Original Contribution
Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact,☆☆,☆☆☆,

https://doi.org/10.1016/j.ajem.2014.02.051Get rights and content

Abstract

Objectives

The aim of this study was to determine the fiscal impact of implementation of a novel emergency department (ED) point-of-care (POC) ultrasound billing and reimbursement program.

Methods

This was a single-center retrospective study at an academic medical center. A novel POC ultrasound billing protocol was implemented using the Q-path Web-based image archival system. Patient care ultrasound examination reports were completed and signed electronically online by faculty using Q-path. A notification was automatically sent to ED coders from Q-path to bill the scans. ED coders billed the professional fees for scans on a daily basis and also notified hospital coders to bill for facility fees. A fiscal analysis was performed at the end of the year after implementing the new billing protocol, and a before-and-after comparison was conducted.

Results

After implementation of the new billing program, there was a 45% increase in the ED faculty participation in billing for patient care examinations (30%-75%). The number of ultrasound examinations billed increased 5.1-fold (4449 vs 857) during the post implementation period. The total units billed increased from previous year for professional services to 4157 from 649 and facility services to 3266 from 516. During the post implementation period, the facility fees revenue increased 7-fold and professional fees revenue increased 6.34-fold. After deducting the capital costs and ongoing operational costs from approximate collections, the net profits gained by our ED ultrasound program was approximately $350 000.

Conclusions

Within 1 year of inception, our novel POC ultrasound billing and reimbursement program generated significant revenue through ultrasound billing.

Introduction

The use of point-of-care (POC) ultrasound in the evaluation of emergency department (ED) patients has grown rapidly in both academic and private settings [1]. POC ultrasound has emerged as an important tool for rapid diagnosis of serious and life-threatening conditions in the ED [2]. Prior studies have demonstrated that emergency physician-performed bedside ultrasound improves diagnostic accuracy and decreases length of stay [3], [4]. The use of ultrasound for procedural guidance has been shown to be cost effective and to decrease complication rates [5]. Bedside ultrasound education has become an essential component of emergency medicine (EM) residency training and residents are required to demonstrate competency in performing bedside ultrasound to meet the Accreditation Council for Graduate Medical Education milestones [6].

The American College of Emergency Physicians (ACEP) Emergency Ultrasound Guidelines outline the scope of practice of emergency ultrasound, training pathways, credentialing, documentation, ultrasound equipment, and quality assurance (QA) process [7]. Successful implementation of an emergency ultrasound program requires financial integration of ultrasound into existing departmental billing and coding. A comprehensive document that addresses emergency ultrasound coding and reimbursement was developed by ACEP and recently updated [8]. This document provides guidance for appropriate emergency ultrasound documentation, current procedural terminology (CPT), International Classification of Diseases-9 coding, payer policy, and reimbursement. There are significant costs associated with an emergency ultrasound program including physician education, appropriate ultrasound equipment, an image archival system, QA, ultrasound machine, and probe maintenance. The development of ED ultrasound billing and reimbursement program is therefore crucial to cover these costs and to provide incentives for emergency physicians who perform ultrasound examinations. To date, very little has been published regarding the financial implications of an ED ultrasound program. The objective of this study was to determine the fiscal impact of implementation of a novel ED POC ultrasound billing and reimbursement program.

Section snippets

Study design

This is a single-center retrospective study at an academic medical center with an annual ED census of 70 000 visits. The study data were collected during fiscal year 2013. Institutional review board approval was obtained for this study protocol.

Study setting and population

The study was conducted in an ED with a 3-year EM residency program and a 5-year EM/pediatrics combined residency program with 49 faculty members. The department offers fellowships in ultrasound, Emergency Medical Service, Toxicology, Sports Medicine, and

Results

After the implementation of the new billing program there was a 45% increase in ED faculty participation in billing for patient care examinations (30%-75%). ED coding staff ensured that all ultrasound examinations billed had appropriate documentation required for billing. Compared to the previous year, the number of ultrasound examinations billed increased 5.1 fold (4449 vs. 857) during the post implementation period. The total units billed increased from previous year for professional services

Discussion

The scope and indications for POC ultrasound in emergency medicine are rapidly growing across the nation. Use of ultrasound in the ED has been shown to improve patient care and is becoming standard practice. Development of a financially viable emergency ultrasound program is essential to cover the costs of implementation (capital, training, and maintenance). A fiscal analysis done by Soremekun et al described actual and potential return on investment for their ED ultrasound program based on

Conclusions

Within 1 year of inception, our novel POC ultrasound billing and reimbursement program generated significant revenue through ultrasound billing. The key components of our billing program included Web-based image archival system for documentation, ongoing faculty and resident education, timely QA review with continuous billing reminders, regular interaction with ED coders, productivity reports, and support from the ED leadership and hospital administration.

Acknowledgments

The authors thank Kelly Kellen for her assistance with implementation of ultrasound billing protocol.

References (11)

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Abstract presented at the American Institute of Ultrasound in Medicine Annual Convention, Las Vegas, NV, March 2014.

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All authors declare that there is no conflict of interest.

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Disclosures: None.

Reprints not available from the authors.

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