title: Billing practices of North Carolina family physicians.
abstract: BACKGROUND
  This study describes billing practices of family physicians. Significant increases in the reimbursement for family physicians are expected from implementation of the resource-based relative value scale (RBRVS). However, the real impact of the RBRVS is unknown since little is known about how family physicians use the present reimbursement system to charge their patients.
  
  
  METHODS
  A random sample of 270 North Carolina family physicians was surveyed, using standardized progress notes of five hypothetical patients.
  
  
  RESULTS
  One hundred thirty-eight (51%) physicians responded; 107 (77.5%) were in private practice. Family physicians in private and nonprivate practices were similar in their Current Procedural Terminology (CPT) coding and level of service for each hypothetical case. Family physicians in smaller communities showed greater variation in CPT coding of visits than did family physicians in larger communities, and they were more likely to use CPT codes that indicated a lower level of visit. Rural family physicians demonstrated a significant inverse relationship between the CPT level of visit coded (ranging from "brief," with a CPT code of 90040, to "comprehensive," coded CPT 90080) and the amount they charged established patients for a "limited" visit (CPT 90050).
  
  
  CONCLUSIONS
  These findings suggest that the lower income of rural physicians is due, in part, to billing at a lower CPT code, and thus charging less for comparable services, than urban physicians. The findings also lend further support to contentions that federal reimbursement reforms will have less impact on the incomes of rural physicians than originally expected.
authors.affiliation: Department of Family Medicine, East Carolina University School of Medicine, Greenville, NC 27835.
authors.forename: J R
authors.initials: JR
authors.lastname: Purvis
authors.forename: R D
authors.initials: RD
authors.lastname: Horner
mesh_terms: D000043:Abstracting and Indexing; D000328:Adult; D000368:Aged; D005194:Family Practice / Q000191:economics; D005251:Fees, Medical; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010350:Patient Credit and Collection / Q000379:methods*; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011216:Practice Management, Medical; D012424:Rural Population; D011795:Surveys and Questionnaires