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

Emergency Medicine Australasia : EMA
Andy Lim, Alvin Lim

Abstract

The aim of the present study was to perform a cost-benefit analysis of retrospectively identifying missed compensable billings in a public Australian ED. A retrospective review of patients who were eligible for billing from the period of 1 April 2018 to 31 January 2019 was undertaken. Individual patient files were examined and reconciliated with the historical billing record and any discrepancies identified. Financial modelling with Vose ModelRisk and R Studio v1.2.5033 was employed to estimate future benefits of such a strategy. Uncertainty analyses included variation in wage cost (AU$0-200/h), discount rate (3-10%), presentation growth rate, percentage compensable, benefit recovered/patient, percentage recoverable and cost per patient. A total of 76 523 patients presented during this time. Of these, 2737 patients were deemed compensable. A total of 740 undocumented billing items were identified with an estimated Medicare Benefits Schedule value of $59 870 and an Australian Medical Association value of $152 400. The net present value (NPV) of this identified cash flow stream in perpetuity was $1 436 892 (Medicare Benefits Schedule) and $3 657 600 (Australian Medical Association) (i.e. the total value of recovering this amount ...Continue Reading

References

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Jun 25, 2019·The Journal of the American Academy of Orthopaedic Surgeons·Robert C JacobsJames D Michelson
Jul 26, 2019·Emergency Medicine Australasia : EMA·Andy Lim, Alvin Lim

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