Department of Surgery, University of Virginia, Charlottesville, Virginia.
Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Ann Thorac Surg. 2014 Mar;97(3):858-64; discussion 864. doi: 10.1016/j.athoracsur.2013.09.100. Epub 2013 Dec 4.
The current economic environment necessitates efforts to prevent avoidable losses in clinical revenue in academic cardiothoracic surgery programs. Inadequate documentation frequently results in delayed, denied, or reduced reimbursement. With the recent increase in integrated residency programs, documentation and compliance are becoming increasingly dependent on junior residents; however, their understanding of reimbursement and documentation guidelines is currently unknown.
An electronically distributed, multi-institutional survey of 6 general and subspecialty surgery programs was conducted consisting of open-ended numeric estimation of Medicare reimbursement for various levels of patient encounters. Closed-ended questions were used to assess resident knowledge of documentation requirements, accompanied by self-estimated compliance with those requirements.
Thirty-seven percent (n = 106) of residents completed the survey. Most residents (77%) believe they play the primary role in documentation; however, knowledge of and compliance with higher level documentation practices range from 19% to 78% and 41% to 76%, respectively. On average, residents overestimate Medicare reimbursement of lower level encounters by as much as 77% and underestimate higher level encounters by as much as 38%. In many cases, the standard deviation of residents' estimates approaches the actual reimbursement value.
Residents have a limited knowledge of documentation requirements. Self-reported compliance, even when guidelines are known, is low. Estimation of financial reimbursement is extremely variable. Residents overestimate reimbursement of lower level encounters and underappreciate reimbursement at higher levels. Ensuring appropriate reimbursement for services rendered will require formal cardiothoracic resident education and ongoing quality control.
当前的经济环境需要努力防止学术心胸外科项目的临床收入中出现不必要的损失。不充分的记录通常会导致报销延迟、被拒绝或减少。随着最近综合住院医师培训计划的增加，记录和合规性越来越依赖于初级住院医师；然而，他们对报销和记录指南的理解目前尚不清楚。
对 6 个普通和亚专科手术项目进行了一项多机构的电子分布式调查，包括对各种级别的患者就诊的 Medicare 报销进行开放式数字估计。使用封闭式问题来评估住院医师对记录要求的了解情况，并结合自我评估对这些要求的遵守情况。
37%（n=106）的住院医师完成了调查。大多数住院医师（77%）认为他们在记录方面发挥主要作用；然而，对更高层次的记录实践的了解和遵守程度从 19%到 78%和 41%到 76%不等。平均而言，住院医师对较低级别就诊的 Medicare 报销的估计过高，高达 77%，对较高级别就诊的估计过低，高达 38%。在许多情况下，住院医师估计的标准差接近实际报销值。
住院医师对记录要求的了解有限。即使知道指南，自我报告的遵守情况也很低。对财务报销的估计非常不稳定。住院医师对较低级别的就诊高估了报销，而对更高水平的就诊则低估了报销。确保对提供的服务进行适当的报销将需要对心胸外科住院医师进行正式教育和持续的质量控制。
