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Third party billing in the VHA: A look at cost and policy

Nugent G, Franchi E, Nugent L, Schehr S, Rodriguez A, Nadeja C. Third party billing in the VHA: A look at cost and policy. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2000 Sep 1; 11:31-41.

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OBJECTIVE: To evaluate the steps VA would need to take to produce bills that comply with Medicare requirements.METHODS: For six study sites, credentialed coders from an independent firm audited a total of 1,105 inpatient, 597 ambulatory surgery and 1,601 outpatient records in July 1998, March 1999, or September 1999. Errors in coding and lack of compliance with billing requirements were flagged and categorized. A second firm tested VA's ability to extract and process billing documents by scanning one full month of data from the six sites and flagging errors.FINDINGS: Overall, inpatient coding errors increased but ambulatory surgery and outpatient errors declined over the three audits. Reimbursement-related error rates were low (mean of 17% to 38%) and declined. They were similar to published rates from Medicare analyses. The creation of pseudo-bills for one month of data flagged errors in 16.7% of 1.5 million data lines.DISCUSSION: Eliminating coding errors will not result in Medicare-compliant bills, although additional coders will be required to code workload not adequately captured in VA (e.g. ambulatory surgeries). Commercial billing and coding software is necessary as is the redesign of some VA databases.

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