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Table 4 Billing practices associated with accuracy of syndrome definitions based on physician claims (OR >1.00 means the encounter characteristic increased the PPV of the syndrome definition, OR < 1.00 means the encounter characteristic reduced the PPV)

From: Patient, physician, encounter, and billing characteristics predict the accuracy of syndromic surveillance case definitions

 

No. visits with a syndrome-positive physician claim

Bivariate regression analysis

Multivariate regression analysis1

Billing practices

Syndrome-positive in the chart

(N = 2,967)

Syndrome-negative in the chart

(N = 1,363)

Total

(N = 4,330)

OR

95% CI

P value

OR

95% CI

P value

 

No.

%

No.

%

No.

%

      

What person entered the diagnostic code in the claim?

            

   Physician

443

14.9

203

14.9

646

14.9

Ref.

Ref.

Ref.

Ref.

Ref.

Ref.

   Secretary or nurse

2,015

67.9

907

66.5

2,922

67.5

1.01

(0.82, 1.26)

0.91

0.93

(0.75, 1.15)

0.50

   Off-site billing company or RAMQ (i.e., paper billing)2

509

17.2

253

18.6

762

17.6

0.92

(0.71, 1.19)

0.52

0.81

(0.62, 1.06)

0.12

Billing software used:

            

   Soft Informatique

715

24.4

342

25.4

1,057

24.8

Ref.

Ref.

Ref.

Ref.

Ref.

Ref.

   Purkinje

721

24.7

264

19.6

985

23.1

1.30

(1.07, 1.60)

0.01

1.29

(1.05, 1.59)

0.02

   ADN Medical

405

13.9

166

12.3

571

13.4

1.16

(0.90, 1.49)

0.24

1.17

(0.91, 1.50)

0.23

   Omni-Med.com Caduceus

250

8.6

124

9.2

374

8.8

0.96

(0.74, 1.25)

0.77

0.94

(0.72, 1.24)

0.67

   Medicus MED-WIN

123

4.2

67

5.0

190

4.5

0.87

(0.65, 1.17)

0.36

0.87

(0.64, 1.17)

0.35

   Facturation.net

73

2.5

64

4.8

137

3.2

0.55

(0.35, 0.86)

0.01

0.54

(0.34, 0.85)

0.01

   ANDX Xclaim

61

2.1

40

3.0

115

2.7

0.73

(0.47, 1.14)

0.17

0.70

(0.42, 1.15)

0.16

   CareOffice

85

2.9

30

2.2

103

2.4

1.36

(0.84, 2.18)

0.21

1.32

(0.76, 2.27)

0.32

   Médifiche

75

2.6

28

2.1

101

2.4

1.28

(0.81, 2.02)

0.29

1.24

(0.77, 1.98)

0.38

   Toubib

52

1.8

43

3.2

95

2.2

0.58

(0.32, 1.05)

0.07

0.53

(0.29, 0.97)

0.04

   FMP

57

2.0

16

1.2

73

1.7

1.71

(0.92, 3.19)

0.09

1.74

(0.90, 3.34)

0.10

   Médicalc Inc.3

49

1.7

19

1.4

68

1.6

1.23

(0.61, 2.47)

0.57

1.27

(0.62, 2.62)

0.51

   Param

47

1.6

18

1.3

65

1.5

1.24

(0.67, 2.29)

0.49

1.19

(0.66, 2.17)

0.56

   ACL Systèmes Santé

43

1.5

20

1.5

63

1.5

1.03

(0.58, 1.84)

0.92

1.06

(0.56, 2.02)

0.85

   Factura-Med

43

1.5

17

1.3

60

1.4

1.20

(0.79, 1.84)

0.39

1.24

(0.81, 1.89)

0.32

   FmedX MED-Office

39

1.3

18

1.3

57

1.3

1.04

(0.48, 2.25)

0.92

0.99

(0.46, 2.13)

0.98

   Sys-Thèmes

24

0.8

9

0.7

33

0.8

1.27

(0.54, 3.00)

0.59

1.24

(0.55, 2.77)

0.61

   Gestimed

12

0.4

14

1.0

26

0.6

0.41

(0.21, 0.81)

0.01

0.45

(0.25, 0.84)

0.01

   Salus

10

0.3

10

0.7

20

0.5

0.48

(0.18, 1.32)

0.16

0.45

(0.14, 1.44)

0.18

   Logimedic

7

0.2

8

0.6

15

0.4

0.41

(0.16, 1.05)

0.06

0.39

(0.15, 1.03)

0.06

   Medi-Go

2

0.1

6

0.5

8

0.2

0.16

(0.02, 1.68)

0.13

0.15

(0.01, 1.72)

0.13

   Services de facturations médicales informatiques 3

4

0.1

3

0.2

7

0.2

0.63

(0.40, 1.01)

0.06

0.65

(0.37, 1.16)

0.14

   Other4

13

0.4

3

0.2

16

0.4

2.12

(0.71, 6.29)

0.18

1.94

(0.71, 5.28)

0.19

   Unknown

15

0.5

17

1.3

32

0.8

0.41

(0.20,0.86)

0.02

0.48

(0.24, 0.93)

0.03

   RAMQ (i.e., paper billing)2

42

1.4

17

1.2

59

1.4

1.18

(0.55, 2.57)

0.67

1.39

(0.63, 3.07)

0.41

 

Mean

SD

Mean

SD

Mean

SD

      

Annual billing volume (per 1,000 claims)5

4,913

2,623

4,913

2,646

4,913

2,630

1.00

(0.97, 1.03)

0.94

1.00

(0.97, 1.04)

0.91

Percent of visits with a missing or unspecified diagnostic code5

2.5

5.7

2.5

5.1

2.5

5.5

1.00

(0.99, 1.02)

0.91

1.01

(0.99, 1.02)

0.34

No distinct diagnostic codes used (per 100 codes)5

228

88

227

97

228

91

1.01

(0.94, 1.10)

0.76

1.02

(0.92, 1.12)

0.75

  1. 1 Multivariate analysis adjusted for all billing practices in Table 4 and all physician characteristics in Table 1.
  2. 2 RAMQ: Régie de l'assurance maladie du Québec (provincial health agency). Few physicians submit paper billing slips (as opposed to using electronic billing software) to the provincial health agency for fee-for-service reimbursement; if they do, they are imposed a $0.50 penalty on every paper bill submitted, and a data entry clerk at the provincial health agency must enter the diagnostic code from the paper billing slip into the RAMQ's computerized billing database (this additional step is a potential source of transcription error).
  3. 3 Software developed and used solely by their namesake off-site billing company.
  4. 4 Single-user billing software developed by individual physicians.
  5. 5 In the study year when the visit took place. The study spanned 2 years: October 1, 2005 to September 30, 2006, and October 1, 2006 to September 30, 2007.
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BMC Public Health

ISSN: 1471-2458

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