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Janz TA, Khan NS, Dhanda AK, Takashima M, Wu AW, Tang DM, Higgins TS, Ramanathan M, Ahmed OG. Multi-Institutional Analysis of Insurance Denial Patterns Within Rhinology. Am J Rhinol Allergy 2024; 38:218-222. [PMID: 38544439 DOI: 10.1177/19458924241242856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue. OBJECTIVE Examine the trends in insurance denials for rhinological procedures. METHODS A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials. RESULTS A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid. CONCLUSION Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.
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Affiliation(s)
- Tyler A Janz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Najm S Khan
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist, Houston, TX, USA
| | - Aatin K Dhanda
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist, Houston, TX, USA
| | - Masayoshi Takashima
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist, Houston, TX, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Thomas S Higgins
- Kentuckiana ENT, A Division of ENT Care Centers, Louisville, KY, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Omar G Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist, Houston, TX, USA
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Garcia GJM, Catalano D, Shum A, Larkee CE, Rhee JS. Estimation of Nasal Airway Cross-sectional Area From Endoscopy Using Depth Maps: A Proof-of-Concept Study. Otolaryngol Head Neck Surg 2024; 170:1581-1589. [PMID: 38329226 DOI: 10.1002/ohn.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/07/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Endoscopy is routinely used to diagnose obstructive airway diseases. Currently, endoscopy is only a visualization technique and does not allow quantification of airspace cross-sectional areas (CSAs). This pilot study tested the hypothesis that CSAs can be accurately estimated from depth maps created from virtual endoscopy videos. STUDY DESIGN Cross-sectional. SETTING Academic tertiary medical center. METHODS Virtual endoscopy and depth map videos of the nasal cavity were digitally created based on anatomically accurate three-dimensional (3D) models built from computed tomography scans of 30 subjects. A software tool was developed to outline the airway perimeter and estimate the airspace CSA from the depth maps. Two otolaryngologists used the software tool to estimate the nasopharynx CSA and the nasal valve minimal CSA (mCSA) in the left and right nasal cavities. Model validation statistics were performed. RESULTS Nasopharynx CSA had a median percent error of 3.7% to 4.6% when compared to the true values measured in the 3D models. Nasal valve mCSA had a median percent error of 22.7% to 33.6% relative to the true values. Raters successfully used the software tool to identify subjects with nasal valve stenosis (ie, mCSA < 0.20 cm2) with a sensitivity of 83.3%, specificity ≥ 90.7%, and classification accuracy ≥ 90.0%. Interrater and intrarater agreements were high. CONCLUSION This study demonstrates that airway CSAs in 3D models can be accurately estimated from depth maps. The development of artificial intelligence algorithms to compute depth maps may soon allow the quantification of airspace CSAs from clinical endoscopies.
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Affiliation(s)
- Guilherme J M Garcia
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dominic Catalano
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Axel Shum
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher E Larkee
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Franzen AM, Sykora H, Hauptmann M, Coordes A. [Contemporary use of instruments during clinical examination in German ENT departments and private practices]. HNO 2022; 70:125-132. [PMID: 34402928 PMCID: PMC8813715 DOI: 10.1007/s00106-021-01096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND The classical forehead reflector as traditionally used by ear, nose, and throat (ENT) physicians for the ENT examination is now iconic for doctors in general. It is unknown which instruments are currently used in Germany to clinically examine ENT patients. Therefore, this study aims to present results of a survey about commonly used instruments. MATERIALS AND METHODS An evaluation of 321 questionnaires from ENT doctors working in general and university hospitals (172) and in private practices (149) was performed. RESULTS The ENT mirror examination is nowadays carried out with a self-illuminating headlamp with battery and/or light guide cable. Approximately 20% of respondents also use a forehead mirror. The microscope is used by 90% of doctors to examine the ears; a rigid endoscope was used in 53.3% to examine the larynx, epipharynx (41.1%), and the nose/sinuses (34.6%). Flexible endoscopes and otoscopes are used only rarely. CONCLUSION The self-illuminating headlamp, which is more often wireless in eastern Germany, has largely replaced the classical forehead reflector, with which doctors younger than 40 years were no longer trained. At least some organs are also examined very regularly with the microscope or rigid endoscope. The flexible endoscope and otoscope are used much less frequently overall, mainly by younger physicians and ENT doctors working in hospitals. The diagnostic potential of flexible endoscopy may be compromised by the outpatient remuneration structures in Germany.
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Affiliation(s)
- Achim M Franzen
- Campus Ruppiner Kliniken, Klinik für HNO-Krankheiten und Plastische Operationen, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Hannes Sykora
- Campus Ruppiner Kliniken, Klinik für HNO-Krankheiten und Plastische Operationen, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Michael Hauptmann
- Institut für Biometrie und Registerforschung, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
- Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Brandenburgischen Technischen Universität Cottbus - Senftenberg, der Medizinischen Hochschule Brandenburg Theodor Fontane und der Universität Potsdam, Senftenberg, Deutschland
| | - Annekatrin Coordes
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member der Freien Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Torabi SJ, Patel RA, Kasle DA, Fujita K, Bhandarkar ND, Kuan EC, Manes RP. Rhinology Medicare reimbursements have not been keeping up with inflation. Int Forum Allergy Rhinol 2021; 12:714-725. [PMID: 34783462 DOI: 10.1002/alr.22912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Studies have suggested that physicians are steadily being paid less per Medicare service over time based on inflation-adjusted dollars. The objective of this study was to determine whether this phenomenon was true for rhinologic procedures. METHODS This study was a retrospective analysis of the 2000-2021 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule investigating fees for in-office endoscopies (Current Procedural Terminology [CPT] codes 31231-31238), in-office balloon ostial dilation (CPTs 31295-31298), in-facility low-relative value unit (RVU) surgeries (<10 work RVUs [wRVUs]; CPTs 31239-31288 and 61782), and in-facility high-RVU surgeries (>10 wRVUs; CPTs 31290-31294). Total number of and reimbursements for these services was obtained from yearly National Part B Summary Datafiles. RESULTS Between 2000 and 2021, adjusted reimbursements for low- and high-wRVU rhinologic surgeries decreased by 50.0% and 36.1%, respectively. The average compound annual growth rate (CAGR) decrease was 3.3% and 2.1%, respectively. Excluding a 48.3% unadjusted reimbursement increase between 2000 and 2004, endoscopies saw an adjusted reimbursement decrease of 29.4% from 2004 onward, an average CAGR of -2.1%. From 2011 onward, balloon ostial dilations saw a decrease in adjusted reimbursement of 43.8%, an average CAGR of -6.0%. Nevertheless, after inflation adjustment, National Part B data reveal that Medicare paid more, in total, for these procedures in 2019 than in 2000 due to increasing utilization. CONCLUSION Medicare reimbursements are complex, adjusted yearly, and undergo constant federal scrutiny due to the increasing costs of health care. These results suggest that, in terms of real dollars, rhinologic procedures have seen a large gradual decrease in Medicare reimbursement, which is important information for policymakers and surgeons alike.
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Affiliation(s)
- Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA.,Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Rahul A Patel
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT.,Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, CT
| | - David A Kasle
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Kevin Fujita
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Naveen D Bhandarkar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA
| | - R Peter Manes
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT
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Patel RA, Torabi SJ, Kasle DA, Narwani V, Manes RP. Billing patterns for in-office computerized tomography scans of the face/sinus by otolaryngologists. Am J Otolaryngol 2021; 42:103140. [PMID: 34175773 DOI: 10.1016/j.amjoto.2021.103140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate billing trends, Medicare reimbursement, and practice setting for Medicare-billing otolaryngologists (ORLs) performing in-office face computerized tomography (CT) scans. METHODS This retrospective study included data on Medicare-billing ORLs from Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). Number of Medicare-billing ORLs performing in-office CT scans, and total sums and medians for Medicare reimbursements, services performed, and number of patients were gathered along with geographic and practice-type distributions. RESULTS In 2018, roughly 1 in 7 Medicare-billing ORLs was performing in-office CT scans, an increase from 1 in 10 in 2012 (48.2% growth). From 2012 to 2018, there has been near-linear growth in number of in-office CT scans performed (58.2% growth), and number of Medicare fee-for-service (FFS) patients receiving an in-office CT scan (64.8% growth). However, at the median, the number of in-office CT scans performed and number of Medicare FFS patients receiving an in-office CT, per physician, has remained constant, despite a decline of 42.3% (2012: $227.67; 2018: $131.26) in median Medicare reimbursements. CONCLUSION Though sharp declines have been seen in Medicare reimbursement, a greater proportion of Medicare-billing ORLs have been performing in-office face CT scans, while median number of in-office CT scans per ORL has remained constant. Although further investigation is certainly warranted, this analysis suggests that ORLs, at least in the case of the Medicare FFS population, are utilizing in-office CT imaging for preoperative planning, pathologic diagnosis, and patient convenience, rather than increased revenue streams. Future studies should focus on observing these billing trends among private insurers.
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Di Maio P, Traverso D, Iocca O, De Virgilio A, Spriano G, Giudice M. Endoscopic nasopharyngoscopy and ENT specialist safety in the COVID 19 era: the back endoscopy approach to the patient. Eur Arch Otorhinolaryngol 2020; 277:2647-2648. [PMID: 32500327 PMCID: PMC7271825 DOI: 10.1007/s00405-020-06093-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 12/18/2022]
Abstract
Purpose To propose a way to safely perform endoscopic nasopharyngoscopy in ENT outpatient clinic during the COVID-19 pandemic. Methods This manuscript highlights the importance of endoscopy in daily ENT clinical practice, which is a pivotal procedure in the diagnosis of many head and neck pathologies. However, since the beginning of the COVID-19 outbreak, the authors have witnessed a drastic reduction (91%) in the use of endoscopic nasopharyngoscopy at their institutions. In fact, it is considered at risk of contamination for healthcare professionals, as any upper airway manipulation procedure. Results In the “Back approach to the patient” for endoscopic nasopharyngoscopy, the operator positions himself behind the patient and faces the monitor. The endoscopist, not being positioned in front of the patient, should, therefore, be less exposed to airborne transmission of SARS-CoV-2 virus. Conclusion This simple variation of the physician’s position during endoscopic nasopharyngoscopy could potentially reduce the risk of contagion since the operator is not in the trajectory of droplets and/or aerosols.
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Affiliation(s)
- Pasquale Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, Via Giovanni Borea, 56, 18038, Sanremo, IM, Italy.
| | - Daniela Traverso
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, Via Giovanni Borea, 56, 18038, Sanremo, IM, Italy
| | - Oreste Iocca
- Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Armando De Virgilio
- Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Giuseppe Spriano
- Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Marco Giudice
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, Via Giovanni Borea, 56, 18038, Sanremo, IM, Italy
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Hur K, Gibbons J, Finch BK. Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits. Otolaryngol Head Neck Surg 2020; 162:860-866. [DOI: 10.1177/0194599820913495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To analyze the spatial variation of sociodemographic factors associated with the geographic distribution of new patient visits to otolaryngologists. Study Design Retrospective cross-sectional analysis. Setting United States. Subject and Methods Medicare new patient visits pooled from 2012 to 2016 to otolaryngology providers were obtained from the Centers for Medicare and Medicaid Services, and county-level sociodemographic data were obtained from the 2012-2016 American Community Survey. The mean number of new patient visits per otolaryngology provider by county was calculated. The spatial variation was analyzed with negative binomial and geographically weighted regression. Predictors included various neighborhood characteristics. Results There were 7,199,129 Medicare new patient visits to otolaryngology providers from 2012 to 2016. A 41.7-fold difference in new patient evaluation rates was observed across US counties (range, 11-458.8 per otolaryngology provider). On multivariable regression analysis, median age, sex, work commute time, percentage insured, and the advantage index of a county were predictors for the rate of new patient visits to otolaryngology providers. However, geographically weighted regression demonstrated that the association of a county’s disadvantage index, advantage index, percentage insured, and work commute times with new patient visits per provider varied across space. Conclusions There are wide geographic differences in the number of new Medicare patients seen by otolaryngologists, and the influence of county sociodemographic factors varied regionally. Further research to analyze the variations in practice patterns of otolaryngologists is warranted to predict future public health needs.
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Affiliation(s)
- Kevin Hur
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joseph Gibbons
- Department of Sociology, San Diego State University, San Diego, California, USA
| | - Brian Karl Finch
- Center for Economic and Social Research, Department of Sociology and Spatial Sciences, University of Southern California, Los Angeles, California, USA
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Youssef SJ, Vyas KS. A Critical Analysis of Medicare Claims for Otolaryngology Procedures. Otolaryngol Head Neck Surg 2019; 161:929-938. [PMID: 31237824 DOI: 10.1177/0194599819858584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study was performed to outline and analyze the overall Medicare landscape with respect to otolaryngologists and beneficiaries, services, and reimbursements. METHODS This is a retrospective analysis of publicly available Medicare utilization and payment data for all otolaryngologists in facility and nonfacility practice settings who provided services to Medicare beneficiaries between January 1, 2012, and December 31, 2016. RESULTS In 2016, a total of $701,195,375 was distributed to 8572 otolaryngology physician providers for 815 unique Healthcare Common Procedure Coding System codes for 13,942,536 procedure claims. Of specialty care, otolaryngology ranks 20th among 54 subspecialties for total Medicare payments. The average number of services coded per provider was 1627. The average otolaryngologist was paid $81,800.67. Thirty-two percent of otolaryngologists did not receive reimbursement for services from Medicare in 2016. DISCUSSION In 2016, the most significant contributors to Medicare payments to otolaryngologists were large-scale, low-cost events that are relatively short procedures done in clinic. Utilization of nasal endoscopy was up trending from 2012 to 2016. Some of the Current Procedural Terminology codes with the greatest discrepancies between submitted charge and Medicare payment among nonfacility otolaryngology providers are more involved than simple office procedures. IMPLICATIONS FOR PRACTICE It is increasingly valuable for physicians to know factors that affect reimbursement for procedures and operations in different settings and to be aware of the trends in variation in their specialty. Otolaryngologists should communicate with policy makers in efforts toward sustainable reimbursement models.
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Affiliation(s)
| | - Krishna S Vyas
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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