Maureen S. Kolasa1, Janet Ellis Cherry
2, Andrew Chilkatowsky
3, David P. Reyes
1, and James P. Lutz
4. (1) National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Rd E52, Atlanta, GA, USA, (2) Division of Disease Control, Immunization Program, Philadelphia Department of Public Health, 500 S Broad St, 2nd Floor, Philadelphia, PA, USA, (3) Immunization Program, Division of Disease Control, Philadelphia Department of Public Health, 500 S. Broad St, Philadelphia, PA, USA, (4) Division of Disease Control/ Immunization Program, Philadelphia Department of Public Health, 500 South Broad Street, 2nd Floor, Philadelphia, PA, USA
BACKGROUND:
Many immunization providers rely on electronic billing systems to report information to registries. If billing data fail to capture some administered immunizations, the registry will not reflect children's true immunization status.
OBJECTIVE:
Assess differences between immunizations administered and immunizations reported to a registry from electronic billing systems in Philadelphia, Pennsylvania.
METHOD:
Philadelphia's Department of Public Health conducted chart audits for children the registry identified as missing immunizations. Chart records were compared to registry records to identify immunizations administered in these practices but not reported to the registry by electronic billing systems. Lost revenue was calculated conservatively by considering only potential reimbursement of administrative fees. Participants were 45 immunization providers serving > 50 children aged 7-35 months and using electronic billing systems to report data to Philadelphia's registry.
RESULT:
The registry identified 12,321 (60%) of 20,611 children served by the study practices that were missing recommended immunizations. Of the 256,969 immunizations administered to these 20,611 children, 62,213 (24%) were not in the registry. The electronic billing systems submitted all administered immunizations for 69% of immunization visits, some but not all for 11% of visits, and none for 20% of visits. Immunizations administered but not billed cost these providers up to $980,477 in lost revenue from administrative fees alone.
CONCLUSION:
When providers used electronic billing systems to enter data into Philadelphia's registry, the electronic billing systems did not report almost 25% of immunizations administered, resulting in incomplete registry data. Improvement of billing data quality would result in more complete registries, higher reported immunization coverage rates, and recovered revenue for immunization providers.
LEARNING OBJECTIVES:
Improvement of electronic billing data will result in improved data quality in immunization registries and recovery of revenue for providers.
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