Educational Needs of Medical Practitioners About Medical Billing: A Scoping Review of the Literature

Abstract

IntroductionThe WHO has suggested the solution to leakage in health systems caused by waste, corruption and fraud is policing and prosecution. However, a growing body of evidence suggests leakage may not always be fraudulent or corrupt, with researchers suggesting medical practitioners may sometimes struggle to understand increasingly complex legal requirements around health financing and billing transactions, which may be improved through education. To explore this phenomenon further, we undertook a systematic review of the literature to identify the medical billing education needs of medical practitioners and whether those needs are being met.MethodsEligible records included English language materials published between 1 January 2000 and 4 May 2020, including empirical research, commentary, opinions and grey literature.ResultsWe identified 74 records as directly relevant to the search criteria. Despite a comprehensive international search, studies were limited to three countries (Australia, Canada, U.S), indicating a need for further work internationally. The literature suggests the education needs of medical practitioners in relation to medical billing compliance are not being met and medical practitioners desire more education on this topic. Evidence suggests education may be effective in improving medical billing compliance and reducing waste in health systems and there is broad agreement amongst medical education stakeholders in multiple jurisdictions that medical billing should be viewed as a core competency of medical education, though there is an apparent inertia to act. Penalties for non-compliant medical billing are serious and medical practitioners are at risk of random audits and investigations for breaches of sometimes incomprehensible, and highly interpretive regulations they may never have been taught.ConclusionDespite acknowledged significance of leakage in health systems due to poor practitioner knowledge of billing practices, there has been very little research to date on education interventions to improve health system efficiency at a practitioner level.