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Concurrent Surgical Patient Safety Indicator Evaluation Results in More Accurate Reporting and Reimbursement

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We sought to determine whether concurrent (before discharge) Agency for Healthcare Research and Quality patient safety indicator evaluation would result in a more expeditious review, accurate reporting, and improved reimbursement. We compared the period of preconcurrent (preC) coding (January 2012 to June 2012) with the period after concurrent coding (postC) began (July 2012 to December 2012) for total billing errors. There were 276 records reviewed in the preC versus 424 in the postC time periods. Overall coding errors were 225 (81.5%) preC versus 365 (86.1%) postC (P = nonsignificant), whereas documentation errors were present in 26 (9.4%) preC versus 40 (9.4%) postC (P = nonsignificant). Total charges were $3,782,024 preC and $2,011,144 postC. Recodes requiring rebilling were 21 (7.6%) preC for a total of $213,723 rebilled versus four (0.9%) postC for a total of $31,327 rebilled (P < 0.0001). Time from service to review was 98.7 preC versus 52.3 postC days (P < 0.0001). Time from service until rebill submitted averaged 100.8 preC versus 54.0 postC days (P = 0.06). Concurrent review allows for more accurate reporting because recodes are completed before discharge. Billing delays prolong time to reimbursement and results in loss of revenue.
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Document Type: Research Article

Affiliations: Division of Trauma, Critical Care & Emergency Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA

Publication date: August 1, 2014

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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