title: Resident awareness of documentation requirements and reimbursement: a multi-institutional survey.
abstract: BACKGROUND
  The current economic environment necessitates efforts to prevent avoidable losses in clinical revenue in academic cardiothoracic surgery programs. Inadequate documentation frequently results in delayed, denied, or reduced reimbursement. With the recent increase in integrated residency programs, documentation and compliance are becoming increasingly dependent on junior residents; however, their understanding of reimbursement and documentation guidelines is currently unknown.
  
  
  METHODS
  An electronically distributed, multi-institutional survey of 6 general and subspecialty surgery programs was conducted consisting of open-ended numeric estimation of Medicare reimbursement for various levels of patient encounters. Closed-ended questions were used to assess resident knowledge of documentation requirements, accompanied by self-estimated compliance with those requirements.
  
  
  RESULTS
  Thirty-seven percent (n = 106) of residents completed the survey. Most residents (77%) believe they play the primary role in documentation; however, knowledge of and compliance with higher level documentation practices range from 19% to 78% and 41% to 76%, respectively. On average, residents overestimate Medicare reimbursement of lower level encounters by as much as 77% and underestimate higher level encounters by as much as 38%. In many cases, the standard deviation of residents' estimates approaches the actual reimbursement value.
  
  
  CONCLUSIONS
  Residents have a limited knowledge of documentation requirements. Self-reported compliance, even when guidelines are known, is low. Estimation of financial reimbursement is extremely variable. Residents overestimate reimbursement of lower level encounters and underappreciate reimbursement at higher levels. Ensuring appropriate reimbursement for services rendered will require formal cardiothoracic resident education and ongoing quality control.
authors: Department of Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: kenan@virginia.edu.
authors: Kenan W
authors: KW
authors: Yount
authors: Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Bradley N
authors: BN
authors: Reames
authors: Department of Surgery, Vanderbilt University, Nashville, Tennessee.
authors: Clark D
authors: CD
authors: Kensinger
authors: Department of Surgery, Columbia University, New York, New York.
authors: Marissa A
authors: MA
authors: Boeck
authors: Department of Surgery, Emory University, Atlanta, Georgia.
authors: Peter W
authors: PW
authors: Thompson
authors: Department of Surgery, Stanford University, Palo Alto, California.
authors: Joseph D
authors: JD
authors: Forrester
authors: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors: Gilbert R
authors: GR
authors: Upchurch
authors: Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Paul G
authors: PG
authors: Gauger
authors: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors: Irving L
authors: IL
authors: Kron
authors: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors: Christine L
authors: CL
authors: Lau
mesh_terms: D004282:Documentation; D007722:Health Knowledge, Attitudes, Practice; D007396:Internship and Residency; D012051:Reimbursement Mechanisms; D013043:Specialties, Surgical; D011795:Surveys and Questionnaires; D014481:United States