial findings of “COVID-19 hospital costs and the proposition of a bundled reimbursement strategy for the health-care system,” which includes 10 hospitals. The chief financial officer, the chief medical officer, and hospital executives of each participating hospital provided information regarding investments attributed to COVID-19 patient treatment. The analysis included variations in occupation rates and billing from 2019 to 2020 observed in each institution, and the investments for medical equipment, individual protection materials and building construction per patient treated. Results: The majority of hospitals registered a decrease in hospitalization rates and revenue from 2019 to 2020. For intensive care units (ICUs), the mean occupancy rate ranged from 88% to 83%, and for wards, it ranged from 85% to 73%. Monthly average revenue decreased by 10%. The mean hospital investment per COVID-19 inpatient was I$6800 (standard deviation 7664), with the purchase of ventilators as the most common investment. For this item, the mean, highest and lowest acquisition cost per ventilator were, respectively, I$31 468, I$48 881 and I$17 777. Conclusion: There was significant variability in acquisition costs and investments by institution for responding to the COVID-19 pandemic. These findings highlight the importance of continuing microeconomic studies for a comprehensive assessment of hospital costs. Only with more detailed analyses, will it be possible to define and drive sustainable strategies to manage and reimburse COVID-19 treatment in health-care systems.

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Schull, Michael J., and Marian Vermeulen. "Ontario's alternate funding arrangements for emergency departments: the impact on the emergency physician workforce." CJEM 7, no. 02 (March 2005): 100–106. http://dx.doi.org/10.1017/s1481803500013051.

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ABSTRACT Background: Difficulty maintaining physician staffing in emergency departments (EDs) prompted the government of Ontario to offer alternate funding arrangements (AFAs) to replace fee-for-service remuneration for physicians working in EDs. Objective: To analyze the effect of AFAs on physician staffing and practice patterns. Methods: We obtained Ontario Health Insurance Program fee-for-service and shadow-billing records for all physician services provided in EDs one year before and one year after implementation of an ED AFA. Only sites with reliable billing data were retained. Physicians were assigned to small/rural, community or teaching hospital groups based on their billing claims. For each hospital type, and all hospitals combined, we compared the pre- and post-AFA periods in terms of the number of physicians working regularly in the ED and their workload. As a possible unintended consequence of AFAs, we also compared physicians' involvement in primary care. Results: Overall, 76.2% of eligible hospitals adopted an ED AFA, of which 49 (42.6%) were included in our study (16 small/rural, 27 community and 6 teaching hospitals). In the post-AFA period, the number of physicians working in EDs increased by 7, from 674 to 681, representing a 1.0% increase overall in the workforce (p = 0.84). The change varied by hospital type, from a 5.8% increase in teaching hospitals to a 2.2% decrease in community hospitals, though none was significant. In the post-AFA period, the number of physicians working a moderate number of days per month increased from 190 to 214, representing a 3.2% absolute increase (p = 0.39), and the number working few (<5) or many (>10) days per month decreased. Post-AFA, the number of physicians working in EDs who also provided primary care services decreased by 1.7%, from 544 to 535 (p = 0.10). Conclusion: Emergency department AFAs have been widely adopted in Ontario, but have not been associated with substantial changes in the overall physician workforce in EDs. However, trends toward increased physician numbers were seen in small/rural and teaching hospitals. There was little evidence of any adverse effects on the provision of primary care services by physicians.

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Elsbach, Kimberly D., Robert I. Sutton, and Kristine E. Principe. "Averting Expected Challenges Through Anticipatory Impression Management: A Study of Hospital Billing." Organization Science 9, no. 1 (February 1998): 68–86. http://dx.doi.org/10.1287/orsc.9.1.68.

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Calderwood, Michael S., Alison Tse Kawai, Robert Jin, and Grace M. Lee. "Centers for medicare and medicaid services hospital-acquired conditions policy for central line-associated bloodstream infection (CLABSI) and cather-associated urinary tract infection (CAUTI) shows minimal impact on hospital reimbursement." Infection Control & Hospital Epidemiology 39, no. 8 (June 28, 2018): 897–901. http://dx.doi.org/10.1017/ice.2018.137.

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ObjectiveIn 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing for hospital-acquired conditions (HACs) not present on admission (POA). We sought to understand why this policy did not impact central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) trends.DesignRetrospective cohort study.SettingAcute-care hospitals in the United States.ParticipantsFee-for-service Medicare patients discharged January 1, 2007, through December 31, 2011.MethodsUsing inpatient Medicare claims data, we analyzed billing practices before and after the HAC policy was implemented, including the use and POA designation of codes for CLABSI or CAUTI. For the 3-year period following policy implementation, we determined the impact on diagnosis-related groups (DRG) determining reimbursement as well as hospital characteristics associated with the reimbursement impact.ResultsDuring the study period, 65,205,607 Medicare fee-for-service hospitalizations occurred at 3,291 acute-care, nonfederal US hospitals. Based on coding, CLABSI and CAUTI affected 0.23% and 0.06% of these hospitalizations, respectively. In addition, following the HAC policy, 82% of the CLABSI codes and 91% of the CAUTI codes were marked POA, which represented a large increase in the use of this designation. Finally, for the small numbers of CLABSI and CAUTI coded as not POA, financial impacts were detected on only 0.4% of the hospitalizations with a CLABSI code and 5.7% with a CAUTI code.ConclusionsPart of the reason the HAC policy did not have its intended impact is that billing codes for CLABSI and CAUTI were rarely used, were commonly listed as POA in the postpolicy period, and infrequently impacted hospital reimbursement.

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Britt, Rebecca, Pamela Davis, Anjali Gresens, Leonard Weireter, T. J. Novosel, Jay Collins, and L. D. Britt. "The Implications of Transfer to an Acute Care Surgical Tertiary Service." American Surgeon 83, no. 12 (December 2017): 1422–26. http://dx.doi.org/10.1177/000313481708301230.

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Tertiary hospitals are increasingly called on by smaller hospitals and free-standing emergency rooms (ERs) to provide surgical care for complex patients. This study assesses patients transferred to an acute care surgery service. The ER and transfer center logs, as well as billing data, were reviewed for 12 months for all cases evaluated by acute care surgery. The charts were reviewed for demographics, comorbidities, and outcomes. A total of 111 transferred patients with complete data were identified, with 59 transferred from another hospital and 52 from a free-standing ER. The hospital transfer patients were older with more comorbidities, had a longer length of stay, and were more likely discharged to skilled care. There was no difference in the percent of patients requiring a procedure; however, significantly more procedures in the hospital transfer group were done by nonsurgical specialties Better infrastructure to monitor the impact of hospital transfers is warranted in the setting of the complex patient population transferred to tertiary hospitals.

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White, Frederick J. "Surprise Billing in a Hospital Emergency Department – An Ethical, Contractual, and Legislative Conundrum." American Journal of Bioethics 20, no. 8 (August 2, 2020): 112–14. http://dx.doi.org/10.1080/15265161.2020.1782516.

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Robbins, S. T. "Optimizing Recovery of Billing for Nutrition Services in the Hospital Based Outpatient Setting." Journal of the American Dietetic Association 95, no. 9 (September 1995): A75. http://dx.doi.org/10.1016/s0002-8223(95)00614-1.

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Chitnis, A. S., M. Vanderkarr, P. Nandwani, C. Connelly, and C. E. Holy. "PMD7 FEMUR FRACTURES BY ANATOMY- RATES AND COSTS IN A HOSPITAL BILLING DATABASE." Value in Health 22 (May 2019): S217. http://dx.doi.org/10.1016/j.jval.2019.04.1005.

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Hull-Grommesh, Lori, Elizabeth Fuselier Ellis, and Thomas A. Mackey. "Implications for cardiology nurse practitioner billing: A comparison of hospital versus office practice." Journal of the American Academy of Nurse Practitioners 22, no. 6 (June 2010): 288–91. http://dx.doi.org/10.1111/j.1745-7599.2010.00509.x.

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Ray, Michael J., William E. Trick, and Michael Y. Lin. "Assessing the Ability of Hospital Diagnosis Codes to Detect Inpatient Exposure to Antibacterial Agents." Infection Control & Hospital Epidemiology 39, no. 4 (February 20, 2018): 377–82. http://dx.doi.org/10.1017/ice.2018.23.

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OBJECTIVEBecause antibacterial history is difficult to obtain, especially when the exposure occurred at an outside hospital, we assessed whether infection-related diagnostic billing codes, which are more readily available through hospital discharge databases, could infer prior antibacterial receipt.DESIGNRetrospective cohort study.PARTICIPANTSThis study included 121,916 hospitalizations representing 78,094 patients across the 3 hospitals.METHODSWe obtained hospital inpatient data from 3 Chicago-area hospitals. Encounters were categorized as “infection” if at least 1 International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code indicated a bacterial infection. From medication administration records, we categorized antibacterial agents and calculated total therapy days using Centers for Disease Control and Prevention (CDC) definitions. We evaluated bivariate associations between infection encounters and 3 categories of antibacterial exposure: any, broad spectrum, or surgical prophylaxis. We constructed multivariable models to evaluate adjusted risk ratios for antibacterial receipt.RESULTSOf the 121,916 inpatient encounters (78,094 patients) across the 3 hospitals, 24% had an associated infection code, 47% received an antibacterial, and 13% received a broad-spectrum antibacterial. Infection-related ICD-9-CM codes were associated with a 2-fold increase in antibacterial administration compared to those lacking such codes (RR, 2.29; 95% confidence interval [CI], 2.27–2.31) and a 5-fold increased risk for broad-spectrum antibacterial administration (RR, 5.52; 95% CI, 5.37–5.67). Encounters with infection codes had 3 times the number of antibacterial days.CONCLUSIONSInfection diagnostic billing codes are strong surrogate markers for prior antibacterial exposure, especially to broad-spectrum antibacterial agents; such an association can be used to enhance early identification of patients at risk of multidrug-resistant organism (MDRO) carriage at the time of admission.Infect Control Hosp Epidemiol 2018;39:377–382

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Burke, Laura G., Robert C. Wild, E. John Orav, and Renee Y. Hsia. "Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries." BMJ Open 8, no. 1 (January 2018): e019357. http://dx.doi.org/10.1136/bmjopen-2017-019357.

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ObjectiveThere has been concern that an increase in billing for high-intensity emergency care is due to changes in coding practices facilitated by electronic health records. We sought to characterise the trends in billing for high-intensity emergency care among Medicare beneficiaries and to examine the degree to which trends in high-intensity billing are explained by changes in patient characteristics and services provided in the emergency department (ED).Design, setting and participantsObservational study using traditional Medicare claims to identify ED visits at non-federal acute care hospitals for elderly beneficiaries in 2006, 2009 and 2012.Outcomes measuresBilling intensity was defined by emergency physician evaluation and management (E&M) codes. We tested for overall trends in high-intensity billing (E&M codes 99285, 99291 and 99292) and in services provided over time using linear regression models, adjusting for patient characteristics. Additionally, we tested for time trends in rates of admission to the hospital and to the intensive care unit (ICU). Next, we classified outpatient visits into 39 diagnosis categories and analysed the change in proportion of high-intensity visits versus the change in number of services. Finally, we quantified the extent to which trends in high-intensity billing are explained by changes in patient demographics and services provided in the ED using multivariable modelling.ResultsHigh-intensity visits grew from 45.8% of 671 103 visits in 2006 to 57.8% of 629 010 visits in 2012 (2.0% absolute increase per year; 95% CI 1.97% to 2.03%) as did the mean number of services provided for admitted (1.28 to 1.41; +0.02 increase in procedures per year; 95% CI 0.018 to 0.021) and discharged ED patients (7.1 to 8.6; +0.25 increase in services per year; 95% CI 0.245 to 0.255). There was a reduction in hospital admission rate from 40.1% to 35.9% (−0.68% per year; 95% CI −0.71% to −0.65%; P<0.001), while the ICU rate of admission rose from 11.7% to 12.3% (+0.11% per year; 95% CI 0.09% to 0.12%; P<0.001). When we stratified by diagnosis category, there was a moderate correlation between change in visits billed as high intensity and the change in mean number of services provided per visit (r=0.38; 95% CI 0.07 to 0.63). Trends in patient characteristics and services provided accounted moderately for the trend in practice intensity for outpatient visits (pseudo R2of 0.47) but very little for inpatient visits (0.051) and visits overall (0.148).ConclusionsIncreases in services provided in the ED moderately account for the trends in billing for high-intensity emergency care for outpatient visits.

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Grider, Jay S. "Economic Impact of Converting an Interventional Pain Medicine Physician Office-Based Practice into a Provider-Based Ambulatory Pain Practice." Pain Physician 3;17, no. 3;5 (March 14, 2014): E253—E261. http://dx.doi.org/10.36076/ppj.2014/17/e253.

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Background: One consequence of the shifting economic health care landscape is the growing trend of physician employment and practice acquisition by hospitals. These acquired practices are often converted into hospital- or provider-based clinics. This designation brings the increased services of the hospital, the accreditation of the hospital, and a new billing structure verses the private clinic (the combination of the facility and professional fee billing). One potential concern with moving to a provider-based designation is that this new structure might make the practice less competitive in a marketplace that may still be dominated by private physician office-based practices. The aim of the current study was to evaluate the impact of the provider-based/hospital fee structure on clinical volume. Objective: Determine the effect of transition to a hospital- or provider-based practice setting (with concomitant cost implications) on patient volume in the current practice milieu. Setting: Community hospital-based academic interventional pain medicine practice. Study Design: Economic analysis of effect of change in price structure on clinical volumes. Methods: The current study evaluates the effect of a change in designation with price implications on the demand for clinical services that accompany the transition to a hospital-based practice setting from a physician office setting in an academic community hospital. Results: Clinical volumes of both procedures and clinic volumes increased in a mature practice setting following transition to a provider-based designation and the accompanying facility and professional fee structure. Following transition to a provider-based designation clinic visits were increased 24% while procedural volume demand did not change. Limitations: Single practice entity and single geographic location in southeastern United States. Conclusions: The conversion to a hospital- or provider-based setting does not negatively impact clinical volume and referrals to community-based pain medicine practice. These results imply that factors other than price are a driver of patient choice. Key words: Economics of interventional pain medicine, hospital-based ambulatory practice, provider-based ambulatory practice, physician-office based practice, price in-elasticity of health care

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Edwards, Jodi D., Mieke Koehoorn, Lara A. Boyd, Boris Sobolev, and Adrian R. Levy. "Diagnostic Accuracy of Transient Ischemic Attack from Physician Claims." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 4 (February 7, 2017): 397–403. http://dx.doi.org/10.1017/cjn.2016.454.

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AbstractBackground:Hospitalization data underestimate the occurrence of transient ischemic attack (TIA). As TIA is frequently diagnosed in primary care, methodologies for the accurate ascertainment of a TIA from physician claims data are required for surveillance and health systems planning in this population. The present study evaluated the diagnostic accuracy of multiple algorithms for TIA from a longitudinal population-based physician billing database.Methods:Population-based administrative data from the province of British Columbia were used to identify the base population (1992–2007;N=102,492). Using discharge records for hospital admissions for acute ischemic stroke with a recent (<90 days) TIA as the reference standard, we performed receiver-operating characteristic analyses to calculate sensitivity, specificity, positive and negative predictive values and overall accuracy, and to compare area under the curve for each physician billing algorithm. To evaluate the impact of different case definitions on population-based TIA burden, we also estimated the annual TIA occurrence associated with each algorithm.Results:Physician billing algorithms showed low to moderate sensitivity, with the algorithm for two consecutive physician visits within 90 days showing the highest sensitivity at 37.7% (CI95%=37.4–38.1). All algorithms demonstrated high specificity and moderate to high overall accuracy, resulting in low positive predictive values (≤5%), low discriminability (0.53–0.57) and high false positive rates (1 – specificity). Population-based estimates of TIA occurrence were comparable to prior studies and declined over time.Conclusions:Physician billing data have insufficient sensitivity to identify TIAs but may be used in combination with hospital discharge data to improve the accuracy of estimating the population-based occurrence of TIAs.

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Vinodkumar, Sudhaya, Binu Gigimon Varghese, and Maninder Singh Setia. "Factors associated with patient satisfaction in a private health care setting in India: A cross-sectional analysis." Journal of Hospital Administration 7, no. 4 (June 13, 2018): 44. http://dx.doi.org/10.5430/jha.v7n4p44.

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The present study was conducted to assess patient satisfaction and factors associated with it in a tertiary care hospital in India; and to evaluate the delay in discharge process and its association with satisfaction. It is a cross-sectional analysis of secondary data abstracted from patient satisfaction forms of 1,054 individuals. We analysed factors associated with rating of hospital services and overall hospital experience. We also evaluated the delay in discharge process and its association with overall satisfaction of these patients. We used regression models to assess factor associated with satisfaction scores and “good hospital experience”. About 91% of individuals reported that their experience in the hospital was good. The mean satisfaction scores were significantly lower in patients with delays in discharge due to insurance problems (-0.14, 95% CI: -0.27, -0.02). An increase in one unit in doctor’s score was significantly associated with “good rating” of hospital services (OR: 1.37, 95% CI: 1.19, 1.58). Similarly, one unit increase in the housekeeping score (OR: 1.34, 95% CI: 1.18, 1.52) and billing score (OR: 1.83, 95% CI: 1.56, 2.16) were significantly associated with an overall “good” rating. Thus, problems faced by patients and relatives during completion of billing procedures are important factors that determine overall satisfaction with health care settings. Improving the interpersonal and communication skills of doctors will be an important intervention for better hospital experience.

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Quick, Jacob A., Ashley N. Bartels, Jeffrey P. Coughenour, and Stephen L. Barnes. "Trauma Transfers and Definitive Imaging: Patient Benefit but at What Cost?" American Surgeon 79, no. 3 (March 2013): 301–4. http://dx.doi.org/10.1177/000313481307900331.

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Many patients undergo computed tomography (CT) scan before transfer to definitive care. Despite this, studies are often repeated on arrival to the trauma center. We evaluated a policy to provide formal in-house interpretation of images performed at outside hospitals. A 3-month retrospective analysis was performed. Two groups were compared. Patients in the in-house interpretation (IHI) group underwent in-house interpretation of outside images. Those images not meeting criteria were placed in the comparison group without in-house radiologic interpretation. Demographics, CT scan data, billing and productivity loss, and extrapolated cancer risk reduction were analyzed. There were no significant differences in demographic or injury data. Fewer total CT scans were performed in the IHI group (223 vs 320, P = 0.04). The IHI group underwent fewer repeated CT scans (25 vs 62, P = 0.02; odds ratio [OR], 0.53). Fewer patients were exposed to repeat CT scans (17 vs 32; OR, 0.48). Total hospital billings decreased by $188,285 ($4,592/patient) in the IHI group. Uncaptured work relative value units totaled 152.19 (3.71/patient) in the IHI group. Radiation exposure decreased by 8 per cent. Use of outside hospital imaging as the definitive evaluation of injured patients is safe and results in an overall decrease in radiation exposure and healthcare cost.

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Pelham, Larry D., Karin E. Bushaw, Michael R. Norwood, and Margaret O'Brien. "Operational Issues for Hospital-Based Home Infusion Pharmacies." Journal of Pharmacy Practice 3, no. 1 (February 1990): 11–18. http://dx.doi.org/10.1177/089719009000300103.

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This article focuses on a nonprofit, hospital-based comprehensive home infusion service in which all intravenous (IV) drugs or nutritional admixtures, professional services, supplies, and reimbursement services are performed solely by inpatient pharmacists, IV therapy nurses, and pharmacy assistants. By modifying an inpatient work load measurement system, additional staff are justified by total time for home infusion service work units. Twenty-four-hour back-up by cross-trained inpatient pharmacists and IV therapy nurses has contributed to the number of patients served by the home infusion service, which has grown steadily. A permanent and complete outpatient medical record is maintained for each patient (separate from inpatient records) in the infusion service and is available for 24-hour easy access for after-hour calls. All multidisciplinary team members participate in formal, weekly patient-care case conferences to review and update all patient therapies. Services covered, billing procedures, procedure codes, allowable charges, prior approval requirements, copayment arrangements, claims processing schedules, and related billing arrangements were first identified. The overall success of the program's reimbursement remains at 85% of charges when combining all patients. Structure, process, and outcome criteria unique to a comprehensive home care quality assurance program evolved from our high volume (total parenteral nutrition [TPN]), high risk (pain management, antibiotics), and problem-prone (TPN, pain management) therapies. Reimbursement remains the most troublesome aspect of initiating a successful hospital-based program. The success of our program depends heavily on the ability to attract and retain a highly motivated professional staff and to maintain strong referral networks with local physicians, hospital discharge planners, and other health care professionals.

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Smith, Thomas J., John Girtman, and Jerry Riggins. "Why Academic Divisions of Hematology/Oncology Are in Trouble and Some Suggestions for Resolution." Journal of Clinical Oncology 19, no. 1 (January 1, 2001): 260–64. http://dx.doi.org/10.1200/jco.2001.19.1.260.

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PURPOSE: Academic divisions of hematology/oncology seem to have difficulty recruiting and retaining excellent productive clinicians. A major reason for this is that salaries do not compete with the private sector for similar work. METHODS: We reviewed divisional finances productivity, and experiences from faculty members leaving. RESULTS: The academic salaries are approximately one third of practice because the chemotherapy concession has been given to the academic hospital. In addition, there may be substantial problems in under-billing, lack of attention to detail in billing, and poor collection practices. CONCLUSION: Academic practice still has much to offer, including opportunities for research and multidisciplinary team management, although the differences may narrow over the coming years. Attention to detail in the billing, collection for work performed, and increasing academic salaries to levels nearer to private practice are necessary components of the solution to recruit and retain quality pro-ductive clinicians.

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Porter, Joan, Luke Mondor, Moira K. Kapral, Jiming Fang, and Ruth E. Hall. "How Reliable Are Administrative Data for Capturing Stroke Patients and Their Care." Cerebrovascular Diseases Extra 6, no. 3 (October 18, 2016): 96–106. http://dx.doi.org/10.1159/000449288.

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Background/Aims: The reliability of diagnostic coding of acute stroke and transient ischemic attack (TIA) in administrative data is uncertain. The purpose of this study is to determine the agreement between administrative data sources and chart audit for the identification of stroke type, stroke risk factors, and the use of hospital-based diagnostic procedures in patients with stroke or TIA. Methods: Medical charts for a population-based sample of patients (n = 14,508) with ischemic stroke, intracerebral hemorrhage (ICH), or TIA discharged from inpatient and emergency departments (ED) in Ontario, Canada, between April 1, 2012 and March 31, 2013, were audited by trained abstractors. Audited data were linked and compared with hospital administrative data and physician billing data. The positive predictive value (PPV) of hospital administrative data and kappa agreement for the reporting of stroke type were calculated. Kappa agreement was also determined for stroke risk factors and for select stroke-related procedures. Results: The PPV for stroke type in inpatient administrative data ranged from 89.5% (95% CI 88.0-91.0) for TIA, 91.9% (95% CI 90.2-93.5) for ICH, and 97.3% (95% CI 96.9-97.7) for ischemic stroke. For ED administrative data, PPV varied from 78.8% (95% CI 76.3-81.2) for ischemic, 86.3% (95% CI 76.8-95.7) for ICH, and 95.3% (95% CI 94.6-96.0) for TIA. The chance-corrected agreement between the audited and administrative data was good for atrial fibrillation (k = 0.60) and very good for diabetes (k = 0.86). Hospital administrative data combined with physician billing data more than doubled the observed agreement for carotid imaging (k = 0.65) and echocardiography (k = 0.66) compared to hospital administrative data alone. Conclusions: Inpatient and ED administrative data were found to be reliable in the reporting of the International Classification of Diagnosis, 10th revision, Canada (ICD-10-CA)-coded ischemic stroke, ICH and TIA, and for the recording of atrial fibrillation and diabetes. The combination of physician billing data with hospital administrative data greatly improved the capture of some diagnostic services provided to inpatients.

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Journal articles on the topic 'Hospital Billing'

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