What If Pediatric Residents Could Bill for Their Outpatient Services?

Ng, Manny; Lawless, Stephen

doi:10.1542/peds.108.4.827

Cited by 32 publications

(12 citation statements)

References 7 publications

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“…Finally, while comparisons between the continuous variables are made based on descriptive statistics rather than statistical significance, this decision facilitates a better characterization of the wide variance of unbiased estimates, the extent of which has not been previously described. Despite these limitations, our findings are generally consistent with many previous studies from a variety of training environments, 6-7,16-17,19-22 and they are significant in documenting not only a lack of knowledge regarding documentation among residents surveyed but also the influence of that educational deficit on residents’ understanding of financial reimbursement.…”

Section: Resultssupporting

confidence: 89%

See 1 more Smart Citation

Resident Awareness of Documentation Requirements and Reimbursement: A Multi-Institutional Survey

Yount

Reames

Kensinger

et al. 2014

The Annals of Thoracic Surgery

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Background: The current economic environment necessitates efforts to prevent avoidable losses in clinical revenue in academic cardiothoracic surgery programs. Inadequate documentation frequently results in delayed, denied, or reduced reimbursement. With the recent increase in integrated residency programs, documentation and compliance are becoming increasingly dependent on junior residents; however, their understanding of reimbursement and documentation guidelines is currently unknown. Methods: An electronically distributed, multi-institutional survey of six general and subspecialty surgery programs was conducted consisting of open-ended numerical estimation of Medicare reimbursement for various levels of patient encounters. Closed-ended questions were used to assess resident knowledge of documentation requirements, accompanied by self-estimated compliance with those requirements. Results: Thirty-seven percent (n=106) of residents completed the survey. Most residents (77%) believe they play the primary role in documentation; however, knowledge of and compliance with higher level documentation practices range from 19-78% and 41-76%, respectively. On average, residents overestimate Medicare reimbursement of lower level encounters by as much as 77% and underestimate higher level encounters by as much as 38%. In many cases, the standard deviation of residents’ estimates approaches the actual reimbursement value. Conclusions: Residents have a limited knowledge of documentation requirements. Self-reported compliance, even when guidelines are known, is low. Estimation of financial reimbursement is extremely variable. Residents overestimate reimbursement of lower level encounters and underappreciate reimbursement at higher levels. Ensuring appropriate reimbursement for services rendered will require formal cardiothoracic resident education and ongoing quality control.

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Section: Resultssupporting

confidence: 89%

“…17 The fact that almost all residents in our study believe in capturing full reimbursement underscores the fact that such lapses are not intentional. Our results instead demonstrate that residents’ knowledge of documentation guidelines, with few exceptions, is low.…”

Section: Resultsmentioning

confidence: 74%

Resident Awareness of Documentation Requirements and Reimbursement: A Multi-Institutional Survey

Yount

Reames

Kensinger

et al. 2014

The Annals of Thoracic Surgery

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“…9 In addition, a study 10 of pediatric residents revealed low agreement for outpatient visit coding, leading the authors to suggest that inadequate training could cause large financial losses. In response to the need for improved training, authors have described problem-based learning curricula.…”

Section: Discussionmentioning

confidence: 99%

A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

Kapa¹,

Beckman²,

Stephen³

et al. 2010

Journal of Graduate Medical Education

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Background The financial success of academic medical centers depends largely on appropriate billing for resident-patient encounters. Objectives of this study were to develop an instrument for billing in internal medicine resident clinics, to compare billing practices among junior versus senior residents, and to estimate financial losses from inappropriate resident billing. Methods For this analysis, we randomly selected 100 patient visit notes from a resident outpatient practice. Three coding specialists used an instrument structured on Medicare billing standards to determine appropriate codes, and interrater reliability was assessed. Billing codes were converted to US dollars based on the national Medicare reimbursement list. Inappropriate billing, based on comparisons with coding specialists, was then determined for residents across years of training. Results Interrater reliability of Current Procedural Terminology components was excellent, with κ ranging from 0.76 for examination to 0.94 for diagnosis. Of the encounters in the study, 55% were underbilled by an average of $45.26 per encounter, and 18% were overbilled by an average of $51.29 per encounter. The percentages of appropriately coded notes were 16.1% for postgraduate year (PGY) 1, 26.8% for PGY-2, and 39.3% for PGY-3 residents (P < .05). Underbilling was 74.2% for PGY-1, 48.8% for PGY-2, and 42.9% for PGY-3 residents (P < .01). There was significantly less overbilling among PGY-1 residents compared with PGY-2 and PGY-3 residents (9.7% versus 24.4% and 17.9%, respectively; P < .05). Conclusions Our study reports a reliable method for assessing billing in internal medicine resident clinics. It exposed large financial losses, which were attributable to junior residents more than senior residents. The findings highlight the need for educational interventions to improve resident coding and billing.

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“…Emergency medicine residents who received less than 2 h of coding and billing instruction consistently made errors in coding that resulted in less reimbursement [34]. Similar findings were observed in other specialties [1,12,33]. Thus, anesthesiology residents may require additional training in coding procedures to improve performance.…”

mentioning

confidence: 62%

“…Surgery residents were aware of the importance of documentation and coding for professional services, but these trainees also felt inadequately prepared for and demonstrated marginal knowledge of this area of practice [12,32]. Such limited knowledge of coding is an important source of lost revenue [23,33,34]. The current retreat described here appeared to improve knowledge in anesthesiology residents, based on the pre-and post-retreat quizzes.…”

mentioning

confidence: 92%

Facilitating the transition to practice: a weekend retreat curriculum for business-of-medicine education of United States anesthesiology residents

2010

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Anesthesiology residents in the United States (US) not only must develop the clinical skills needed to provide independent patient care, but also are required to become familiar with the business aspects of the modern health care system. Unfortunately, practice management education may be inadequate during anesthesiology residency training. The authors describe the design and implementation of a weekend retreat curriculum in business-of-medicine education for anesthesiology residents. Experts were recruited to discuss interviewing skills, contract law and negotiation, billing and reimbursement, insurance, malpractice, and financial planning. A strict lecture didactic format was avoided, and presentations were designed to encourage speaker-audience interaction. The program was relatively simple to design and implement, satisfied several Accreditation Council of Graduate Medical Education core competencies for US anesthesiology education, may be altered as practice management evolves, and may be adapted to accommodate the needs of programs in other countries.

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What If Pediatric Residents Could Bill for Their Outpatient Services?

Abstract: When pediatric residents are not trained adequately in proper coding practices, the potential for billing discrepancies is high and potential reimbursement differences may be substantial. Discussion of financial issues should be considered in curriculum development.

Cited by 32 publications

References 7 publications

Resident Awareness of Documentation Requirements and Reimbursement: A Multi-Institutional Survey

Resident Awareness of Documentation Requirements and Reimbursement: A Multi-Institutional Survey

A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

Facilitating the transition to practice: a weekend retreat curriculum for business-of-medicine education of United States anesthesiology residents

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