{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:40:58Z","timestamp":1747183258579,"version":"3.40.5"},"reference-count":18,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Medical billing practices have received increasing scrutiny in Australia and worldwide. In 2015, the Australian Government initiated a comprehensive review of the Medicare Benefits Schedule (MBS), including spinal surgery. This study provides a snapshot of five spinal surgeon billing patterns and associated costs in the workers compensation system in New South Wales prior to these changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study used workers compensation billing data from the State Insurance Regulatory Authority to capture elective spinal surgeries in New South Wales from 2010 to 2018. The main outcome measures were: proportion of items billed within recommended limits (up to 150% of the listed Australian Medical Association (AMA) fee); surgical billing patterns including repeat billing of items during a single episode of surgery; use of paediatric or scoliosis items; use of surgical items from outside the spinal surgery schedule; co\u2010billing of items not permitted as per the AMA Fees List item descriptions and associated costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 12\u2009622 spinal surgeries in 9520 patients. While only 2.2% of items were billed above the recommended limits, 38% of surgeries included at least one of the five billing patterns. The average cost increase was AU$4700 per surgery, 47% greater than surgeries which did not include the specified billing patterns, for a total additional cost of AU$22.9\u2009M over the 9\u2010year study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Five spinal surgery billing patterns accounted for an additional AU$22.9 million in direct surgical costs from 2010 to 2018.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.18647","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T08:46:44Z","timestamp":1691398004000},"page":"2106-2111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Audit of surgeon billing in workers compensation\u2010insured elective spinal surgery in New South Wales, Australia from 2010 to 2018"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6258-3692","authenticated-orcid":false,"given":"Adriane M.","family":"Lewin","sequence":"first","affiliation":[{"name":"South West Clinical Campuses, Discipline of Surgery, Faculty of Medicine and Health UNSW Sydney  Sydney New South Wales Australia"},{"name":"Whitlam Orthopaedic Research Centre Ingham Institute for Applied Medical Research  Liverpool New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine M.","family":"Naylor","sequence":"additional","affiliation":[{"name":"South West Clinical Campuses, Discipline of Surgery, Faculty of Medicine and Health UNSW Sydney  Sydney New South Wales Australia"},{"name":"Whitlam Orthopaedic Research Centre Ingham Institute for Applied Medical Research  Liverpool New South Wales Australia"},{"name":"South Western Sydney Local Health District Liverpool Hospital  Liverpool New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Sheridan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Liverpool Hospital  Liverpool New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian A.","family":"Harris","sequence":"additional","affiliation":[{"name":"South West Clinical Campuses, Discipline of Surgery, Faculty of Medicine and Health UNSW Sydney  Sydney New South Wales Australia"},{"name":"Whitlam Orthopaedic Research Centre Ingham Institute for Applied Medical Research  Liverpool New South Wales Australia"},{"name":"South Western Sydney Local Health District Liverpool Hospital  Liverpool New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)30947-3"},{"key":"e_1_2_8_3_1","unstructured":"CollinsR.Using technology to prevent and detect billing and claims fraud. Private Health Insurance Claims Leakage and Fraud Forum 2010. Sydney Australia 2010."},{"key":"e_1_2_8_4_1","first-page":"691","article-title":"Measurement issues in evaluating physicians' practice patterns using hospital billing and surgeon's self\u2010report data","volume":"57","author":"Eward AM","year":"1991","journal-title":"Am. Surg."},{"key":"e_1_2_8_5_1","unstructured":"Australian Government.How to comply with your Medicare obligations 2021. [Cited 2 Sep 2022.] Available from URL:https:\/\/www.health.gov.au\/health-topics\/medicare-compliance\/how-to-comply-with-your-medicare-obligations."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0262211"},{"key":"e_1_2_8_7_1","unstructured":"Australian Government.MBS Online Medicare Benefits Schedule 2022[Cited 2 Sep 2022.] Available from URL:http:\/\/www.mbsonline.gov.au\/internet\/mbsonline\/publishing.nsf\/Content\/Home."},{"key":"e_1_2_8_8_1","unstructured":"Australian Government.Medicare Benefits Schedule (MBS) Review Australian Government;2021[Cited 2 Sep 2022.] Available from URL:https:\/\/www.health.gov.au\/initiatives-and-programs\/mbs-review."},{"volume-title":"Taskforce Findings Spinal Surgery Clinical Committee Report","year":"2018","author":"Australian Government","key":"e_1_2_8_9_1"},{"key":"e_1_2_8_10_1","unstructured":"DonnelyC.Workers Compensation (Surgeon Fees) Order 2019 under the Workers Compensation Act 1987. NSW Government Gazette: Government of New South Wales 2018."},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06900-8"},{"key":"e_1_2_8_12_1","unstructured":"State Insurance Regulatory Authority of New South Wales.Annual Report 2021\u20102022. Sydney Australia."},{"volume-title":"What Is the MBS and Medicare?","year":"2016","author":"Australian Government","key":"e_1_2_8_13_1"},{"volume-title":"Changes to MBS Items for Spinal Surgery Services","year":"2018","author":"Australian Government","key":"e_1_2_8_14_1"},{"volume-title":"Compliance and Performance Review of the Workers Compensation Nominal Insurer Scheme","year":"2019","author":"State Insurance Regulatory Authority of New South Wales","key":"e_1_2_8_15_1"},{"key":"e_1_2_8_16_1","unstructured":"Australian Medical Association.List of Medical Services and Fees2018."},{"volume-title":"Saving Private Health 1: Reining in Hospital Costs and Specialist Bills. Grattan Institute Report","author":"Duckett S","key":"e_1_2_8_17_1"},{"volume-title":"Some Doctors Still Billing Medicare for the Most Complicated, Expensive Office Visits","year":"2017","author":"Ornstein C","key":"e_1_2_8_18_1"},{"key":"e_1_2_8_19_1","first-page":"741","article-title":"High\u2010billing general practitioners and family physicians in Ontario: how do they do it? An analysis of practice patterns of GP\/FPs with annual billings over $400,000","volume":"158","author":"Chan B","year":"1998","journal-title":"CMAJ"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.18647","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T05:08:53Z","timestamp":1694754533000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.18647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,7]]},"references-count":18,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/ans.18647"],"URL":"https:\/\/doi.org\/10.1111\/ans.18647","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"type":"print","value":"1445-1433"},{"type":"electronic","value":"1445-2197"}],"subject":[],"published":{"date-parts":[[2023,8,7]]},"assertion":[{"value":"2023-03-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}