title: Wound center facility billing: A retrospective analysis of time, wound size, and acuity scoring for determining facility level of service.
abstract: Outpatient wound center facility reimbursement for Medicare beneficiaries can be a challenge to determine and obtain. To compare methods of calculating facility service levels for outpatient wound centers and to demonstrate the advantages of an acuity-based billing system (one that incorporates components of facility work that is non-reimbursable by procedure codes and that represents an activity-based costing approach to medical billing), a retrospective study of 5,098 patient encounters contained in a wound care-specific electronic medical record database was conducted. Approximately 500 patient visits to the outpatient wound center of a Texas regional hospital between April 2003 and November 2004 were categorized by service level in documentation and facility management software. Visits previously billed using a time-based system were compared to the Centers for Medicare and Medicaid Services' proposed three-tiered wound size-based system. The time-based system also was compared to an acuity-based scoring system. The Pearson correlation coefficient between billed level of service by time and estimated level of service by acuity was 0.442 and the majority of follow-up visits were billed as Level 3 and above (on a time level of 1 to 5) , confirming that time is not a surrogate for actual work performed. Wound size also was found to be unrelated to service level (Pearson correlation = 0.017) and 97% of wound areas were < 100 cm2. The acuity-based scoring system produced a near-normal distribution of results, producing more mid-range billings than extremes; no other method produced this distribution. Hospital-based outpatient wound centers should develop, review, and refine acuity score-based models on which to determine billed level of service.
authors.affiliation: Department of Anesthesiology, The University of Texas Health Science Center, Houston, TX, USA. Caroline.E.Fife@uth.tmc.edu
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Fife
authors.forename: David
authors.initials: D
authors.lastname: Walker
authors.forename: Wade
authors.initials: W
authors.lastname: Farrow
authors.forename: Gordon
authors.initials: G
authors.lastname: Otto
mesh_terms: D000066:Accounting / Q000458:organization & administration*; D015982:Bias; D004282:Documentation; D006302:Health Services Research; D006801:Humans; D006278:Medicare / Q000458:organization & administration*; D016011:Normal Distribution; D009730:Nursing Assessment; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D011340:Problem Solving; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012984:Software; D013781:Texas; D013997:Time Factors; D016526:Workload; D014947:Wounds and Injuries / Q000145:classification / Q000191:economics* / Q000473:pathology / Q000628:therapy