A systematic review of outpatient billing practices.

Objectives: Healthcare coding and billing are an important aspect of practice management that directly impacts the financial stability of a health care practice. To financially sustain or grow a medical practice, it is imperative that resident and faculty physicians have knowledge and skills for accurate billing in every patient encounter. Methods: A systematic review was conducted to identify recently published studies that report on improvements in medical coding and billing accuracy, clinical documentation, and reimbursement rate. A search of three databases yielded a total of 5754 records. After screening, 41 records were sought for retrieval and a total of 18 records were obtained for review. Results: Following a thorough review of literature, the most common reasons for inaccurate or inappropriate billing were a lack of formal education within residency curriculum, inadequate clinical documentation supporting level of billing, and lack of a feedback system aimed to correct billing errors. Conclusion: A formal education curriculum implemented in training could enhance knowledge and application of accurate billing and coding and further benefit practice longevity. The purpose of this systematic review is to apply knowledge gained to the development and implementation of a quality improvement study intended to improve accuracy of coding and billing within an academic pediatric outpatient center.

Rethinking the Obvious: Time for New Ideas on Medical Malpractice Tort Reform.

States have engaged in medical malpractice litigation reforms over the past 30 years to reduce malpractice insurance premiums, increase the supply of physicians, reduce the cost of health care, and increase efficiency. These reforms have included caps on noneconomic damages and legal procedural changes. Despite these reforms, health care costs in the United States remain among the highest in the world, provider shortages remain, and defensive medicine practices persist. The purpose of this study was to determine how successful traditional medical malpractice reforms have been at controlling medical costs, decreasing defensive medicine practices, lowering malpractice premiums, and reducing the frequency of medical malpractice litigation. Research has shown that direct reforms and aggressive damage caps have had the most significant impact on lowering malpractice premiums and increasing physician supply. Out of the metrics that were improved by malpractice reforms, similar improvements were shown because of quality reform measures. While traditional tort reforms have shown some targeted improvement, large-scale, system-wide change has not been realized, and thus it is time to consider alternative reforms.

Examining the Benefits of the 340b Drug Discount Program.

The 340B Drug Discount Program required drug manufacturers to provide discounted outpatient drugs to health care organizations serving vulnerable patient populations to allow these institutions to offer more services to more people. As the 340B program expanded, controversy centered on which entities have benefited from the program. Many health care organizations sold 340B drugs to well-insured patients at full price and have thus been financially rewarded. Amendments to the program have permitted 340B providers to use contract pharmacies to dispense 340B medications, furthering the debate over which stakeholders are benefiting from the program. The purpose of this study was to determine which stakeholders benefited because of the 340B Drug Discount Program and what have been the drivers of recent changes to the program. The study used a literature review. One database aggregator and six academic databases were used to collect 70 total sources. These sources were reviewed and reduced to 39 sources, which were used in the written research. Of these, 20 sources were used in the Results section. Research showed that 340B eligible entities and contract pharmacies have financially benefited from the 340B program. Patient benefit has been indirect, as qualified providers have expanded service offerings and increased access to health care services. Regulatory reform, as well as profit potential, has driven the expansion of 340B as more providers have expanded eligible service lines. Although the goal of the 340B program has often been misconstrued, direct financial benefits to eligible providers have allowed for this expansion of access.