What Factors Influence Physicians' Billing Accuracy?

Abstract

Every year, medical billing errors cost the United States government billions in public funds wrongfully or erroneously paid out. While recent reports indicate modest decline in hospital billing errors, the rate of physician evaluation and management billing errors show no signs of improvement. Opinions vary on the causes of these billing errors and consequently on the appropriate countermeasures. Despite this national crisis, to date, no strategies have proven to improve physician billing accuracy. This research examines the existing literature to explore theories and constructs that explain causal factors of physician billing errors and to illuminate gaps in the research which if explored, may result in potential strategies for improving billing accuracy.

A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system

“…Similar studies have also indicated that due to the inadequate reflection of labor value caused by the introduction of new policies, medical professionals resort to unexpected behaviors, providing the system with authentic feedback. This feedback is beneficial for the real exposure of problems and facilitates the development of solutions to bring the healthcare system back on track (22)(23)(24). Therefore, we can conclude that unexpected behaviors cannot simply be categorized as negative or positive; they are merely behavioral changes.…”