Improving Billing Practices for Patients Admitted for Neonatal Fever
Purpose/Aim Extreme variability in billing and coding among physicians exists, often due to a lack of physician education and knowledge about billing. Errors or omissions in billing can lead to significant financial repercussions for an institution, and may lead to lost opportunities in furthering the institutional mission. Our project aimed to improve clinical documentation and coding of neonatal fever by 25% from November 2016 to February 2017 among Pediatric Hospital Medicine providers at a large, free-standing children’s hospital. Design/Methods After examining the top ten diagnoses seen within our section, neonatal fever was identified as a common diagnosis with wide variability in billing practices. After collaboration with PHM billing specialists, compliance team and coders, we determined that the most appropriate billing code was 99477 (intensive care services in a neonate). Key driver and fishbone diagrams were created to assist in developing a bundle of interventions aimed at improving the use of the appropriate billing code, including: 1. Provider education via emails, a billing workshop, and reminder posters 2. Weekly chart audits of billing practices, with feedback sent to the section via email 3. Individual provider feedback 4. Creation of a history and physical template with the EMR that supported appropriate documentation required to bill 99477 code Metrics included: Outcome: percentage of neonatal fever patients billed with the 99477 code Process: percentage of charts with appropriate documentation to support level of billing Balance: rate of claim denials Results We demonstrated a significant increase in percentage of patients who were billed 99477 as a result of our project, from 7.9% to 58.6%, which exceeded our initial aim (Chart 1). Special cause variation was met on statistical process control chart. For our process measure, the average percentage of charts with appropriate documentation for intensive billing code was 35% with a trend towards improvement. For our balance measure, we had no insurance denials during our study period, which we will continue to monitor. Conclusions/Discussion Initial barriers included confusion among providers regarding use of the billing code. This was overcome with re-education and personalized feedback. To ensure sustainability, we will continue regularly scheduled group and individual feedback. We also will expand to other diagnoses and attempt to measure the financial impact billing practice changes.
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