Compensable Billing in the Emergency Department – A Cost Benefit Analysis of an Initiative to Increase Billings Accuracy

Objectives:Compensable patients under the Transport Accident Commission, Workcover or Overseas Visitor Agreement are a source of hospital revenue to augment Activity Based Funding for effective and efficient delivery of healthcare. Departments under pressure to provide emergency care within the National Efficient Price rely on accurate reimbursement arrangements. This study aimed to perform an economic evaluation in the form of a cost-benefit analysis (CBA) to assess an initiative to increase billing accuracy.Method:A retrospective review of patients who were eligible for billing from the period of 1st April 2018 to 31st January 2019 was undertaken. Individual patient files were examined and reconciliated with the historical billing record and any discrepancies identified.Results:A total of 76,523 patients presented to the emergency department during the ten-month period of April 2018 to January 2019 inclusive. Of these, 2,737 patients were deemed compensable. A total of 740 undocumented billing items were identified with an estimated Medicare Benefits Schedule (MBS) value of $59,870.50 and an Australian Medical Association (AMA) value of $152,400.00. The Net Present Value (NPV) of this identified cash flow stream in perpetuity was $1,436,892 (MBS) and $3,657,600 (AMA). The positive NPV was maintained with sensitivity analysis.Conclusion:This was a positive study that demonstrated that, for this population of presentations, and for this particular system of billing identification, all scenarios examined led to a positive Net Present Value favoring the initiation of a system of billings recovery for compensable patients presenting to an Australian emergency department