Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits.
Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits.
复制标题
DOI：
10.1001/jamanetworkopen.2022.29504
复制
发表时间：
2022-08-01
影响因子：
13.8
通讯作者：
Laiteerapong, Neda
中科院分区：
文献类型：
--
作者：
Miksanek, Tyler J.;Edwards, Samuel T.;Weyer, George;Laiteerapong, Neda
这项经济评估估计了门诊医生在不同时间段的患者接触的年收入。2021年评估和管理服务指南的变化如何影响医生的报销？在对不同就诊时间的患者进行的经济评价中，医疗决策计费方法与持续10分钟或15分钟的回访患者报销较高相关。对于较长的访问，基于时间的计费方法与较高的报销。这项研究的结果表明，以时间为基础的计费与经济利益的医生在较低的流量诊所与较长的病人访问。医生基于时间的计费选项已经扩展，使许多医生能够根据花费的时间而不是医疗决策（MDM）水平来计费。然而，迄今为止没有任何研究估计了与按时间计费有关的收入变化。比较使用基于时间的计费与基于MDM的计费的医生在不同时间的门诊访视中的评价和管理（E/M）报销。这项经济评估使用了2019年门诊E/M代码的账单数据和2021年医疗保险和医疗补助服务中心的报销率。通用诊所模板的建模进行估计预期的年度E/M收入为一个全职医生在门诊诊所使用收费服务计费。对不同患者访视模板的年度E/M收入进行建模。回访患者的标准化时间为10至45分钟，新患者的访视时间是其两倍。根据MDM计费，访视时长增加与E/M收入减少相关（30分钟新患者访视/15分钟回访患者访视为564 188美元，40分钟新患者访视/20分钟回访患者访视为423 137美元）。在按时间计费的情况下，随着访视时间的增加，年度E/M收入保持相似（30分钟新患者访视/15分钟回访患者访视为400 432美元，40分钟新患者访视/20分钟回访患者访视为458 718美元）。与基于时间的计费相比，基于MDM的计费与10至15分钟回访患者的更高E/M收入相关（400 432美元vs 564 188美元）。基于时间的计费与持续20分钟或更长时间的回访患者的更高E/M收入相关。最高的建模E/M收入为846273美元，发生在基于MDM的计费下的10分钟回访患者。这项研究的结果表明，MDM为基础的计费和基于时间的计费的相对经济效益不同，并与患者访问的长度。与患者就诊时间较短的医生相比，患者就诊时间较长的医生更有可能通过使用基于时间的计费来增加收入。
This economic evaluation estimates annual revenue for different durations of patient encounters among physicians in outpatient clinics. How does the 2021 change in evaluation and management services guidelines, which allow for time-based billing inclusive of work before and after outpatient visits, affect reimbursement of physicians? In this economic evaluation of patient visits of different lengths, the medical decision-making billing method was associated with higher reimbursement for return patient visits lasting 10 or 15 minutes. For longer visits, the time-based billing method was associated with higher reimbursement. Findings of this study suggest that the time-based billing is associated with economic benefits for physicians in lower-volume clinics with longer patient visits. Time-based billing options for physicians have expanded, enabling many physicians to bill according to time spent instead of medical decision-making (MDM) level for fee-for-service outpatient visits. However, no study to date has estimated the revenue changes associated with time-based billing. To compare evaluation and management (E/M) reimbursement for physicians using time-based billing vs MDM-based billing for outpatient visits of varying lengths. This economic evaluation used 2019 billing data for outpatient E/M codes and 2021 reimbursement rates from the Centers for Medicare & Medicaid Services. Modeling of generic clinic templates was performed to estimate expected yearly E/M revenues for a single full-time physician working in an outpatient clinic using fee-for-service billing. Yearly E/M revenues for different patient visit templates were modeled. The standardized length of return patient visits was 10 to 45 minutes, and new patient visits were twice as long in duration. Under MDM-based billing, increased visit length was associated with decreased E/M revenue ($564 188 for 30-minute new patient visit/15-minute return patient visit vs $423 137 for 40-minute new patient visit/20-minute return patient visit). Under time-based billing, yearly E/M revenue remained similar across increasing visit lengths ($400 432 for 30-minute new patient visit/15-minute return patient visit vs $458 718 for 40-minute new patient visit/20-minute return patient visit). Compared with time-based billing, MDM-based billing was associated with higher E/M revenue for 10- to 15-minute return patient visits ($400 432 vs $564 188). Time-based billing was associated with higher E/M revenue for return patient visits lasting 20 minutes or longer. The highest modeled E/M revenue of $846 273 occurred for 10-minute return patient visits under MDM-based billing. Results of this study showed that the relative economic benefits of MDM-based billing and time-based billing differed and were associated with the length of patient visits. Physicians with longer patient visits were more likely to experience revenue increases from using time-based billing than physicians with shorter patient visits.
登录
查看更多内容
影响因子：
12.7
作者：
Privett, Natalie;Guerrier, Shanice
通讯作者：
Guerrier, Shanice
影响因子：
2.1
作者：
Bank, Alan J.;Obetz, Christopher;Kenney, William O.
通讯作者：
Kenney, William O.
影响因子：
3
作者：
Neprash, Hannah T.;Everhart, Alexander;Cross, Dori A.
通讯作者：
Cross, Dori A.
影响因子：
4.4
作者：
Arndt, Brian G.;Beasley, John W.;Gilchrist, Valerie J.
通讯作者：
Gilchrist, Valerie J.
影响因子：
5.7
作者：
Pozdnyakova, Anastasia;Laiteerapong, Neda;Lee, Wei Wei
通讯作者：
Lee, Wei Wei