4.1 Main research questions and sub research questions used
Main question: How can the current medical treatments data synchronization be optimized in relation to the hospital billing system for a more efficient and accurate billing system?
Sub question 1: Which medical billing systems is state-of-the-art in medical treatment data synchronization at this moment? (Literature)
Sub question 2: How could the current data processing and billing system be described? (Analysis)
Sub question 3: What are the requirements for an efficient, effective and accurate billing system? (Redesign)
Literature Review
Introduction
Recent literature shows that the development in technology brings numerous things that individuals have not had in many years, especially in the healthcare. The basis of the literature selected was to inform that when it comes to things like the billing system, there have not been many breaks to make things easier but there is not much research that taps into the new technology that can help with the medical billing system. According to Wang (2012), today’s generation, modernization and development is elevating more technology. In fact, one of these things is the new computerized recording system to do things like billing. With that said, the current medical treatments data synchronization can be optimized in relation to the hospital billing system for a more efficient and accurate billing system by using the electronic medical records.
Historical Background
History shows that using paper when it comes to the medical billing system in Health care has not been successful. In 2008 the National Quality Forum released a report in which it identified areas in healthcare that needed ameliorating, including accurate billing system (The National Quality forum, 2008). Research shows that the oldest type of EMR, traditional EMRs started getting a foothold in the early nineties, and is classically a combination of software and hardware. Known as the client-server setup (CSS), these Electronic medical records consist of a main server that directs essential software and data to client computers by means of a secure intranet. History shows that due to doing medical billing process on paper has led to disaster. According to Mentes (2009) the potential danger to doctors for improper billing could involve loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from contribution in programs from the government.
According to Petrosyan, & Mason, (2008) over the years there are various factors participating to the increasing prices of health care and deteriorating compensations to physicians. However, a lot of this has to do with poor medical billing and coding that is in relation to loss of income to physician practices (Lane & Thompson, 2001). Nevertheless, history has shown when it comes to the medical treatment data synchronization in relation to the hospital billing system for appendicitis patients there needs to be an outline of a risk management approach that involves addressing both reimbursement and compliance concerns.
Definition of Terms
- Tabularization – To arrange or put in a tabular form.
- Manual – Functioned by hand rather than automatically or mechanically.
- Storing – the function or process of keeping something typically on storage.
- Filing – the process or act of arranging records or files in an arranged manner for instance mathematically or alphabetically.
- Retrieving – the process or act of getting something that has been stored.
- Medical Records – are collection of documents belonging to a patient pertaining to their health or hospital records that comprise of treatment, consultation, and etc.
- Recording System – an organized process of compiling records that include retrieving and storing of data.
Theoretical
As stated by Ludwig Von Bertalaffy in his System Theory (General System Theory, 1968), system has turned out to be popular with the advance information technology when it comes to a more efficient and accurate billing system. Such that in hospitals, and city health offices all through discussion must record all patients medical record as stated by the diagnosis of physicians before they will go through additional medicines. This step by itself is vital and time consuming part for both the patients and the medical doctor alike, because it takes a long time to record each patient’s information, which is a boring process for a huge number of patients. This study is fastened on the model of Ludwig Von Bertalaffy in his system theory. His theory mentions that the stream of recording in every clinic, city health offices, and hospitals will be accurate and fast with the use of computerization (Fulton & Leon, 2010). This theory likewise suggests that computerization is appropriate to the recorder throughout consultation period. In this application, time consuming especially when it comes to the medical billing system will be minimized. One requirement is adopting a complete EHR which can be a costly and long process. All of the hospitals will have in order to develop strategies are the following: cover, manage, and recover costs; coordinate and time the rollout; staff the process; and also keep their systems up-to-date.
Requirements for an Efficient, Effective and accurate Billing System
According to Ueberrueck & Gastinger (2004) one requirement is adopting a complete EHR which can be a costly and long process but is effective in order to run an efficient, effective and accurate billing system. Also, in order to run an efficient, effective and accurate billing system, hospitals will have to come up with some strategies that will do the following: cover, manage, and recover costs; coordinate and time the rollout; staff the process; and also keep their systems up-to-date. Other experts state that providing good service to patients should always be the goal of an effective healthcare provider and without it, there billing system is not accurate enough (Kulik & Maguire, 2013). Research shows that to run an efficient, effective and accurate billing system an organization should always be thinking of new ways to improve their service in able to reach success. However, according to Son & Kim (2012) requirements for an efficient, effective and accurate billing system is either for the organization to develop a billing system on their own or they you can seek for professional help from companies that provide medical billing services. Choosing to develop a system on their own would take a lot of time and effort from their corporation. Research shows that many companies would prefer to just develop a team or even hire new personnel so that they are able to handle the project (Taylor & Ozaeta, 2004). An outsourced billing service on the other hand is the easier choice for most companies because of less hassle. Another requirement is making sure that the staff is fully trained and prepared. According to Kanumba (2011)making sure that proper communication is in place among staff and patients is key in order for the billing to be successful because when the communication is misleading, patients tend not to trust the procedure because they think they are being ripped off or mishandled.
Research shows that there are many State of the art billing systems and healthcare billing systems. One example of healthcare billing systems is called the Chart logic which is something that is useful in the healthcare billing systems and is a practice management software tool (Taylor & Ozaeta, 2004). According to Stahlfeld (2007) there are several practices that understand that utilizing a medical practice management software tools can make simpler the everyday processes of any clinic or hospital and lead to a more efficient place of work. Most experts believe that with a full-featured medical practice management system, any practice can understand some truly amazing efficiency benefits: ChartLogic's medical billing software consist of a charge capture module from the electronic medical records software, alongside with numerous other simple approaches of claim data entry (Ueberrueck & Gastinger, 2004). Research shows that small and large medical practices all over the country have made the choice to apply billing software in their practice because of the numerous benefits, for instance with the following features:
- Cutting costs
- Saving a lot of time
- Keeping patient information current and also up-to-date
- Exchanging insurance records and bills much more electronically
- Simplifying the association of all of the patient data
- Entrance to work from wherever
- Recurrent software updates
- Fast insurance claims entry, advanced e-mail reports make BillingLogic convenient advanced insurance claims scrubbing and easy to use.
- Simple patient registration and payment distribution methods by simplifying the data entry.
- ChartLogic's also consist of advanced customizable collections and recall letter system that aids in improving receivables and patient follow-up arrangements.
An example of an art billing system would be The Hanover. According to U.S. Hospital Chief of Staff, Aaron Kepner at Phoebe Hospital in Albany, GA makes the following quote about Hanover. “Billing is considered to be the single major source of customer criticisms and as a result one of the most visible and vital touch points for any hospital to make sure business is done more effectively especially when dealing with patients that have appendicitis . We believe that the investment in the Hanover our new billing has enormous potential to further develops customer satisfaction especially for those that had appendicitis” (Kepner, 2012). The new system called the Hanover is state of the art billing system that is available for both commercial and personal lines which will offers both agents and their clienteles’ easy-to-use online implements, an greater on-line experience in addition to what they define as a “best-in-class billing statement that is easy to comprehend.” (Taylor & Ozaeta, 2004) The Hanover’s new billing system provides important advantages for its customers. Experts show that it will be much easier to set up payment plans and then it will also be able to change payments plans – and the new bill strategy will produce rarer customer questions (Kulik & Maguire, 2013). The new billing system is then packed with features to increase the customer experience — and this will also save agents a lot of time:
- Stress-free-to-read bill. A totally new bill design aids customers in discovering billing detail for instance amount unpaid at a glance. Directed marketing and service message benefits in communicating important information to clienteles (Kulik & Maguire, 2013).
- More payment plan choices. They have put together a lot of new payment plans to assist customers in managing their budget more effortlessly. Payment plan choices differ by the region and state.
- Pick any due day. Clienteles are able to pick any due day that is between 1 and 30 for their billing due date, proposing them bigger elasticity to organize expenses to fit their requirements (Kulik & Maguire, 2013).
- Electronic Funds Transfer. Every one of the payment plans are able to utilize Electronic Funds Transfer, not just once-a-month payment plans.
- One account bill for all approaches. All rules for a single client will now show on one bill, even if the rules have diverse payment plans.
Figure 2The Hanover billing process (Hannover, 2010).
Current Research Studies
Current research explains the need for electronic medical records in the billing because of the improper coding. However, the risks associated with improper coding can be expensive for physicians. Medical bills may be repudiated and payments can sometimes be withheld by private payers and government when medical bills with coding errors are defer to for payment. Doctors may be omitted from contribution in any government-funded program under the False Claims Act (Rypins, 2000). This can have an effect on the medical treatment data synchronization in relation to the hospital billing system for appendicitis patients because they will not be able to get the proper attention, especially if there is some kind of issue that could occur. State and Federal regulatory agencies possibly will execute financial authorizations and penalizing actions on the medical practice which could affect having a proper billing system. As a result, it is sensible for providers to pay attention to changes in coding principles, documentation standards and reimbursement requirements with the intention of reducing risks related with inappropriate coding and billing (Lane & Thompson, 2001).
Other current research shows that programs such as the OIG's compliance program is a type of method the helps with a more efficient and accurate billing system the According to Fulton & Leon, (2010) the OIG's compliance program guidance instructs practitioners to do things such as document medical records precisely and correctly consistent with the level of service that is being issued. However, this is beneficial for the medical treatment data synchronization in relation to the hospital billing system for appendicitis patients because it guides principles that have been established for documentation especially when it comes to things such as billing. The current research shows that medical record documentation is observed by the OIG as the foundation for billing and coding purposes. It also makes the argument that the steps to attaining accurate and appropriate medical record documentation for thing such as the medical treatment data organization in relation to the hospital billing system should be outlined below in order to have organization:
- Practice accurate, appropriate, and thorough documentation for appendicitis patients.
- Utilize suitable diagnosis codes for examination and personal history for appendicitis patients.
- Connect suitable diagnosis with correct procedure code.
- Utilize modifiers properly.
- Recognize other insurance coverage when billing places such as Medicare for patients with appendicitis.
General Assumptions for efficient and accurate billing system
Research shows that According to Stahlfeld & Madden (2007) EMR & Billing are beneficial for a more efficient and accurate billing system for appendicitis patients because it helps reduce administrative tasks and paperwork by systematizing billing work processes, permitting everyone to spend more time with their patients. This is very beneficial to the workers as well because it helps them with thing such as getting paid faster with their automated services that streamline the billing and coding processes and shorten their revenue cycle to make the most of collections, decrease denied claims and eventually increase the cash flow. The extensive utilization of EHR adoption is vital for the billing proves especially dealing with appendicitis patients. With Electronic Health Records, neglectful medical mistakes can be stopped, administrative productivities will increase, pointless health care prices will be condensed which cab benefit appendicitis patients and the overall quality of health will increase coast-to-coast (Wang & Yang, 2012). Research shows that digitizing the entire medical record-keeping process is one of the major objectives of the Obama Administration and Electronic Health Records adoption will continue to rise over the years in order to build a healthier future for appendicitis patients. With the execution of Health Information Technology (Health IT), it is possible for medical doctors to better manage patient care through the safe and sound use and sharing of patient health information regarding appendicitis patients. Health Information Technology involves the utilization of electronic health records (EHRs) as opposed to paper-based medical records to keep up for appendicitis patient’s health information.
According to Leeuwenburgh & Stoker, (2010) advanced billing processes is much more organized and makes sure that all critical information is perfectly handled and complete simplicity is upheld on the subject of the billing customs of the hospital. In such a situation the practices and hospitals can focus on delivering the best likely medical care to the appendicitis patients and patients are certain of clarity and transparency.
Conclusion
According to Kaminski & Haigh (2005) it is clear that there is not enough research on bringing some sort of a solution to a more efficient and accurate billing system. It is obvious that in such a situation the practices and hospitals should be able to put more of an emphasis on giving the best possible medical care to the patients as well as making sure that the billing process is easy and accurate. According to the literature, Berg “(2006) believes that introducing electronic medical records is a trustworthy tool that will make every one’s life easier. The literature makes it clear that the old methods of pen and paper are causing mistakes when it comes to the billing system and therefore adopting a new method makes sense.
References:
Berg, E. R., Mehta, S. D., Mitchell, P., Soto, J., & al, e. (2006). Length of stay by route of contrast administration for diagnosis of appendicitis by computed-tomography scan. Academic Emergency Medicine, 13(10), 1040-1045.
Bondi, M., M.D., Miller, R., M.D., Zbar, A., M.D., Hazan, Y., M.D., Appelman, Z., M.D., Caspi, B., M.D., & Mavor, E., M.D. (2012). Improving the diagnostic accuracy of ultrasonography in suspected acute appendicitis by the combined trans abdominal and transvaginal approach. The American Surgeon, 78(1), 98-103.
Chattopadhyay, S., Rabhi, F., Acharya, U. R., Joshi, R., & Gajendran, R. (2012). An approach to model right iliac fossa pain using pain-only-parameters for screening acute appendicitis. Journal of Medical Systems, 36(3), 1491-502.
Firilas, A. M., Higginbotham, P. H., Johnson, D. D., Jackson, R. J., & al, e. (1999). A new economic benchmark for surgical treatment of appendicitis. The American Surgeon, 65(8), 769-73.
Frei, S. P., Bond, W. F., Bazuro, R. K., Richardson, D. M., Sierzega, G. M., & Wasser, T. E. (2008). Is early analgesia associated with delayed treatment of appendicitis? The American Journal of Emergency Medicine, 26(2), 176-80.
Fulton, M. B., Fontenot, B., & Leon, S. M. (2010). Drainage with antibiotics is effective therapy for appendicitis in pregnancy. JAAPA : Journal of the American Academy of Physician Assistants, 23(3), 29-31.
Hernandez, R., Jain, A., Rosiere, L., & Henderson, S. O. (2008). A prospective clinical trial evaluating urinary 5-hydroxyindoleacetic acid levels in the diagnosis of acute appendicitis. The American Journal of Emergency Medicine, 26(3), 282-6.
Kaminski, A., Liu, I. A., Applebaum, H., Lee, S. L., & Haigh, P. I. (2005). Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Archives of Surgery, 140(9), 897-901.
Kanumba, E. S., Mabula, J. B., Rambau, P., & Chalya, P. L. (2011). Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at Buganda medical Centre, kwanza, Tanzania. BMC Surgery, 11(1), 4.
Kepner, A. M., Bacasnot, J. V., & Stahlman, B. A. (2012). Intravenous contrast alone vs. intravenous and oral contrast computed tomography for the diagnosis of appendicitis in adult ED patients. The American Journal of Emergency Medicine, 30(9), 1765-73.
Kulik, D. M., Uleryk, E. M., & Maguire, J. L. (2013). Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. Journal of Clinical Epidemiology, 66(1), 95-104.
Lane, J. S., Schmit, P. J., Chandler, C. F., Bennion, R. S., & Thompson,Jesse E.,,Jr. (2001). Ileocecectomy is definitive treatment for advanced appendicitis. The American Surgeon, 67(12), 1117-22.
Leeuwenburgh, M. M. N., Laméris, W., van Randen, A., Bossuyt, P. M. M., Boermeester, M. A., & Stoker, J. (2010). Optimizing imaging in suspected appendicitis (OPTIMAP-study): A multicenter diagnostic accuracy study of MRI in patients with suspected acute appendicitis. study protocol. BMC Emergency Medicine, 10(1), 19.
Lien, W., Huang, S., Chi, C., Liu, K., Lin, M., Lai, T.Wang, H. (2006). Appendiceal outer diameter as an indicator for differentiating appendiceal mucocele from appendicitis. The American Journal of Emergency Medicine, 24(7), 801-5.
Mentes, O., Eryilmaz, M., Harlak, A., Ozer, T., Balkan, M., Kozak, O., & Tufan, T. (2009). Can d -dimer become a new diagnostic parameter for acute appendicitis? The American Journal of Emergency Medicine, 27(7), 765-9.
Neff, L. P., Ladd, M. R., Becher, R. D., Jordanhazy, R. A., Gallaher, J. R., & Pranikoff, T. (2011). Computerized tomography utilization in children with appendicitis-differences in referring and children's hospitals. The American Surgeon, 77(8), 1061-5.
Oliak, D., Sinow, R., French, S., Udani, V. M., & Stamos, M. J. (1999). Computed tomography scanning for the diagnosis of perforated appendicitis. The American Surgeon, 65(10), 959-64.
Paajanen, H., Grönroos, J., M., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., Salminen, P. (2013). A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial). BMC Surgery, 13(1), 3.
Park, H., M.D., Jang, M., M.D., Kim, I., M.D., Jeon, J., M.D., Lee, H., M.D., Yang, D., M.D., & Lee, Bong-Hwa, M.D., P.H.D. (2010). Distal appendiceal dilatation in equivocal appendicitis may be a useful sign for prediction of normal appendix. The American Surgeon, 76(2), 211-4.
Petrosyan, M., Estrada, J., Chan, S., Somers, S., Yacoub, W. N., Kelso, R. L., & Mason, R. J. (2008). CT scan in patients with suspected appendicitis: Clinical implications for the acute care surgeon. European Surgical Research, 40(2), 211-9.
Pittman-Waller, V., Myers, J. G., Stewart, R. M., Dent, D. L., & al, e. (2000). Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies. The American Surgeon, 66(6), 548-54.
Riesenman, Paul J,M.D., M.S., Riesenman, K. P., M.D., Stone, T. J., B.S., Beidler, S. K., M.D., Douillet, C. D., P.H.D., Rich, P. B., M.D., . . . Gallagher, Edgar G,J.R., M.D. (2008). Nonfocused enhanced CT evaluation of acute appendicitis increases length of stay in the emergency department but does not increase perforation Rate/DISCUSSION. The American Surgeon, 74(6), 488-92; discussion 492-3.
Rypins, E. B., & Kipper, S. L. (2000). Scintigraphic determination of equivocal appendicitis. The American Surgeon, 66(9), 891-5.
Son, C. S., Jang, B. K., Seo, S. T., Kim, M. S., & Kim, Y. N. (2012). A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis. BMC Medical Informatics and Decision Making, 12(1), 17. d
Stahlfeld, K., Hower, J., Homitsky, S., Madden, J., & al, e. (2007). Is acute appendicitis a surgical emergency?/DISCUSSION. The American Surgeon, 73(6), 626-9; discussion 629-30.
Taylor, E., Berjis, A., Bosch, T., Hoehne, F., & Ozaeta, M. (2004). The efficacy of postoperative oral antibiotics in appendicitis: A randomized prospective double-blinded study. The American Surgeon, 70(10), 858-62.
The National Quality forum. (2008, March 23). Retrieved from http://www.biochemia-medica.com/content/overview-patient-safety-healthcare-and-laboratory-diagnostics
Trent, S. A., Valley, M. A., Brookler, K., Haukoos, J. S., & Zerzan, J. T. (2013). Potential barriers associated with increased prevalence of perforated appendicitis in Colorado’s pediatric Medicaid population. The American Journal of Emergency Medicine, 31(3), 469-72.
Ueberrueck, T., Koch, A., Meyer, L., Hinkel, M., & Gastinger, I. (2004). Ninety-four appendectomies for suspected acute appendicitis during pregnancy. World Journal of Surgery, 28(5), 508-11.
Wang, S., Fang, J., Liao, C., Kuo, I., Yang, C. O., Yeh, C., Yang, S. (2012). Prospective study of computed tomography in patients with suspected acute appendicitis and low Alvarado score. The American Journal of Emergency Medicine, 30(8), 1597-601.
Weber, T. R., Keller, M. A., Bower, R. J., Spinner, G., & Vierling, K. (2003). Is delayed operative treatment worth the trouble with perforated appendicitis is children? The American Journal of Surgery, 186(6), 685-8; discussion 688-9.
