Department of Emergency Medicine, Monash Medical Centre, Melbourne, Victoria, Australia.
Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Emerg Med Australas. 2020 Dec;32(6):1021-1026. doi: 10.1111/1742-6723.13557. Epub 2020 Jun 12.
The aim of the present study was to perform a cost-benefit analysis of retrospectively identifying missed compensable billings in a public Australian ED.
A retrospective review of patients who were eligible for billing from the period of 1 April 2018 to 31 January 2019 was undertaken. Individual patient files were examined and reconciliated with the historical billing record and any discrepancies identified. Financial modelling with Vose ModelRisk and R Studio v1.2.5033 was employed to estimate future benefits of such a strategy. Uncertainty analyses included variation in wage cost (AU$0-200/h), discount rate (3-10%), presentation growth rate, percentage compensable, benefit recovered/patient, percentage recoverable and cost per patient.
A total of 76 523 patients presented during this time. Of these, 2737 patients were deemed compensable. A total of 740 undocumented billing items were identified with an estimated Medicare Benefits Schedule value of $59 870 and an Australian Medical Association value of $152 400. The net present value (NPV) of this identified cash flow stream in perpetuity was $1 436 892 (Medicare Benefits Schedule) and $3 657 600 (Australian Medical Association) (i.e. the total value of recovering this amount of money each year indefinitely, corrected for the time value of money). The positive NPV was maintained with sensitivity analysis.
All scenarios examined led to a positive NPV favouring retrospectively identifying missed compensable billings.
本研究旨在对澳大利亚一家公立急诊部中遗漏的可计费项目进行成本效益分析。
对 2018 年 4 月 1 日至 2019 年 1 月 31 日期间符合计费条件的患者进行回顾性审查。检查每位患者的病历，与历史计费记录进行对账，并确定任何差异。采用 Vose ModelRisk 和 R Studio v1.2.5033 进行财务建模，以估计实施此类策略的未来收益。不确定性分析包括工资成本（0-200 澳元/小时）、折现率（3%-10%）、就诊增长率、可补偿比例、每位患者的收益回收额、可回收比例和每位患者的成本。
在此期间共有 76523 名患者就诊。其中，2737 名患者被认为可补偿。共发现 740 项未记录的计费项目，其医疗保险福利计划价值为 59870 澳元，澳大利亚医学协会价值为 152400 澳元。该现金流量在无限期内的净现值（NPV）为 1436892 澳元（医疗保险福利计划）和 3657600 澳元（澳大利亚医学协会）（即每年无限期收回这笔款项的总价值，经修正后考虑了货币的时间价值）。敏感性分析表明，净现值为正。
所有检查的情景都导致净现值为正，有利于追溯识别遗漏的可计费项目。
