How accurate are we? A comparison of resident and staff physician billing knowledge and exposure to billing education during residency training

Austin, Ryan E; Schroeder, Herbert P. von

doi:10.1503/cjs.008718

Cited by 27 publications

(38 citation statements)

References 17 publications

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“…This study has shown that further training in “billing and coding” was the most highly prioritized of the 8 core business principles by Canadian plastic surgery residents. A study by Austin and von Schroeder 5 compared billing knowledge and accuracy amongst a group of 16 senior surgical residents and 17 staff surgeons. This study found that while staff physicians had a greater accuracy that residents on a billing assessment with more correct codes and fewer incorrect or missed codes, the overall billing accuracy in both groups was poor.…”

Section: Discussionmentioning

confidence: 99%

“…In the current model of medical education, there is a predominant focus on clinical competency, while the nonclinical aspects of medical practice, including business and practice management, go overlooked and undertaught. 4 , 5 Studies have shown that trainees and graduates from a variety of subspecialty training programs report inadequate exposure to practice management education during their residency training, even though these trainees feel that this education is important for establishing and maintaining a medical practice after residency. 5-11 Interestingly, surveys of residency program directors and educators have also demonstrated an acknowledgment for the importance of practice management education in residency training programs.…”

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confidence: 99%

“… 4 , 5 Studies have shown that trainees and graduates from a variety of subspecialty training programs report inadequate exposure to practice management education during their residency training, even though these trainees feel that this education is important for establishing and maintaining a medical practice after residency. 5-11 Interestingly, surveys of residency program directors and educators have also demonstrated an acknowledgment for the importance of practice management education in residency training programs. 4 , 12-14 In fact, the medical education bodies in Canada and the United States have long recognized that practice management should be a core competency in medical training.…”

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confidence: 99%

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Practice Management Knowledge Amongst Plastic Surgery Residents in Canada: A National Survey

Al-Shaqsi

Hong

Austin³

et al. 2020

Aesthetic Surgery Journal Open Forum

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Business and practice management principles are critical components of healthcare provision. Business and practice management is currently undertaught in plastic surgery training programs. The objective was to assess the status of business and practice management teaching amongst plastic surgery programs in Canada. An online survey of all enrolled plastic surgery residents was conducted in 2019 to 2020. Participants were invited to rate their knowledge and confidence about core principles in business and practice management. Sixty-five out of 126 residents responded to this survey (response rate, 51.6%). Only 7.8% of participants had previous business and practice management training; 23.1% reported receiving training in business and practice management during their residency. Participants reported a low level of knowledge and confidence in business and practice management (average Likert score between 3 and 4). Participants reported a high desire for future training in business and practice management particularly in billing and coding (91.2%) and business operations (91.2%). Plastic surgery residents in Canada reported a low level of knowledge and confidence about business and practice management. They desire the inclusion of business and practice management training in future curriculum.

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Section: Discussionmentioning

confidence: 99%

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Practice Management Knowledge Amongst Plastic Surgery Residents in Canada: A National Survey

Al-Shaqsi

Hong

Austin³

et al. 2020

Aesthetic Surgery Journal Open Forum

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“…Since 2016, we found an increase in the number of U.S studies on this topic, where results have echoed earlier findings that the level of medical billing literacy amongst medical practitioners remains demonstrably low and may be improved by targeted education. [11][12][13][14][15] In one recent U.S study more than 70% of medical practitioner participants felt there was a need for medical billing and coding to be included in the medical curriculum 16 and a 2019 study of senior residents and staff physicians in Ontario, Canada (n=33) 17 described the billing accuracy of the medical practitioner participants as poor overall, with billing errors and omissions causing substantial revenue losses. Participants in that study felt that current medical billing education was both insufficient and ineffective and desired more.…”

Section: Empirical Literature -Us and Canadamentioning

confidence: 99%

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

Faux

Adams

Wardle

2021

Preprint

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IntroductionThe WHO has suggested the solution to leakage in health systems caused by waste, corruption and fraud is policing and prosecution. However, a growing body of evidence suggests leakage may not always be fraudulent or corrupt, with researchers suggesting medical practitioners may sometimes struggle to understand increasingly complex legal requirements around health financing and billing transactions, which may be improved through education. To explore this phenomenon further, we undertook a systematic review of the literature to identify the medical billing education needs of medical practitioners and whether those needs are being met.MethodsEligible records included English language materials published between 1 January 2000 and 4 May 2020, including empirical research, commentary, opinions and grey literature.ResultsWe identified 74 records as directly relevant to the search criteria. Despite a comprehensive international search, studies were limited to three countries (Australia, Canada, U.S), indicating a need for further work internationally. The literature suggests the education needs of medical practitioners in relation to medical billing compliance are not being met and medical practitioners desire more education on this topic. Evidence suggests education may be effective in improving medical billing compliance and reducing waste in health systems and there is broad agreement amongst medical education stakeholders in multiple jurisdictions that medical billing should be viewed as a core competency of medical education, though there is an apparent inertia to act. Penalties for non-compliant medical billing are serious and medical practitioners are at risk of random audits and investigations for breaches of sometimes incomprehensible, and highly interpretive regulations they may never have been taught.ConclusionDespite acknowledged significance of leakage in health systems due to poor practitioner knowledge of billing practices, there has been very little research to date on education interventions to improve health system efficiency at a practitioner level.

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“…The common reasons for improper payments were insufficient documentation errors (64.1%), medical necessity errors (17.5%), incorrect coding errors (13.1%), and no documentation errors (1.7%) [8]. With regard to the effort of evaluating coding errors, numerous studies have associated physicians' limited training and knowledge of billing and insurance-related activities with high errors [9][10][11][12]. King et al [10] showed that family physicians' coding accuracy was 52% for established patients and 17% for new patients, as established patients were undercoded, thus failing to report the full services provided, whereas new patients were overcoded, an abuse in reporting medical services not actually performed.…”

Section: Introductionmentioning

confidence: 99%

Neural Machine Translation–Based Automated Current Procedural Terminology Classification System Using Procedure Text: Development and Validation Study

Joo¹,

Burns²,

Lakshmanan³

et al. 2021

JMIR Form Res

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Background Administrative costs for billing and insurance-related activities in the United States are substantial. One critical cause of the high overhead of administrative costs is medical billing errors. With advanced deep learning techniques, developing advanced models to predict hospital and professional billing codes has become feasible. These models can be used for administrative cost reduction and billing process improvements. Objective In this study, we aim to develop an automated anesthesiology current procedural terminology (CPT) prediction system that translates manually entered surgical procedure text into standard forms using neural machine translation (NMT) techniques. The standard forms are calculated using similarity scores to predict the most appropriate CPT codes. Although this system aims to enhance medical billing coding accuracy to reduce administrative costs, we compare its performance with that of previously developed machine learning algorithms. Methods We collected and analyzed all operative procedures performed at Michigan Medicine between January 2017 and June 2019 (2.5 years). The first 2 years of data were used to train and validate the existing models and compare the results from the NMT-based model. Data from 2019 (6-month follow-up period) were then used to measure the accuracy of the CPT code prediction. Three experimental settings were designed with different data types to evaluate the models. Experiment 1 used the surgical procedure text entered manually in the electronic health record. Experiment 2 used preprocessing of the procedure text. Experiment 3 used preprocessing of the combined procedure text and preoperative diagnoses. The NMT-based model was compared with the support vector machine (SVM) and long short-term memory (LSTM) models. Results The NMT model yielded the highest top-1 accuracy in experiments 1 and 2 at 81.64% and 81.71% compared with the SVM model (81.19% and 81.27%, respectively) and the LSTM model (80.96% and 81.07%, respectively). The SVM model yielded the highest top-1 accuracy of 84.30% in experiment 3, followed by the LSTM model (83.70%) and the NMT model (82.80%). In experiment 3, the addition of preoperative diagnoses showed 3.7%, 3.2%, and 1.3% increases in the SVM, LSTM, and NMT models in top-1 accuracy over those in experiment 2, respectively. For top-3 accuracy, the SVM, LSTM, and NMT models achieved 95.64%, 95.72%, and 95.60% for experiment 1, 95.75%, 95.67%, and 95.69% for experiment 2, and 95.88%, 95.93%, and 95.06% for experiment 3, respectively. Conclusions This study demonstrates the feasibility of creating an automated anesthesiology CPT classification system based on NMT techniques using surgical procedure text and preoperative diagnosis. Our results show that the performance of the NMT-based CPT prediction system is equivalent to that of the SVM and LSTM prediction models. Importantly, we found that including preoperative diagnoses improved the accuracy of using the procedure text alone.

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How accurate are we? A comparison of resident and staff physician billing knowledge and exposure to billing education during residency training

Cited by 27 publications

References 17 publications

Practice Management Knowledge Amongst Plastic Surgery Residents in Canada: A National Survey

Practice Management Knowledge Amongst Plastic Surgery Residents in Canada: A National Survey

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

Neural Machine Translation–Based Automated Current Procedural Terminology Classification System Using Procedure Text: Development and Validation Study

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