Compensable billing in the emergency department: an analysis of efficiency of a manual system of entry

Andy Lim, Alvin Lim

Research output: Contribution to journalMeeting AbstractOtherpeer-review

Abstract

Background:
Compensable patients under the Transport Accident Commission, Workcover or Overseas Visitor Agreement are a source of hospital revenue to augment Activity Based Funding for effective and efficient delivery of healthcare. Departments under pressure to provide emergency care within the National Efficient Price rely on accurate reimbursement arrangements. This appears to be the first scientific study to address the accuracy of a system of billings recovery in an Australian public metropolitan emergency department.

Objectives:
To perform an economic evaluation in the form of a cost-benefit analysis (CBA) to assess an initiative to increase billing accuracy.

Method:
A retrospective review of patients who were eligible for billing from the period of 1st April 2018 to 31st January 2019 was undertaken. Individual patient files were examined and reconciliated with the historical billing record and any discrepancies identified.

Results:
A total of 76,523 patients presented to the emergency department during the ten-month period of April 2018 to January 2019 inclusive. Of these, 2,737 were deemed compensable. A total of 740 undocumented billing items were identified with an estimated Medicare Benefits Schedule (MBS) value of $59,870.50 and an Australian Medical Association (AMA) value of $152,400.00. The Net Present Value (NPV) of this identified cash flow stream in perpetuity was $1,436,892 (MBS) and $3,657,600 (AMA). The positive NPV was maintained with sensitivity analysis.

Conclusion:
There is potential to maximize funding from compensable patients and suggested solutions include increasing compliance through principles of motivation theory or automating the process via electronic solutions.
Original languageEnglish
Pages (from-to)28
Number of pages1
JournalEmergency Medicine Australasia
Volume32
Issue numberS1
Publication statusPublished - 7 Mar 2020
EventAustralasian College for Emergency Medicine, Annual Scientific Meeting, 2019 - Grand Chancellor Hotel, Hobart, Australia
Duration: 17 Nov 201921 Nov 2019
http://acem2019.com

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