On-line Medicaid billing system for physicians' services

Automation of a Patient Medical Profile from Insurance Claims Data: A Possible First Step in Automating Ambulatory Medical Records on a National Scale

“…Our own measurements o f encoding (Mesel and Wirtschafter, 1975) by carrier personnel showed that accuracy varies between 50 percent and 75 percent. This unhappy state o f affairs is a reflection of the lack of performance standards in contracts for intermediary services and o f the lack of perceived benefits that could be derived from improved accuracy by the carriers in carrying out their ad ministrative goals.…”

“…If the results of laboratory tests were reported on claims forms, a much more complete profile would not only be available for direct patient care but would also be available for evaluating the processes and outcomes of care. On examination o f those conditions which acccount for more than 50 percent of the diagnoses made by general practitioners we found that for most of the twenty (Mesel and Wirtschafter, 1975) claims data already can provide many answers to intermediate and long term outcomes.…”

“…That these defects can be remedied has been demonstrated in another project (Mesel and Wirtschafter, 1975) in which Medicaid claims data were entered directly into computer files by physicians' office personnel using a Touch Tone ® phone with Card Dialer ® as a remote terminal. This experiment demonstrated the ease, ac curacy, and efficiency of source data collection and entry.…”

“…In primary care, 10 services account for 80 percent of all services provided to Medicaid patients (Mesel and Wirtschafter, 1975). Numerous other procedure codes are used by medical insurers and intermediaries.…”

“…Of this amount more than half could be fairly at tributed to system development costs rather than to operating costs. By any standard this is a trivial fraction o f the combined cost of preparing and processing insurance claims in Medicaid and Medicare programs (Mesel and Wirtschafter, 1975;and HEW, 1973b), which range from $3.60 to $4.85 per claim. The more costly aspect would be to produce a paper copy of the profile and to mail it to the patient's physician.…”