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.

Antibiotic Prescriptions for Upper Respiratory Infections in a Pediatric Office Versus an Urgent Care Center.

It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physicians in these settings. This retrospective chart review evaluated pediatricians' antibiotic prescribing practices for patients with symptoms of an upper respiratory tract infection in the office setting and an urgent care setting. There was no difference in the total antibiotic prescribing rate by pediatricians in their primary care office versus an urgent care setting. Pediatricians who were high antibiotic prescribers in the office setting were also high prescribers in the urgent care. The highest prescribing physicians prescribed the appropriate recommended antibiotics for a particular diagnosis the lowest percentage of the time. Efforts to promote antimicrobial stewardship should be directed toward the individual physician and not toward the location where the patients are being evaluated.