Improving Newborn Professional Billing at a Community Hospital.

Area of Science:

• Healthcare Management
• Medical Billing and Coding
• Pediatric Hospital Medicine

Background:

• Newborns are a significant patient group in community hospitals with varied care requirements.
• Professional billing for newborn care is crucial for revenue, but often hampered by insufficient provider knowledge of billing codes.
• Hospital Care Current Procedural Terminology (CPT) evaluation and management (E/M) codes were underutilized for newborns needing advanced monitoring or therapy.

Purpose of the Study:

• To increase the utilization of Level 2 and 3 Hospital Care CPT E/M codes for newborns from 1% to 15% within a community hospital setting.

Main Methods:

• A process improvement project was implemented in a mother-baby unit from October 2022 to October 2023.
• Interventions included education, real-time guidance, and improved access to billing codes to address identified underuse.
• Retrospective chart review assessed the appropriateness of clinical documentation supporting code usage.

Main Results:

• The utilization of Level 2 and 3 Hospital Care CPT E/M codes rose to 17%, exceeding the target.
• This resulted in a 7% increase in work relative value units and an estimated $37,805 increase in revenue per 10,000 billing encounters.
• Appropriate documentation supported code use in 72% of reviewed charts.

Conclusions:

• Educational initiatives and improved billing tools successfully enhanced the appropriate use of newborn billing codes.
• The project optimized revenue generation in a community hospital setting through better professional billing practices for infant care.