Who teaches medical billing? A national cross-sectional survey of Australian medical education stakeholders

Abstract

ImportanceBilling errors and healthcare fraud have been described by the WHO as ‘the last great unreduced health-care cost’. Estimates suggest that 7% of global health expenditure (US$487 billion) is wasted from this phenomenon. Irrespective of different payment models, challenges exist at the interface of medical billing and medical practice across the globe. Medical billing education has been cited as an effective preventative strategy, with targeted education saving $A250 million in Australia in 1 year from an estimated $A1–3 billion of waste.ObjectiveThis study attempts to systematically map all avenues of medical practitioner education on medical billing in Australia and explores the perceptions of medical education stakeholders on this topic.DesignNational cross-sectional survey between April 2014 and June 2015. No patient or public involvement. Data analysis—descriptive statistics via frequency distributions.ParticipantsAll stakeholders who educate medical practitioners regarding clinical practice (n=66). 86% responded.ResultsThere is little medical billing education occurring in Australia. The majority of stakeholders (70%, n=40) did not offer/have never offered a medical billing course. 89% thought medical billing should be taught, including 30% (n=17) who were already teaching it. There was no consensus on when medical billing education should occur.ConclusionsTo our knowledge, this is the first attempt of any country to map the ways doctors learn the complex legal and administrative infrastructure in which they work. Consistent with US findings, Australian doctors may not have expected legal and administrative literacy. Rather than reliance on ad hoc training, development of an Australian medical billing curriculum should be encouraged to improve compliance, expedite judicial processes and reduce waste. In the absence of adequate education, disciplinary bodies in all countries must consider pleas of ignorance by doctors under investigation, where appropriate, for incorrect medical billing.

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

“…2 In Australia, despite an overarching assumption that doctors have high legal literacy in relation to correct billing using Australia's national universal health system, Medicare, 2 a recent study seeking to measure that experience, challenged that assumption, suggesting medical practitioners may instead be experiencing difficulties accessing reliable medical billing advice. 3 In 2016, the Government of the Netherlands acknowledged this educational gap by introducing a requirement that universities and medical specialist training colleges provide education to medical practitioners in relation to medical billing and the costs of providing care, the stated aim being to tackle billing mistakes and fraud through prevention, rather than solely through punitive post-payment policing. 4 However, while medical billing education has been recognised as an effective measure to improve compliance, reduce incorrect billing and improve integrity of health financing systems, 5 formal education initiatives remain rare and many medical practitioners may have received no training whatsoever.…”

Wading through Molasses: A qualitative examination of the experiences, perceptions, attitudes, and knowledge of Australian medical practitioners regarding medical billing

“…3 However, how much non-compliant billing is deliberate is uncertain, as it rests in a spectrum with criminal fraud at one end and unintentional errors at the other and currently the precise quantum of each is unknown. 4 This is largely because the problem is not what can be seen, but what cannot. Lax regulation, government maladministration, system complexity and the fact that medical practitioners are never taught how to use the system correctly at any point in their careers have all been cited as factors contributing to this problem.…”

“…Lax regulation, government maladministration, system complexity and the fact that medical practitioners are never taught how to use the system correctly at any point in their careers have all been cited as factors contributing to this problem. 4 Increasing complexity has occurred in tangent with increased penalties for non-compliance 5 and pressure on medical practitioners to bill correctly has reached the point where some authors have suggested that compliance with Medicare billing rules has become a contributing factor to medical practitioner burnout and suicide. 6 However, one area of activity that has been overlooked is improving user knowledge of the medical billing system.…”

“…1 In Australia, it has been suggested that the rate of non-compliant billing under Medicare caused by deliberate abuses of the scheme by medical practitioners is between 10-15%. 2 However, non-compliant billing rests in a spectrum with criminal fraud at one end and unintentional errors at the other, and currently the precise quantum of each is unknown, 3 largely because the problem is not what can be seen, but what cannot. For example, under the Australian Medicare scheme both a fraudulent bill for a service never provided, as well as an unintentional administrative mistake such as entering the wrong date of service, would likely All rights reserved.…”

“…The reasons for this include regulatory and administrative failures by the government, 1 the fact that billing codes are received by the government devoid of context, 1 the medical billing system having become byzantine 1 and the fact that medical practitioners are never taught how to use the system correctly at any point in their careers. 3 In May 2018, the Federal Government announced an investment of $9.5 million over five years to continue improving Medicare compliance arrangements and debt recovery practices, and on the back of that announcement, quickly enacted The Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Act 2018, which introduced further measures designed to improve compliance. This included a new Shared Debt Recovery Scheme, which commenced on 1 July 2019, enabling the Department to hold an organisation who employs or contracts a medical practitioner partially responsible for incorrect Medicare claims.…”