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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.