KEYWORDS:
Billing Data, Data Quality
BACKGROUND:
Several Utah Statewide Immunization Information System (USIIS) member health care providers have estimated that only 75-80% of immunizations administered are submitted for payment through their billing systems. They feel this is due to administrative error and oversight. An error rate this high can lead to a significant loss of income for those providers.
OBJECTIVE(S):
USIIS staff decided to study this further to determine if the estimate was accurate. If it is accurate, it would strengthen the business case for providers to participate in USIIS. Health care providers could benefit financially by adopting USIIS as their immunization tracking system and periodically comparing their billing and USIIS immunization data for immunizations administered but not billed.
METHOD(S):
Research of USIIS records indicated three providers that were utilizing USIIS on a regular basis and also using three different billing systems, respectively. It was decided to use data from these three providers and their billing systems for the study. In doing the comparison of the data we had to determine the quality of the data received through the billing systems.
RESULT(S):
Our initial findings are that the billing data is accurate but 20-25% incomplete. These results are also confirmed through chart audits.
CONCLUSIONS(S):
1. Billing data can be a good resource for historical data, it is accurate but it is incomplete.
2. Providing a comparison report of clinical immunizations data and billing immunization data can be a solid monetary motivator for providers to enroll.
LEARNING OBJECTIVES:
Show the value of billing data for enrollment and historical data.
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