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| [PMID]: | 29466590 |
| [Au] Autor: | Tseng P; Kaplan RS; Richman BD; Shah MA; Schulman KA |
| [Ad] Endereço: | Duke University School of Medicine, Durham, North Carolina. |
| [Ti] Título: | Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System. |
| [So] Source: | JAMA;319(7):691-697, 2018 02 20. | | [Is] ISSN: | 1538-3598 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | Importance: Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. Objective: To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. Design, Setting, and Participants: This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Exposures: Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Main Outcomes and Measures: Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Results: Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. Conclusions and Relevance: In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses. |
| [Mh] Termos MeSH primário: |
Centros Médicos Acadêmicos/economia
Custos de Cuidados de Saúde/estatística & dados numéricos
Seguro Saúde/organização & administração
Administração da Prática Médica/economia
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| [Mh] Termos MeSH secundário: |
Centros Médicos Acadêmicos/organização & administração
Custos e Análise de Custo
Seguro Saúde/economia
Sistemas Computadorizados de Registros Médicos/economia
Modelos Organizacionais
Análise e Desempenho de Tarefas
Fatores de Tempo
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE |
| [Em] Mês de entrada: | 1803 |
| [Cu] Atualização por classe: | 180302 |
[Lr] Data última revisão:
| 180302 |
| [Sb] Subgrupo de revista: | AIM; IM |
| [Da] Data de entrada para processamento: | 180222 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1001/jama.2017.19148 |
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