Billing Department Research Articles

A Cohort Study Comparing Cost-Efficiency of Abdominal and Robotic Sacrocolpopexy

ObjectivesTo compare cost and reimbursement of robotic and abdominal sacrocolpopexy procedures to evaluate which approach may minimize costs while improving the hospital profit margin-. MethodsWe performed an IRB-exempt retrospective cohort study investigating all patients who underwent robotic or abdominal sacrocolpopexy at our hospital between July 1, 2018 and May 31,2022. Patient demographic, procedural, and post-operative course data were extracted via chart review including duration of procedure, time in operating room, complications, and length of hospital stay. The billing department provided information on estimated cost of stay and reimbursement rates. ResultsA total of 203 robotic and 291 abdominal cases were included in analysis. The groups had significant differences in demographics, including race and insurance status. Abdominal procedures were associated with lower costs ($7675.99 versus 8747.48, p<0.0001) and higher reimbursement rates ($16210.48 versus $10102.28, p<0.0001), with the total collected (reimbursement minus cost), or profit margin, differing significantly ($8534.50 versus $1354.80, p<0.0001). Discrepancies in reimbursement and profit remained after controlling for secondary procedures. Abdominal cases also had shorter average duration (129.9 vs. 168.4 minutes, p<0.0001). Abdominal sacrocolpopexy was associated with higher estimated blood loss (EBL) (109.2 vs. 97.9, p<0.0001) and longer hospital stay (26.3 versus 15.9 hours, p<0.0001). ConclusionsDespite longer hospital stays and slightly higher EBL, abdominal sacrocolpopexy appears to have lower costs and higher reimbursement rates than robotic sacrocolpopexy, with a higher profit margin for the hospital.

Analysis of the Internal Control System for Receivables at CV. Putra Riau Mandiri

In carrying out its activities to achieve the stated goals, companies must exercise control. The controls implemented must provide benefits, in this case being able to increase the effectiveness and efficiency of operations. This research focuses on analysis of the receivables control system. The purpose of this research is to describe and analyze how internal control at CV. Putra Riau Mandiri Pekanbaru. This research uses qualitative tests with a descriptive-analysis approach to internal control of trade receivables which refers to the COSO framework on the elements of internal control. The results of the research show that in the transaction authorization section the separation of duties is still not in accordance with COSO theory because there are still trapped functions and responsibilities in the sales and billing sections. Then, adequate documents are in accordance with COSO theory that every transaction has been properly documented. However, in the internal information section between the billing, accounting and finance sections, there is still a need for internal documents, namely payment receipt documents in hardfile and softfile form. Then, in terms of data and file security, it is running in accordance with COSO theory because the existing data has been properly backed up. The cause of uncollected receivables due to the manager's ignorance regarding several invoices is because there are duplicate tasks in the billing department, then there are frequent delays in recording the repayment of receivables so that in recapitulation of repayment there are often errors in recording receivable payments.

Financial Trends of AML Patients over the Past Decade

Background: Over the past 30 years, the incidence of acute myelogenous leukemia (AML) has progressively increased across the globe, and until recently, therapeutic options were primarily limited to the standard “7 + 3” cytotoxic chemotherapy. The economic burden associated with the management of AML has steadily increased and significantly escalated with the introduction of new targeted therapies. To our knowledge, there are very few studies that have looked at the major drivers of cost in AML treatment over the past decade and how they have evolved. Methods: We conducted a retrospective review with IRB approval of all the medical costs associated with the initial course of chemotherapy, administered in the hospital setting, in newly diagnosed AML patients at the Georgia Cancer Center (GCC) from 2011 to 2022. All medical costs were obtained through the accounting system at Augusta University Medical Center (AUMC) using the Patient Billing Department. Every direct cost from the patient's first to last day of hospitalization during which they received induction was included. Results: A total of 183 patients were identified. Patients were excluded for the following reasons: 3 patients left to receive induction elsewhere, and 2 patients left against medical advice for unclear reasons. A total of 178 newly diagnosed AML patients fit the above criteria during this period with a median age of 61 years. The median length of stay (LOS) of these 178 patients was 30 days. Between 2011 to 2016, 71 patients were treated and had a median age of 65 years, while 107 patients were treated between 2017 to 2022 with a median age of 57 years. Major drivers of total direct cost were identified which included inpatient bed (~40%), medications (~20%), blood bank products (~15%), and lab tests (~14%). Medication costs were further reviewed with breakdown as follows: chemotherapy (~3%), antibiotics (~10%), and all other medications (~7%). These medication costs were based on 340B pricing. The average and median direct costs from the above categories were compared from 2011-2016 to 2017-2022 (Table 1). The 2017-2022 group had significantly lower median and average bed cost, blood bank product cost, and overall total cost. The LOS was also noted to be shorter in the 2017-2022 group. We then analyzed the subset of patients (n=64) who received standard induction chemotherapy and excluded patients who required reinduction (n=8) or who died during induction (n=13). The same trends were identified in this subset analysis. AML patients with FLT3 mutations, which consisted of 41 of the total 178 patients, were of particular interest given the increased number of targeted therapies that have been approved since 2017. This was investigated further by comparing the direct average and median costs of the categories noted above between the 2011-2016 group with 11 FLT3+ AML patients to the 2017-2022 group with 30 FLT3+ AML patients (Table 2). The average and median medication costs, including chemotherapy, antibiotics, and all other medications, were higher in the 2017-2022 group. This resulted in the total direct cost being higher in the 2017-2022 group despite having lower blood bank and inpatient bed costs. Conclusion: Over the past decade, many significant changes have occurred in several of the driving factors associated with the cost of AML therapy. Still, there has been a decrease in length of stay, inpatient bed costs, blood bank costs, and overall total costs from 2017-2022 compared to 2011-2016. In the subset of FLT3+ AML patients, there was a shift in the financial landscape with an increase in medication costs that influenced the overall cost. It is likely that the economic impact from this will continue to grow as novel therapies become more available and the number of patients being treated continues to increase.

Evaluation Of Standard Operational Procedure For Receivable Collection Of PT. XYZ

The aim of this research is to evaluate the implementation of Standard Operational Procedures for Receivables Collection at PT. XYZ and knowing the obstacles and delivering. solutions and suggestions for PT. XYS receivable collection procedures. The research method uses qualitative descriptive analysis supported by data collection from observation, documentation and interviews. Meanwhile, the data analysis method used is the Champion method. The results of Champion's research stated that the Standard Operating Procedures were declared effective by the billing department with a percentage of 91.67%. However, there are still obstacles in the receivables collection process, namely the cash collection process carried out by the collector team is not completed. For this reason, the author advises companies to consider adding collector staff and collaborating with cash payment outlets.

Time motion study of registration and billing department of a tertiary care hospital in Raigad district of Maharashtra, India

Background: Time motion studies are used for planning and performance evaluation of the system. Effective time management in the registration and billing department of the hospital will save patients time and improve patient satisfaction. This study was conducted in the registration and billing department of a tertiary care hospital in Navi Mumbai. Objectives: The study aimed to analyze the time required for patients/relatives in the registration and billing department and the experience of the patients/relatives regarding the front office and discharge process in a tertiary care hospital. Materials and Methods: Acrosssectional study was conducted using the convenience sampling method, with 300 participants from the billing and registration department. The study was conducted in a tertiary care hospital using a pretested structured questionnaire from August 2021 to January 2022. Results: Three-fourth (75%) and 19% of patients completed the Out-patient Department/In-patient Department registration within 5 minutes and 10 minutes, respectively, with reasonable patient satisfaction. Twenty-two percent and 45% of patients had to wait for 30 minutes and 45 minutes to complete the billing process of laboratory investigations, respectively, and patient satisfaction was reasonable. For the discharge process of Mahatma Jyotirao Phule Jan Arogya Yojana scheme patients, 60% and 37% had to wait for 3 to 5 hours and less than 3 hours, respectively. The root cause analysis for the delay in the billing and discharge process showed that the patient load was high for daily discharges, less staff, and slow hospital software functioning in the billing department. Conclusion: The study recommended workforce and space management to improve the quality of services and patient satisfaction

Evaluation of Cost and Parental Satisfaction in Type B Polydactyly Excision Completed in Office Vs. Operating Room

Background/Objective:One in 500 children in the US are born with polydactyly, extra digits on hands or feet. Out of those children, 95% of cases comprise of type B polydactyly, in which the extra digit is attached by neurovascular bundle without bones. Surgeries to remove type B polydactylies by excision have been traditionally performed in operating rooms. Even though operating room surgeries are successful, they can be expensive and time consuming. In contrast, the surgeries performed in physician’s office, while non-traditional, can minimize expenses and save time and effort. We hypothesize that excisions conducted in offices are safe alternatives to operating room excision and are associated with definitive financial savings for patients’ families and hospitals, while increasing satisfaction of parents.&#x0D; Methods:Using CPT codes and reviewing electronic medical records, we identified all patients from 2019 to 2022 who had been treated for Type B Polydactyly with either office procedures or OR procedures, all of which had been performed at Riley Children’s Hospital. Patient billing data were obtained from Indiana University Hospital billing department. Average charge to patients for total cost of procedure and estimated removal of one digit were analyzed and compared. A 9-question parental satisfaction questionnaire was administered to patient’s parents over phone call.&#x0D; Results:Thus far, out of 93 patients who underwent type B polydactyly removal, 36 patients received procedures in physician’s offices, and 57 patients received procedures in ORs. Average charge to patients per digit removed for in-office group was around $500 cheaper than that of OR group. Average total charge to patients for in-office group was around $600 cheaper than that of OR group. Parental satisfaction data are pending.&#x0D; Conclusion and Potential Impact:This study shows the cost effectiveness of type B polydactyly excision in office. With analysis of future satisfaction survey data, we hope to gauge parental satisfaction associated with in-office excisions and promote in-office excisions as effective alternative to OR excisions.

102: DOES CASE MIX INDEX TELL THE STORY OF HOW SICK OUR PATIENTS ARE IN AN ICU?

Introduction: CMS uses the case mix index for calculating payments, not for disease severity per se. It is variable based on documentation and coding. APACHE and Acute physiological scoring (APS) are developed to predict disease severity and mortality in ICU. Houston Methodist Baytown (HMB) is considered a complex care hospital for Vizient. The billing and compliance department reviews our ICU documentation periodically. Higher ICU-related DRG services like tracheostomy, ECMO, impella are done. We wanted to evaluate if CMI correlates with mortality rate compared to APACHE and APS in a complex care hospital. Methods: Retrospective study of ICU data at HMB, a 24-bed medical-surgical ICU from Jan 2021 to March 2022. CMI, APACHE, and APS were obtained from ICU (clarity database, EPIC) and VICU dashboards. Descriptive statistics and Pearson correlation was used to evaluate CMI and APACHE, APS in predicting mortality rate. The mortality rate is defined as a percentage of patients with ICU stays who expired during an ICU stay. The mortality index is defined as the observed mortality rate/ expected mortality rate. Results: We had 2758 ICU encounters from January 2021 to March 2022. Mean CMI- 3.426, Mean APACHE -65, Mean APS -54. The average Mortality rate is 8.8%, average mortality index is 0.61. There is a strong positive correlation between APACHE- r=0.914, p=0.029; APS- r= 0.947, p= 0.014 and mortality. CMI also correlated well with mortality r=0.9131, p=0.03. Conclusions: APACHE and APS have strong correlations to predict mortality however CMI also correlated well with the mortality rate for complex care ICU patients. If appropriate documentation and high-risk patient services are provided, then CMI in those hospitals might correlate well with the ICU mortality rate.

Incidence of Typical Neutrophil Count with Fy(a-b-) Status Among Hematology Referrals for Neutropenia at an Urban Safety-Net Hospital

Typical neutrophil count with Fy(a-b-) status, known variously as Duffy null phenotype or Benign Ethnic Neutropenia, causes asymptomatic neutropenia without clinical sequelae.[i][ii] Fy(a-b-) phenotype is correlated to homozygosity of a single nucleotide polymorphism in the promoter region of atypical chemokine receptor 1 (ACKR1; formerly known as DARC), a decoy chemokine receptor, and may protect against malaria infection.[iii][iv] This genotype is enriched in malaria-endemic regions.[v] 25% to 50% of people of African ancestry in the United States are thought to have Fy(a-b-) status and are often erroneously identified as having pathologically low neutrophil counts. We performed a retrospective chart review of new neutropenia referrals to Hematology Clinic at Boston Medical Center (BMC) to evaluate diagnostic patterns for typical neutrophil count with Fy(a-b-) status. Overall, 103 new referrals for evaluation of neutropenia were made to BMC Hematology Clinic from 1/2020 to 2/2022, of which 78 were included for further analysis. Demographic and laboratory data are summarized in the accompanying Table. Typical neutrophil count with Fy(a-b-) status was identified as the primary etiology for neutropenia in 64.1% (50 of 78 referrals), of which 41 (82%) identified as African American or Black or were born in an African or Caribbean country. Of patients suspected of having Duffy null phenotype, 66% (33 of 50 patients) underwent confirmatory blood bank testing, and 97% (32 of 33) of these patients were found to have Fy(a-b-) status. Average cost of laboratory visit was calculated for each new referral using the Outpatient Price Transparency Tool from BMC Billing Department, which is based on chargemaster prices for the hospital. Patients with typical neutrophil count with Fy(a-b-) status on average had lower, but not negligible, cost of workup ($363.82 vs $689.46; p<.005 by unpaired student's T test assuming unequal variance) and were statistically less likely to have a follow up appointment (p=0.039 by unpaired student's T test assuming unequal variance) compared to those without. Though this phenotype reflects normal variation of white cell count in non-White populations, it is a "...label that illustrates how common phenotypes seen in non-White individuals continue to be considered nonstandard in the medical community." Workup of referrals that have typical neutrophil count with Fy(a-b-) status is not currently recommended, unless they have a change in their baseline white cell count or new, atypical features concerning for a secondary etiology.[vi] In our study, asymptomatic referrals were the majority and represent an unnecessary cost burden on an overtaxed healthcare system. Fy(a,b) antigen testing provides a low-cost alternative to hematology referral for confirmation of Fy(a-b-) status for patients or providers who require reassurance. Expanded use of serological Fy(a,b) antigen testing by primary care providers for patients with ancestry from malaria-endemic regions and chronic, asymptomatic neutropenia could reduce cost of care and referrals to Hematology clinic. [i] Ortiz MV, Meier ER, Hsieh MM. Identification and Clinical Characterization of Children With Benign Ethnic Neutropenia. J Pediatr Hematol Oncol. 2016 Apr;38(3):e140-3. doi: 10.1097/MPH.0000000000000528. PMID: 26925714; PMCID: PMC5102334. [ii] Merz LE, Achebe M. When non-Whiteness becomes a condition. Blood. 2021 Jan 7;137(1):13-15. doi: 10.1182/blood.2020008600. PMID: 33181819. [iii] Reich D et al. Reduced neutrophil count in people of African descent is due to a regulatory variant in the Duffy antigen receptor for chemokines gene. PLoS Genet. 2009 Jan;5(1):e1000360. doi: 10.1371/journal.pgen.1000360. Epub 2009 Jan 30. PMID: 19180233; PMCID: PMC2628742. [iv] Miller LH, Mason SJ, Clyde DF, McGinniss MH. The resistance factor to Plasmodium vivax in blacks. The Duffy-blood-group genotype, FyFy. N Engl J Med. 1976 Aug 5;295(6):302-4. doi: 10.1056/NEJM197608052950602. PMID: 778616. [v] Haddy TB, Rana SR, Castro O. Benign ethnic neutropenia: what is a normal absolute neutrophil count? J Lab Clin Med. 1999 Jan;133(1):15-22. doi: 10.1053/lc.1999.v133.a94931. PMID: 10385477. [vi] Gibson C, Berliner N. How we evaluate and treat neutropenia in adults. Blood (2014) 124 (8): 1251-1258. https://doi.org/10.1182/blood-2014-02-482612 Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Can Natural Language Processing and Artificial Intelligence Automate The Generation of Billing Codes From Operative Note Dictations?

Retrospective Cohort Study. Using natural language processing (NLP) in combination with machine learning on standard operative notes may allow for efficient billing, maximization of collections, and minimization of coder error. This study was conducted as a pilot study to determine if a machine learning algorithm can accurately identify billing Current Procedural Terminology (CPT) codes on patient operative notes. This was a retrospective analysis of operative notes from patients who underwent elective spine surgery by a single senior surgeon from 9/2015 to 1/2020. Algorithm performance was measured by performing receiver operating characteristic (ROC) analysis, calculating the area under the ROC curve (AUC) and the area under the precision-recall curve (AUPRC). A deep learning NLP algorithm and a Random Forest algorithm were both trained and tested on operative notes to predict CPT codes. CPT codes generated by the billing department were compared to those generated by our model. The random forest machine learning model had an AUC of .94 and an AUPRC of .85. The deep learning model had a final AUC of .72 and an AUPRC of .44. The random forest model had a weighted average, class-by-class accuracy of 87%. The LSTM deep learning model had a weighted average, class-by-class accuracy 0f 59%. Combining natural language processing with machine learning is a valid approach for automatic generation of CPT billing codes. The random forest machine learning model outperformed the LSTM deep learning model in this case. These models can be used by orthopedic or neurosurgery departments to allow for efficient billing.

Abstract WP32: Thinking Outside The Box In Delivering Advanced Stroke Care In A Pandemic

Background: The challenges presented by the COVID-19 Pandemic have caused healthcare providers, hospitals, and systems of care to re-think how care is provided to other acute time-sensitive diseases, such as stroke. Stroke admissions to hospitals decreased during the initial surge of COVID-19 cases. Purpose: To ensure Stroke patients who are eligible for endovascular therapy (EVT) receive timely access to evaluation and treatment when healthcare systems may be too overwhelmed with lack of post-procedural ICU beds and resources. Method: As a Primary Stroke Center (PSC), patients with stroke symptoms are quickly evaluated for potential treatment and advanced therapy. With Rapid software imaging, CTA and CT-P are readily available and reliable tools to diagnosis Large Vessel Occlusions (LVO). When eligible for EVT, patients are transferred emergently to a Comprehensive Stroke Center. With limited resources in the region, delays in care and transfers, ED and ICU beds were not readily available. Neuro-interventionalists were available to perform EVT but limited for lack of ICU bed availability. The CSC and PSC collaborated to develop a plan to transfer eligible patients for the EVT and transfer patient back to PSC ICU for post-procedure care. This allows the patient to receive appropriate and timely stroke care despite limited access to ICU beds at the CSC. Results: The CSC collaborated with the PSC to put this contingency plan into place. When an EVT eligible patient is identified at the PSC, the CSC is contacted for evaluation. If the patient is a candidate, the PCS admits patient to ICU and emergently transfers to CSC for outpatient procedure. This was approved by the billing department at both facilities. Conclusions: Modifications to stroke algorithms and care may be necessary during a Pandemic to maintain safe, efficient, and effective care. Communication and collaboration are key between stroke centers and stroke systems of care to facilitate positive outcomes without adding more challenges to an overwhelmed healthcare system

Physician Reimbursement for Vascular Surgery Procedures and Vascular Laboratory Studies Before and After the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA), fully implemented by 2015, has significantly increased the number of Americans with health insurance. However, its impact on physician reimbursement (PR) is not well studied. Our objective was to determine the ACA's impact on the professional component of PR for selected vascular surgery (VS) procedures and vascular laboratory (VL) studies at our institution. PR for the following 5 VS procedures and 4 VL studies were obtained from our billing department: CPT 34803 (Endovascular aortic repair, EVAR), 35301 (carotid endarterectomy, CEA), 35656 (lower extremity bypass, LEB), 36010 (introduction of catheter into vena cava, ICVC), 36200 first, 93922 (ankle brachial index, ABI), 93925 (lower extremity arterial duplex, LEA duplex), 93970 (lower extremity venous duplex, LEV Duplex), and 93990 (hemodialysis duplex). The data was organized by payer: Medicare, Medicaid, Commercial Insurers (CI), and Other. PR was studied pre-ACA (January 2008 through December 2009) and post-ACA (January 2015 through December 2016). The post-ACA PR and inflation adjusted reimbursement (IAR) in 2016 dollars using the consumer price index (CPI) were calculated and compared using one-sample t-test. The percent difference between the post-ACA PR and IAR was also compared. PR for 1,637 VS procedures and 16,333 VL studies was analyzed. The post-ACA PR was significantly lower than the IAR for most Medicare and Medicaid procedures. For EVAR, post-ACA reimbursement was overall on par with the IAR but significantly lower for Medicare. For CEA, post-ACA reimbursement was overall lower than IAR. For LEB, overall average PR was lower than IAR, with statistically significant lower Medicare and Medicaid (P < 0.001) payments. For ICAo, overall PR was significantly lower than the IAR and this was true across all insurance types. In contrast, for ICV, the post-ACA reimbursement was higher than IAR for all payers but did not reach statistical significance (P=0.25). The post-ACA PR was significantly higher than the IAR for most VL studies, except for Medicare PR. The percent change for VS procedures were mostly negative for the Medicaid and Medicare groups. This results in potential annual shortcomings of $2, 862 and $20,923 respectively. When comparing reimbursement before and after ACA implementation, Medicare and Medicaid PR for most VS procedures has not kept up with inflation. However, for most VL procedures, PR has exceeded inflation. Further efforts are needed to support Vascular Surgery reimbursement including higher valuation of the Medicare Conversion factor.

PENERAPAN ALGORITMA FLOYD WARSHALL UNTUK MENENTUKAN JALUR WIFI TERPENDEK DI STUDENTCOMP

Studentcomp is one of the service providers engaged in the IT field. Studentcomp is located at Jl. Raya Lekong, Gandukepuh, Sukorejo, Ponorogo. Studentcomp offers several services, one of which is wireless wifi service. In these services, there are often obstacles in terms of billing to the customer's place. this often makes the billing department wrong in determining which path to take and which customers have not paid and which have paid. then a system is made that can help the employees of the wifi billing department in determining the shortest path to the customer's place using the floyd warshall algorithm. the floyd warshall algorithm itself uses a dynamic system so that it guarantees in terms of determining the optimum solution in terms of determining the shortest path. The results obtained by applying this algorithm to the system are assisting employees in determining the shortest path that must be taken to the customer's place and being able to find out which customers have or have not paid.

Preoperative meningioma embolization reduces perioperative blood loss: a multi-center retrospective matched case-control study

Background and Purpose The utility of preoperative embolization remains controversial within the literature. Here, we evaluate whether preoperative meningioma embolization is effective in reducing intraoperative blood loss, safe to perform, and cost-effective when compared with surgical resection without preoperative embolization. Methods Twenty-nine patients with meningiomas were matched by tumor size and location to 29 control patients with meningiomas at another institution where preoperative embolization was not practiced. The variables evaluated were pre- and post-operative hemoglobin and hematocrit levels as a measure of operative blood loss and postoperative morbidity. The additional cost of undergoing angiography and embolization was calculated from hospital charges obtained from the billing department. Results The mean decrease in perioperative hemoglobin and hematocrit was 0.9 and 2.7, respectively, in the embolization group and 2.8 and 10.0, respectively, in the control group for a significant decrease in operative blood loss as measured by change in hematocrit and hemoglobin levels after surgery. There was no significant difference in operative blood loss when subdividing patients based on tumor location. There were no angiogram-related complications. Twenty-two of 29 patients (76%) underwent embolization of a feeding artery, whereas 7 patients underwent only a diagnostic angiogram. The mean additional charge per patient in the embolization group was $88,767. Conclusions Preoperative embolization was safe and effective in reducing the overall perioperative blood loss in patients undergoing meningioma resection, as measured by the change in postoperative hemoglobin and hematocrit levels. However, the cost of embolization was significant.

An Assessment of the Economic Feasibility of Selected Surgeries in the Obstetrics and Gynaecology Department under Community-Based Health Insurance (CBHI) in a Tertiary Care Hospital in South India.

Community-Based Health Insurance (CBHI) is a form of micro health insurance targeted at low-income groups that permits for grouping of assets to tackle the expenses of future, uncertain, health-related circumstances. According to the International Labour Organisation, more than 80% of India's employed nonagricultural population is in the informal sector, implying that they are possibly excluded from receiving health insurance benefits. This is where CBHI comes into play, wherein groups of people belonging to a community define the demand and benefits and pool their resources to provide financial protection to all their members. This study aims to scrutinize the package prices sanctioned by these schemes and compare them with the cost incurred by the hospital. The expense pattern of three surgeries in the Department of Obstetrics and Gynaecology was analysed under three insurance schemes: Arogya Bhagya Yojana, Arogya Karnataka, and Employees' State Insurance Scheme. Methodology. A retrospective study was conducted in a 2,032-bedded tertiary care hospital in South India. Patients of abdominal hysterectomy, vaginal hysterectomy, and caesarean section surgeries covered by any of the insurance schemes mentioned above were a part of the inclusion criteria. The patient records were examined from the hospital's Medical Records Department (MRD). The patients' bills were assembled from the inpatient billing department to scrutinize all the expenses associated with each surgery. The variable costs include consumables, medicine, electricity and AC, diagnostics, blood bank materials, doctor's fee, package differences, and others. In contrast, fixed costs include bed cost, equipment cost (purchase + annual maintenance cost), manpower cost-OT, manpower cost-nursing, and allocated indirect costs associated with the medical treatment. These were computed and compared with the package price of respective insurance schemes to determine if the schemes are profit-yielding schemes or loss-yielding schemes, using the data from the finance department. Results and Conclusion. It has been observed that the operating loss of the hospital for abdominal hysterectomy, vaginal hysterectomy, and caesarean section under CBHI schemes ranges between 7% and 36%. The highest loss was observed in Arogya Karnataka Scheme for caesarean section surgery (BPL patients). The amount received through these schemes is insufficient to cover the costs acquired by the hospital, let alone make a profit. However, under Arogya Bhagya and ESI Schemes, the hospital has made a profit in covering the variable costs for these surgeries. The study concludes that the hospital is running under loss due to the three Community-Based Health Insurance (CBHI) schemes.

Comparison of Inpatient Standard-of-Care to Outpatient Oritavancin Therapy for Patients With Acute Uncomplicated Cellulitis

Background: Shifting inpatient antibiotic treatment to outpatient parenteral antimicrobial therapy may minimize treatment for acute bacterial skin and skin structure infections, including cellulitis. The purpose of this evaluation was to compare 30-day hospital readmission or admission due to cellulitis and economic outcomes of inpatient standard-of-care (SoC) management of acute uncomplicated cellulitis to outpatient oritavancin therapy. Methods: This retrospective, observational cohort study was conducted at a 941-bed community teaching hospital. Adult patients 18 years and older treated for acute uncomplicated cellulitis between February 2015 to December 2018 were eligible for inclusion. Information was obtained from hospital and billing department records. Patients were assigned to either inpatient SoC or outpatient oritavancin cohorts for comparison. Results: 1,549 patients were included in the study (1,348 in the inpatient SoC cohort and 201 in the outpatient oritavancin cohort). The average length of stay for patients admitted was 3.6 ± 1.5 days. The primary outcome of 30-day hospital readmission or admission due to cellulitis occurred in 49/1348 (3.6%) patients in the inpatient SoC cohort versus 1/201 (0.5%) in the outpatient oritavancin cohort (p = 0.02). The difference between costs and reimbursement was improved in the outpatient oritavancin group (p < 0.001). Conclusion: Outpatient oritavancin for acute uncomplicated cellulitis was associated with reduction in 30-day hospital readmissions or admissions compared to inpatient SoC. Beneficial economic outcomes for the outpatient oritavancin cohort were observed. Additional studies are required to confirm these findings.

Cost-Effectiveness of Using LDL-Direct Versus Lipid-Panel as Part of the Inpatient Stroke Workup

Objective: To investigate whether utilizing a LDL-direct laboratory test rather than a lipid panel to determine LDL-C as part of the inpatient stroke and TIA workup is more cost-effective to the patient and hospital system. A retrospective analysis was conducted on all patients admitted to UCSD La Jolla and Hillcrest Hospital and discharged with a final diagnosis of ischemic stroke or transient ischemic attack between 7/2016 and 6/2019. A cost-analysis was extrapolated based on the current cost of each test as provided by the UCSD hospital billing department as of June 2020. Patients started on a statin, who were not on one prior to admission, were also analyzed to highlight the importance of an accurate LDL-C on management of dyslipidemia. Results: A total of 1245 patients were included in the study with 87% representing Ischemic strokes and 13% transient ischemic attacks. Over the three-year period, a total savings of $77,545 would be achieved if LDL-direct were used in place of a lipid-panel, representing an overall cost savings of 33%. Over the same time-frame, 536 (43%) patients were started on a statin that were not previously on one. Conclusions: Ordering a LDL-direct test should be considered over a lipid panel to evaluate LDL-C as it may prove to be the most cost effective approach to both the patient and Healthcare system.

Clinically Significant Hepatopathology Detected At Cholecystectomy Dramatically Increases Billing

Abstract Introduction/Objective Incidental hepatic tissue obtained via cholecystectomy is generally minute and inconsequential. For these reasons, the hepatic tissue is bundled with the gallbladder and cannot invoke additional billing. However, hepatic tissue that is very large or that harbors significant hepatopathology has clinical utility and could justify additional billing. We hypothesized that such incidental hepatic tissue would dramatically increase billing because the liver is billed at a higher level of complexity than the gallbladder and requires cytochemistry for evaluation. Methods We retrospectively reviewed pathology reports, slides, and codes from 9 specimens from cholecystectomy that contained hepatic tissue that was grossly evident or that demonstrated significant hepatopathology. Our billing department with decades of experience but without medical training codified the reports using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and Current Procedural Terminology (CPT), blinded to our study. Results The patients included 5 women and 4 men, ages 18 to 72 years. Five specimens contained very large pieces of liver 0.8 cm to 2.2 cm long and 0.3 cm to 1.8 cm thick. Diagnoses included nonalcoholic fatty liver disease or steatohepatitis (6 specimens), de novo alpha-1 antitrypsin deficiency (2 specimens), de novo sinusoidal amyloidosis (1 specimen), hemosiderosis (1 specimen), and obstruction (1 specimen). Some specimens demonstrated multiple diagnoses. Only ICD-10 codes K76.0 (6 specimens) and K75.81 (2 specimens) were generated, corresponding to nonalcoholic fatty liver disease and steatohepatitis, respectively. ICD-10 codes were omitted for 1 specimen. Although all specimens generated CPT codes 88312 (20 charges) and 88313 (14 charges), corresponding to cytochemistry, none generated CPT code 88307, corresponding to the liver. Conclusion Incidental hepatic tissue obtained via cholecystectomy dramatically increases billing, but significant hepatic findings and exceptions to coding principles must be clearly conveyed to billing departments to ensure proper coding.

Estimates of Direct and Indirect Costs of Ankle Fractures: A Prospective Analysis.

The quantification of the costs of ankle fractures and their associated treatments has garnered increased attention in orthopaedics through cost-effectiveness analysis. The purpose of this study was to prospectively assess the direct and indirect costs of ankle fractures in operatively and nonoperatively treated patients. A prospective, observational, single-center study was performed. Adult patients presenting for an initial consult for an ankle fracture were enrolled and were followed until recurring indirect costs amounted to zero. Patients completed a cost form at every visit that assessed time away from work and the money spent in the last week on transportation, household chores, and self-care due to an ankle fracture. Direct cost data were obtained directly from the hospital billing department. Sixty patients were included in this study. With regard to patient characteristics, the mean patient age was 46.5 years, 55% of patients were female, 10% of patients had diabetes, and 17% of patients were active smokers. Weber A fractures composed 12% of fractures, Weber B fractures composed 72% of fractures, and Weber C fractures composed 18% of fractures. Operatively treated patients (n = 37) had significantly higher total costs and direct costs compared with nonoperatively treated patients (p < 0.01). In all patients, losses from missed work accounted for the largest portion of total and indirect costs, with a mean percentage of 35.8% of the total cost. The mean period preceding return to work of the 39 employed patients was 11.2 weeks. Longer periods of return to work were significantly associated with surgical fixation and having less than a college-level education (p < 0.05). The mean time for recurring observed costs to cease was 19.1 weeks. In patients treated operatively and nonoperatively, the largest discrete cost component was a specific indirect cost. Indirect costs accounted for a mean of 41.3% of the total cost. Although the majority of the direct costs of ankle fractures are accrued in the period immediately following the injury, indirect cost components will regularly be incurred for nearly 5 months and often longer. To capture the full economic impact of these injuries, future research should include detailed reporting on an intervention's impact on the indirect costs of ankle fractures. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Measuring the Total Cost of Ankle Fractures: A Prospective Analysis

Category:Trauma; AnkleIntroduction/Purpose:Ankle fractures (AFx) are the most common foot and ankle fracture seen at hospitals in the United States, and are undoubtedly costly to patients. Quantification of the costs of fractures and their associated treatments has garnered increased attention in orthopedics in recent years through cost-effectiveness analysis. However, literature pertaining to AFx’s almost never reports on the indirect costs of AFx’s, and thus fails to accurately assess the true value of treatments. The purpose of this study was to prospectively assess the direct and indirect costs of AFx’s in operatively and nonoperatively treated patients. Secondary analysis included evaluation of the composition of indirect cost, the duration these costs are endured, and the factors that influence their magnitude.Methods:A prospective observational single-center study was performed. Adult patients presenting for initial consult for an AFx that could speak English or Spanish were enrolled. Polytrauma patients and those unable to provide complete indirect cost data were excluded. Patients completed a cost form that asked the money they had spent in the last week on transportation, household chores, and self-care due to their AFx. Patients were considered to have complete indirect cost data if they returned for follow-up visits until they reported no recurring indirect costs and had returned to work. Direct cost data was obtained directly from the hospital billing department. Amount collected was utilized. Direct costs included any costs incurred from staff treating the patient, supplies required for treatment, and the use of healthcare facilities. A descriptive analysis of the entire cohort and stratification by operative status was performed for the primary comparative analysis.Results:60 patients were ultimately analyzed. Average age was 46.5 years. 55% were female. 10% of patients were diabetic. 17% smoked cigarettes actively. Weber A, B, and C fractures composed 12%, 72%, and 18% of fractures, respectively. Operatively treated patients (n=37) had a significantly higher total and direct cost than non-operative patients (P<0.01). Average salary of the 39 employed patients was $61,416 and return to work period was 11.2 weeks. In all patients, lost income accounted for the largest portion of total and indirect cost, averaging 38% of total cost. Longer periods of return to work were significantly associated with undergoing surgery and having less than a college-level education (P<0.05). Average number of weeks for indirect costs to amount to zero was 19.1.Conclusion:In patients treated operatively and nonoperatively, the largest cost component was an indirect cost: missed wages at 28.6% and 63.3%, respectively. While the majority of the direct costs of AFx’s are accrued in the period immediately following the injury, indirect cost components will regularly be incurred for nearly 5 months and often longer. The degree and duration to which these indirect costs accumulate are novel findings. Future research should no longer neglect reporting on an intervention’s impact on the indirect costs of AFx’s.

P72. Natural language processing of operative note dictations to automatically generate CPT codes for billing

BACKGROUND CONTEXT Medical notes contain a rich supply of medical data, yet the format of unstructured text precludes this data from being readily used by computers for data mining. Using natural language processing (NLP) in combination with machine learning on standard operative notes may allow for efficient billing, maximization of collections and minimization of coder error. PURPOSE We hypothesize that a machine learning algorithm can accurately identify billing CPT codes on unstructured patient operative notes. STUDY DESIGN/SETTING This was a retrospective analysis of medical notes from a large, single-center academic institution's database comprised of cases from a single surgeon. PATIENT SAMPLE Inclusion criteria included patients who underwent elective spine surgery by a single senior surgeon from 9/2015 to 1/2020. OUTCOME MEASURES Algorithm performance was measured by performing receiver-operating characteristic (ROC) analysis and calculating the area under the ROC curve (AUC). METHODS Inclusion criteria included patients who underwent elective spine surgery by a single senior surgeon from 9/2015 to 1/2020. Algorithm performance was measured by performing receiver-operating characteristic (ROC) analysis and calculating the area under the ROC curve (AUC). The data was randomized with 70% used for training and 30% used for testing. Labels (CPT codes) were generated by the billing and coding department. NLP (natural language processing) techniques were used to analyze standard operative notes and train an algorithm to automatically generate CPT codes. A deep learning NLP algorithm (bidirectional long short-term memory network with attention) was tested on operative notes to predict CPT codes. CPT codes generated by the billing department were compared to those generated by our model. RESULTS A total of 391 operative dictations fit our inclusion criteria. The NLP algorithm identified the correct CPT codes on the validation set with a final accuracy of 98%. The overall AUC was 80% for the top 36 CPT Codes. The average class by class accuracy for the top 36 CPT Codes was 80%. CONCLUSIONS Combining NLP with ML is a valid approach for automatic generation of CPT billing codes, and it can be used by departments to allow for efficient billing, maximization of collections and minimization of coder error. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.