Cost–benefit analysis of retrospectively identifying missed compensable billings in the emergency department

Abstract

Objective: The aim of the present study was to perform a cost-benefit analysis of retrospectively identifying missed compensable billings in a public Australian ED. Methods: A retrospective review of patients who were eligible for billing from the period of 1 April 2018 to 31 January 2019 was undertaken. (Medicare Benefits Schedule) and $3 657 600 (Australian Medical Association) (i.e. the total value of recovering this amount of money each year indefinitely, corrected for the time value of money). The positive NPV was maintained with sensitivity analysis. Conclusion: All scenarios examined led to a positive NPV favouring retrospectively identifying missed compensable billings.

Effect of a simplified billing form and the SARS‐CoV‐2 pandemic on compensable billings in an Australian metropolitan emergency department: An interrupted time series analysis

“…An increase in billings rate could be explained by increasing complexity of patients, hence requiring more consults, procedures, and resuscitation time, or it could be explained by a pre‐existing system that did not effectively identify patients or capture these item numbers. The latter has already been demonstrated in published literature, 1 and would be a more likely explanation. Perhaps this new upgrade is simply better at identifying patients who can be billed appropriately, without increasing overall billings.…”

“…Compensable billings in the Australian ED setting have received little attention and have only been examined in the context of an economic evaluation to identify missed compensable billings. 1 Since the previous study, 1 which examined billings recovery in the context of a voluntary, multi‐screen data entry process, the hospital has adopted a new simplified billings form (Fig. S1) with prompts in the context of a wider digital transformation.…”