Educational needs of medical practitioners about medical billing: a scoping review of the literature

Introduction: The World Health Organization has suggested the solution to health system waste caused by incorrect billing and fraud is policing and prosecution. However, a growing body of evidence suggests leakage may not always be fraudulent or corrupt, with researchers suggesting medical practitioners may sometimes struggle to understand increasingly complex legal requirements around health financing and billing transactions, which may be improved through education. To explore this phenomenon further, we undertook a scoping review of the literature to identify the medical billing education needs of medical practitioners and whether those needs are being met. Methods: Eligible records included English language materials published between 1 January 2000 and 4 May 2020. Searches were conducted on MEDLINE, PubMed, Google Scholar, CINAHL, LexisNexis and Heinonline. Results: We identified 74 records as directly relevant to the search criteria. Despite undertaking a comprehensive, English language search, with no country restrictions, studies meeting the inclusion criteria were limited to three countries (Australia, Canada, US), indicating a need for further work internationally. The literature suggests the education needs of medical practitioners in relation to medical billing compliance are not being met and medical practitioners desire more education on this topic. Evidence suggests education may be effective in improving medical billing compliance and reducing waste in health systems. There is broad agreement amongst medical education stakeholders in multiple jurisdictions that medical billing should be viewed as a core competency of medical education, though there is an apparent inertia to include this competency in medical education curricula. Penalties for non-compliant medical billing are serious and medical practitioners are at risk of random audits and investigations for breaches of sometimes incomprehensible, and highly interpretive regulations they may never have been taught. Conclusion: Despite acknowledged significance of waste in health systems due to poor practitioner knowledge of billing practices, there has been very little research to date on education interventions to improve health system efficiency at a practitioner level

Medicare billing, law and practice: Complex, incomprehensible and beginning to unravel

© 2019 Thomson Head Office. All rights reserved. Australia's Medicare is still widely considered one of the world's best health systems. However, continual political tinkering for 40 years has led to a medical billing and payment system that has become labyrinthine in its complexity and is more vulnerable to abuse now, from all stakeholders, than when first introduced. Continuing to make alterations to Medicare without addressing underlying structural issues, may compound Australia's health reform challenges, increase the incidence of non-compliance and expenditure and thwart necessary reforms to develop a modern, data-driven, digitally informed health system. For the medical practitioners who are required to navigate the increasing complexity and relentless change, they will remain at high risk of investigation and prosecution in what has become an anarchic operating environment that they cannot avoid, but do not understand

Adinkras: A Graphical Technology for Supersymmetric Representation Theory

We present a symbolic method for organizing the representation theory of one-dimensional superalgebras. This relies on special objects, which we have called adinkra symbols, which supply tangible geometric forms to the still-emerging mathematical basis underlying supersymmetry.Comment: 44 pages, LaTeX, 35 figure

Effective Symmetries of the Minimal Supermultiplet of N = 8 Extended Worldline Supersymmetry

A minimal representation of the N = 8 extended worldline supersymmetry, known as the `ultra-multiplet', is closely related to a family of supermultiplets with the same, E(8) chromotopology. We catalogue their effective symmetries and find a Spin(4) x Z(2) subgroup common to them all, which explains the particular basis used in the original construction. We specify a constrained superfield representation of the supermultiplets in the ultra-multiplet family, and show that such a superfield representation in fact exists for all adinkraic supermultiplets. We also exhibit the correspondences between these supermultiplets, their Adinkras and the E(8) root lattice bases. Finally, we construct quadratic Lagrangians that provide the standard kinetic terms and afford a mixing of an even number of such supermultiplets controlled by a coupling to an external 2-form of fluxes.Comment: 13 Figure

Who teaches medical billing? A national cross-sectional survey of Australian medical education stakeholders

© 2018 Author(s). Importance Billing errors and healthcare fraud have been described by the WHO as the last great unreduced health-care cost'. Estimates suggest that 7% of global health expenditure (US$487 billion) is wasted from this phenomenon. Irrespective of different payment models, challenges exist at the interface of medical billing and medical practice across the globe. Medical billing education has been cited as an effective preventative strategy, with targeted education saving$A250 million in Australia in 1 year from an estimated $A1-3 billion of waste. Objective This study attempts to systematically map all avenues of medical practitioner education on medical billing in Australia and explores the perceptions of medical education stakeholders on this topic. Design National cross-sectional survey between April 2014 and June 2015. No patient or public involvement. Data analysis-descriptive statistics via frequency distributions. Participants All stakeholders who educate medical practitioners regarding clinical practice (n=66). 86% responded. Results There is little medical billing education occurring in Australia. The majority of stakeholders (70%, n=40) did not offer/have never offered a medical billing course. 89% thought medical billing should be taught, including 30% (n=17) who were already teaching it. There was no consensus on when medical billing education should occur. Conclusions To our knowledge, this is the first attempt of any country to map the ways doctors learn the complex legal and administrative infrastructure in which they work. Consistent with US findings, Australian doctors may not have expected legal and administrative literacy. Rather than reliance on ad hoc training, development of an Australian medical billing curriculum should be encouraged to improve compliance, expedite judicial processes and reduce waste. In the absence of adequate education, disciplinary bodies in all countries must consider pleas of ignorance by doctors under investigation, where appropriate, for incorrect medical billing