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Associations Between Education, Accu...

Phillis, Kathryn Joyce.

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Associations Between Education, Accurate Coding and Documentation to Provider Reimbursement, as Measured by Expected Reimbursement, in the U.S. Medical Billing System.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Associations Between Education, Accurate Coding and Documentation to Provider Reimbursement, as Measured by Expected Reimbursement, in the U.S. Medical Billing System./
Author:	Phillis, Kathryn Joyce.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2020,
Description:	113 p.
Notes:	Source: Dissertations Abstracts International, Volume: 82-05, Section: B.
Contained By:	Dissertations Abstracts International82-05B.
Subject:	Health sciences. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28151636
ISBN:	9798684671555

Associations Between Education, Accurate Coding and Documentation to Provider Reimbursement, as Measured by Expected Reimbursement, in the U.S. Medical Billing System.
Phillis, Kathryn Joyce.

Associations Between Education, Accurate Coding and Documentation to Provider Reimbursement, as Measured by Expected Reimbursement, in the U.S. Medical Billing System. - Ann Arbor : ProQuest Dissertations & Theses, 2020 - 113 p.

Source: Dissertations Abstracts International, Volume: 82-05, Section: B.

Thesis (Ph.D.)--Trident University International, 2020.

This item must not be sold to any third party vendors.

Medical providers in the United States often file claims without necessary information that could maximize reimbursement, resulting in claims denials and potentially lost revenue. This study sought to explore reasons for claims denials resulting in missed opportunities for revenue, and whether provider education had an impact on reducing denials and subsequently lost potential revenue. The study examined the impact of front office data entry, medical coding and documentation on expected provider reimbursement during two three-month periods - July through September 2018 and again July through September 2019. This study specifically looked at outpatient medical providers, however the research and findings could apply to any and all providers. This study used secondary data, pulling from organizational records to examine the association between independent variables and provider reimbursement, as measured by expected reimbursement, in the current United States (U.S.) medical billing system. It is a quantitative, correlational research design. The researcher used a multiple regression, predictive study for quantitative analysis. Specific to this study, billing and coding for outpatient home-based care across the states of Iowa, Tennessee, Texas and Arizona were explored. Independent variables which were assessed included insurance documentation, provider documentation, front office education, provider education, timely claims follow-up and training. In the end, the study demonstrated that several factors impact expected revenue associated with provider reimbursement. Total provider errors attributed to insurance errors in 2018 were $99,229 and timely filing errors were $212,003. For 2019, total provider errors attributed to insurance errors were $11,025 and timely filing errors were $5,728. This indicates a 97% reduction in errors post-provider education.All types of providers showed the need for education. The need for front office education was quite evident as a result of the study, as Staff 1 without prior education had errors resulting in $95,422 in lost revenue insurance errors in 2018 while Staff 2 with prior education had only $3,807 in lost revenue insurance errors in 2018. Post-education, Staff 1 improved, however still had $10,811 in lost revenue insurance errors in 2019 whereas Staff 2 improved and had only $214 in lost revenue insurance errors in 2019. The data from this study can be used to formulate tools for providers and their staff to positively impact optimal reimbursement.

ISBN: 9798684671555Subjects--Topical Terms:

3168359
Health sciences.
Subjects--Index Terms:

Medical billing system

Associations Between Education, Accurate Coding and Documentation to Provider Reimbursement, as Measured by Expected Reimbursement, in the U.S. Medical Billing System.
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