Dwore R B, Murray B P, Parsons R J, Smith P M, Vorderer L H
College of Health, University of Utah, Salt Lake City 84112, USA.
J Hosp Mark. 1995;9(2):63-93. doi: 10.1300/j043v09n02_07.
To survive and thrive, rural hospitals are seeking enhanced revenues. This study focuses on outpatient laboratory and radiology coding and billing accuracy in a nonrandom sample of seven rural hospitals in a Western state. Information was gathered on (1) procedures incorrectly coded, (2) potential revenue increases from correct coding and billing, (3) barriers to implementing changes, and (4) perceived audit value. The identified major source of potential revenue enhancement was increased fees from private payers. Correct coding and billing to Medicare and Medicaid offered the potential of additional revenue. Participating administrators appreciated the validation of coding and billing practices and identification of potential enhanced revenues. Five of seven hospitals (71.4%) selectively implemented recommended changes. Complete compliance with recommended changes was limited by barriers of tradition, competition, and reimbursement, which must be overcome to realize successful implementation. Joint Commission on Accreditation of Healthcare Organization's (JCAHO) new Total Quality Management/Continuous Quality Improvement (TQM/CQI) emphasis provides an opportunity for revenue enhancement through coding/billing assessments and interdepartmental focus and coordination.
为了生存和发展，农村医院正在寻求增加收入。本研究聚焦于西部某州七家农村医院的非随机样本中的门诊实验室和放射科编码及计费准确性。收集了以下方面的信息：（1）编码错误的程序；（2）正确编码和计费可能带来的收入增加；（3）实施变革的障碍；（4）感知到的审计价值。确定的潜在收入增加的主要来源是来自私人支付方的费用增加。向医疗保险和医疗补助计划正确编码和计费有增加额外收入的潜力。参与的管理人员赞赏对编码和计费做法的验证以及对潜在增加收入的识别。七家医院中有五家（71.4%）选择性地实施了建议的变革。传统、竞争和报销等障碍限制了对建议变革的完全遵守，要实现成功实施就必须克服这些障碍。医疗组织联合认证委员会（JCAHO）新强调的全面质量管理/持续质量改进（TQM/CQI）通过编码/计费评估以及部门间的关注和协调提供了增加收入的机会。
