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Jun 14, 2017

Forensic Analysis of Professional Medical Charges

 Forensic Analysis of Professional Medical Charges


David Tanaka, Duke University Medical Center

Title: Forensic Analysis of Professional Medical Charges Background: Charge submission for clinical services is an essential but distracting service. Consequently, performance of this activity may be inconsistent between providers. A forensic analysis of the charge process can reveal systematic errors resulting in loss revenue opportunities. Methods: A retrospective analysis of submitted professional charges using JMP 9.0 (Cary, NC). Data were imported into JMP from a native Excel database (.cvs limited) prior to examination for obvious inconsistencies using the JMP distribution platform. Data were nest sorted on patient, service date, CPT code and payment history. Additional database inconsistencies were identified using JMP programming scripts. Results: Non-1st day code submitted on 1st day = 130 Billed 1st day charge after 1st day = 457 Gaps (epochs of missed days) = 138 Sum of missed days: 117 days Estimated financial losses: >$250,000 in missed revenues (not charges) Conclusion: Current medical billing practices result in systematic losses due to inconsistency of billings and inadequate or timely review of the submitted charge. Future electronic programs (EPIC) may improve both the efficiency and accuracy of the charge submission process.

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