Accurate Evaluation and Management (E&M) billing and coding is an essential skill for medical clinicians. Consequences of incorrect E&M billing and coding include delayed patient treatment, delayed reimbursements from third party payers, and even charges of insurance fraud. The accuracy of billing and coding is especially salient in practices whose patient population is covered primarily by Medicare/Medicaid, as is the case in many Northeast Tennessee clinics. Despite the importance of accurate E&M billing and coding, recently graduated physicians moving into their first year of residency are often under-informed regarding proper billing and coding. Much of their knowledge about the process is picked up piecemeal over the course of their residency. The purpose of this study is to educate incoming post-graduate year one (PGY1) medical residents on the E&M billing and coding system for a rural Family Medicine clinic. During their first month as PGY1 resident physicians, participants were given a survey to assess their knowledge of E&M billing and coding for outpatient encounters. Participants then attended an educational session on this topic and received handouts that they could reference in the future. The participants were then surveyed again. Data analysis is currently underway. A repeated measure t-test will be utilized to determine if the educational session and informational handouts led to a statistically significant increase in PGY1 resident knowledge of E&M billing and coding. It is expected that participants will show significant knowledge gains as a result of the educational training. This research has important implications for medical resident training, particularly in rural practices that treat large populations covered by Medicare/Medicaid.

Clean water has become a scarce and pricey commodity. Companies, governments and the public are realising more and more the importance of efficient and effective water use and the conservation of South Africa’s natural water resources. Governments are implementing conservation and usage laws while companies are trying to get as much use out of their water while staying within the law. This dissertation focusses on the potable water measuring and billing practices taking place on the SASOL 1 site. A field study, interviews and questionnaires were used to gather the relevant data which was subsequently compiled into a Stakeholder Requirement Statement. The latter is a description of the ideal system that would meet all the requirements for measuring potable water and billing customers on the SASOL 1 site. / MIng (Development and Management Engineering), North-West University, Potchefstroom Campus, 2014

Clean water has become a scarce and pricey commodity. Companies, governments and the public are realising more and more the importance of efficient and effective water use and the conservation of South Africa’s natural water resources. Governments are implementing conservation and usage laws while companies are trying to get as much use out of their water while staying within the law. This dissertation focusses on the potable water measuring and billing practices taking place on the SASOL 1 site. A field study, interviews and questionnaires were used to gather the relevant data which was subsequently compiled into a Stakeholder Requirement Statement. The latter is a description of the ideal system that would meet all the requirements for measuring potable water and billing customers on the SASOL 1 site. / MIng (Development and Management Engineering), North-West University, Potchefstroom Campus, 2014

As instituições hospitalares que prestam serviços às operadoras de planos de saúde investem na auditoria de contas visando à adequada remuneração do atendimento prestado. No momento da pré-análise das contas a equipe de auditoria realiza correções para fundamentar a cobrança dos procedimentos, evitar glosas e perdas de faturamento. Nesta perspectiva esta pesquisa objetivou verificar os itens componentes das contas dos pacientes internados, conferidos por enfermeiras, que mais receberam ajustes no momento da pré-análise; identificar o impacto dos ajustes no faturamento das contas analisadas pela equipe de auditoria (médicos e enfermeiras) do hospital após a pré-analise; calcular o faturamento que esta equipe consegue ajustar nas contas e identificar as glosas relacionadas aos itens por ela conferidos. Tratou-se de uma pesquisa exploratória, descritiva, retrospectiva, de abordagem quantitativa na modalidade de estudo de caso, desenvolvida no Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram estudadas 2.613 contas pré-analisadas pela equipe de auditoria do InCor no período de janeiro a dezembro de 2011. O faturamento concentrou-se em 04 (62,9%) das 34 operadoras de planos de saúde credenciadas. Houve predominância da operadora A (27,6%), porém o maior valor médio obtido por conta referiu-se a operadora D com R$ 19.187,50. Os itens mais incluídos nas contas pelas enfermeiras foram gases (90,5%); materiais de internação (85%) e serviço de enfermagem (83,2%). Materiais de Hemodinâmica com média de R$ 1.055,90 (DP± 3.953,45); gases com média de R$ 707, 91 (DP± 843,95) e equipamentos com média de R$ 689, 42 (DP± 1145,20) constituíram os itens de maior impacto financeiro nesses ajustes. Os itens mais excluídos das contas referiram-se a medicamentos de internação (41,2%); equipamentos (28%) e serviços de enfermagem (17%). Em relação aos ajustes negativos os itens que tiveram maior impacto financeiro foram os materiais de Hemodinâmica com média de R$ 3.860,15 (DP± 15.220,80); medicamentos utilizados na Hemodinâmica com média de R$ 1.983,04 (DP± 8.324,42) e gases com média de R$ 1.048,51 (DP± 3.025,53). As enfermeiras incluíram R$ 1.877.168,64 e excluíram R$ 1.155.351,36 e os médicos incluíram R$ 563.927,46 e excluíram R$ 657.190,19. Caso não fosse realizada a pré-análise, haveria a perda de R$ 628.554,55 no faturamento. Dentre as contas analisadas 91,42% receberam ajustes, sendo 57,59% positivos, com média de R$ 1.340,75 (DP±2.502,93) e 33,83% negativos, com média de R$ 1.571,58 (DP± 5.990,51). O total de glosas dos itens analisados por enfermeiras ou por médicos, bem como em itens examinados por ambos, correspondeu em média a R$ 380,51 (DP±1.533,05). As glosas referentes aos itens conferidos por médicos perfizeram um total médio de R$ 311,94 (DP±646,86) e as glosas referentes aos itens conferidos por enfermeiras de R$ 255,84 (DP± 1.636,76). O excesso de ajustes evidenciou a deficiência e a falta de uniformidade dos registros da equipe de saúde. Considera-se que esta pesquisa representa a possibilidade de avanço no conhecimento acerca da auditoria de contas hospitalares à medida que investigou o processo de pré-análise realizado por enfermeiras e médicos auditores / Hospitals that provide services to health plan companies invest in the audit of accounts aiming to provide adequate remuneration of their service. The pre-analysis of accounts is when the audit team makes corrections to determine the foundations for billing the procedures, and to avoid disallowances and revenue losses. From that perspective, the objective of the present study was to identify the patient bill items that were most corrected after being submitted to pre-analysis; identify the impact of those corrections on the revenue of accounts that were analyzed by the hospitals audit team (physicians and nurses) after the pre-analysis; calculate the revenue that the referred team is able to correct, and identify the disallowances related to the items they checked. This exploratory, descriptive, retrospective case study was performed at the Heart Institute (InCor) of the University of São Paulo School of Medicine Clinics Hospital (HCFMUSP) using a quantitative approach. The study included a total of 2,613 accounts that had been pre-analyzed by the InCor audit team in the period spanning January to December of 2011. The revenue was concentrated in four (62.9%) of the 34 credited health plan companies. There was predominance by company A (27.6%), but the highest mean value per account was obtained by company D, with R$ 19,187.50. The items most often included in the accounts by the nurses were gauzes (90.5%); hospitalization materials (85%) and nursing care (83.2%). Hemodynamics materials, with a mean R$ 1,055.90 (SD± 3,953.45); gauzes, with a mean R$ 707.91 (SD± 843.95), and equipment, with a mean R$ 689.42 (SD± 1145.20) were the items with the strongest financial impact on the corrections. The items most often excluded from the accounts referred to hospitalization medications (41.2%); equipment (28%) and nursing care (17%). Regarding the negative changes, the items with the strongest financial impact were Hemodynamics materials, with a mean R$ 3,860.15 (SD± 15,220.80); medications used in Hemodynamics, with a mean R$ 1,983.04 (SD± 8,324.42), and gauzes, with a mean R$ 1,048.51 (SD± 3,025.53). Nurses included a total of R$ 1,877,168.64, and excluded R$ 1,155,351.36, while physicians included R$ 563,927.46 and excluded R$ 657,190.19. If the pre-analysis had not been performed, there would have been a revenue loss of R$ 628,554.55. Of all the accounts submitted to analysis, 91.42% were corrected, of which 57.59% were positive, with a mean R$ 1,340.75 (SD±2,502.93) and 33.83% were negative, with a mean R$ 1,571.58 (SD± 5,990.51). Regarding disallowances, the final sum considering the items analyzed by nurses, physicians or both corresponded to a mean R$ 380.51 (SD±1,533.05). The disallowances referring to the items analyzed by physicians added up to a mean total of R$ 311.94 (SD±646.86), and those referring to the items analyzed by nurses to R$ 255.84 (SD± 1,636.76). The excessive number of corrections showed the lack of uniformity in the records made by the health team. This study represents a possibility of knowledge advancement regarding the audit of hospital accounts as it investigated the pre-analysis process performed by nurses and physicians

Failure to collect reimbursement because of changing regulations negatively impacts hospital profitability. A multiple case study approach was used to explore the successful strategies billing managers employed to collect reimbursement for all legitimate Medicare claims. The target population for this study included 5 hospital billing managers from 3 organizations in the Northern New Jersey region. The complexity theory was used as a framework for assessing changing Medicare regulations and how the managers adapted to them. The data collection process for this study involved gathering data from participant interviews, documentation from the organizations of the participants, and government documented regulations and manuals. The logical and sequential order of data analysis for this study embraced Yin's 5-steps data analysis that includes compiling data, disassembling data, reassembling data, interpreting the data, and concluding. The successful strategies billing managers used that emerged as themes were remaining up to date with Medicare changing compliance regulations; enhancing communication with staff, multiple departments, and Medicare; and adopting a robust billing system and other systems that compliment billing. The implications of this study for social change include the potential to ensure access to patient care for benefiting families and communities through the sharing of successful strategies for Medicare claims.

Pervasive digitization of human environment has dramatically changed our everyday lives. New technologies which have become an integral part of our daily routine have deeply affected our perception of the surrounding world and have opened qualitatively new opportunities. In an urban environment, the influence of such changes is especially tangible and acute. For example, ubiquitous computing (also commonly referred to as UbiComp) is a pure vision no more and has transformed the digital world dramatically. Pervasive use of smartphones, integration of processing power into various artefacts as well as the overall miniaturization of computing devices can already be witnessed on a daily basis even by laypersons. In particular, transport being an integral part of any urban ecosystem have been affected by these changes. Consequently, public transport systems have undergone transformation as well and are currently dynamically evolving. In many cities around the world, the concept of the so-called electronic ticketing (e-ticketing) is being extensively used for issuing travel permissions which may eventually result in conventional paper-based tickets being completely phased out already in the nearest future. Opal Card in Sydney, Oyster Card in London, Touch & Travel in Germany and many more are all the examples of how well the e-ticketing has been accepted both by customers and public transport companies. Despite numerous benefits provided by such e-ticketing systems for public transport, serious privacy concern arise. The main reason lies in the fact that using these systems may imply the dramatic multiplication of digital traces left by individuals, also beyond the transport scope. Unfortunately, there has been little effort so far to explicitly tackle this issue. There is still not enough motivation and public pressure imposed on industry to invest into privacy. In academia, the majority of solutions targeted at this problem quite often limit the real-world pertinence of the resultant privacy-preserving concepts due to the fact that inherent advantages of e-ticketing systems for public transport cannot be fully leveraged. This thesis is aimed at solving the aforementioned problem by providing a privacy-preserving framework which can be used for developing e-ticketing systems for public transport with privacy protection integrated from the outset. At the same time, the advantages of e-ticketing such as fine-grained billing, flexible pricing schemes, and transparent use (which are often the main drivers for public to roll out such systems) can be retained.

As instituições hospitalares que prestam serviços às operadoras de planos de saúde investem na auditoria de contas visando à adequada remuneração do atendimento prestado. No momento da pré-análise das contas a equipe de auditoria realiza correções para fundamentar a cobrança dos procedimentos, evitar glosas e perdas de faturamento. Nesta perspectiva esta pesquisa objetivou verificar os itens componentes das contas dos pacientes internados, conferidos por enfermeiras, que mais receberam ajustes no momento da pré-análise; identificar o impacto dos ajustes no faturamento das contas analisadas pela equipe de auditoria (médicos e enfermeiras) do hospital após a pré-analise; calcular o faturamento que esta equipe consegue ajustar nas contas e identificar as glosas relacionadas aos itens por ela conferidos. Tratou-se de uma pesquisa exploratória, descritiva, retrospectiva, de abordagem quantitativa na modalidade de estudo de caso, desenvolvida no Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram estudadas 2.613 contas pré-analisadas pela equipe de auditoria do InCor no período de janeiro a dezembro de 2011. O faturamento concentrou-se em 04 (62,9%) das 34 operadoras de planos de saúde credenciadas. Houve predominância da operadora A (27,6%), porém o maior valor médio obtido por conta referiu-se a operadora D com R$ 19.187,50. Os itens mais incluídos nas contas pelas enfermeiras foram gases (90,5%); materiais de internação (85%) e serviço de enfermagem (83,2%). Materiais de Hemodinâmica com média de R$ 1.055,90 (DP± 3.953,45); gases com média de R$ 707, 91 (DP± 843,95) e equipamentos com média de R$ 689, 42 (DP± 1145,20) constituíram os itens de maior impacto financeiro nesses ajustes. Os itens mais excluídos das contas referiram-se a medicamentos de internação (41,2%); equipamentos (28%) e serviços de enfermagem (17%). Em relação aos ajustes negativos os itens que tiveram maior impacto financeiro foram os materiais de Hemodinâmica com média de R$ 3.860,15 (DP± 15.220,80); medicamentos utilizados na Hemodinâmica com média de R$ 1.983,04 (DP± 8.324,42) e gases com média de R$ 1.048,51 (DP± 3.025,53). As enfermeiras incluíram R$ 1.877.168,64 e excluíram R$ 1.155.351,36 e os médicos incluíram R$ 563.927,46 e excluíram R$ 657.190,19. Caso não fosse realizada a pré-análise, haveria a perda de R$ 628.554,55 no faturamento. Dentre as contas analisadas 91,42% receberam ajustes, sendo 57,59% positivos, com média de R$ 1.340,75 (DP±2.502,93) e 33,83% negativos, com média de R$ 1.571,58 (DP± 5.990,51). O total de glosas dos itens analisados por enfermeiras ou por médicos, bem como em itens examinados por ambos, correspondeu em média a R$ 380,51 (DP±1.533,05). As glosas referentes aos itens conferidos por médicos perfizeram um total médio de R$ 311,94 (DP±646,86) e as glosas referentes aos itens conferidos por enfermeiras de R$ 255,84 (DP± 1.636,76). O excesso de ajustes evidenciou a deficiência e a falta de uniformidade dos registros da equipe de saúde. Considera-se que esta pesquisa representa a possibilidade de avanço no conhecimento acerca da auditoria de contas hospitalares à medida que investigou o processo de pré-análise realizado por enfermeiras e médicos auditores / Hospitals that provide services to health plan companies invest in the audit of accounts aiming to provide adequate remuneration of their service. The pre-analysis of accounts is when the audit team makes corrections to determine the foundations for billing the procedures, and to avoid disallowances and revenue losses. From that perspective, the objective of the present study was to identify the patient bill items that were most corrected after being submitted to pre-analysis; identify the impact of those corrections on the revenue of accounts that were analyzed by the hospitals audit team (physicians and nurses) after the pre-analysis; calculate the revenue that the referred team is able to correct, and identify the disallowances related to the items they checked. This exploratory, descriptive, retrospective case study was performed at the Heart Institute (InCor) of the University of São Paulo School of Medicine Clinics Hospital (HCFMUSP) using a quantitative approach. The study included a total of 2,613 accounts that had been pre-analyzed by the InCor audit team in the period spanning January to December of 2011. The revenue was concentrated in four (62.9%) of the 34 credited health plan companies. There was predominance by company A (27.6%), but the highest mean value per account was obtained by company D, with R$ 19,187.50. The items most often included in the accounts by the nurses were gauzes (90.5%); hospitalization materials (85%) and nursing care (83.2%). Hemodynamics materials, with a mean R$ 1,055.90 (SD± 3,953.45); gauzes, with a mean R$ 707.91 (SD± 843.95), and equipment, with a mean R$ 689.42 (SD± 1145.20) were the items with the strongest financial impact on the corrections. The items most often excluded from the accounts referred to hospitalization medications (41.2%); equipment (28%) and nursing care (17%). Regarding the negative changes, the items with the strongest financial impact were Hemodynamics materials, with a mean R$ 3,860.15 (SD± 15,220.80); medications used in Hemodynamics, with a mean R$ 1,983.04 (SD± 8,324.42), and gauzes, with a mean R$ 1,048.51 (SD± 3,025.53). Nurses included a total of R$ 1,877,168.64, and excluded R$ 1,155,351.36, while physicians included R$ 563,927.46 and excluded R$ 657,190.19. If the pre-analysis had not been performed, there would have been a revenue loss of R$ 628,554.55. Of all the accounts submitted to analysis, 91.42% were corrected, of which 57.59% were positive, with a mean R$ 1,340.75 (SD±2,502.93) and 33.83% were negative, with a mean R$ 1,571.58 (SD± 5,990.51). Regarding disallowances, the final sum considering the items analyzed by nurses, physicians or both corresponded to a mean R$ 380.51 (SD±1,533.05). The disallowances referring to the items analyzed by physicians added up to a mean total of R$ 311.94 (SD±646.86), and those referring to the items analyzed by nurses to R$ 255.84 (SD± 1,636.76). The excessive number of corrections showed the lack of uniformity in the records made by the health team. This study represents a possibility of knowledge advancement regarding the audit of hospital accounts as it investigated the pre-analysis process performed by nurses and physicians

Changing the architecture of the Ericsson Billing Gateway application has shown to solve the problem with dynamic memory management that decreased the performance. The new architecture that is focused on processes instead of threads showed increased performance. It also allowed for the possibility to adjust the process / thread configuration towards the network topology and hardware. Measurements of different configurations showed the importance of an accurate configuration and also that certain guidelines could be established based on the results. / Genom att ändra architecturen på Billing Gateway löste man på Ericsson problemet med "Dynamisk minneshantering". Den nya architecturen som fokuserar på processer istället för trådar visade ökad prestanda. Den nya architecturen tillät också vissa konfigurationsmöjligheter gentemot nätverkstopologi och hårdvara. Mätningar på olika konfigurationer visade vikten av rätt konfiguration och också att vissa riktlinjer kunde utrönas från resultaten. / Phone#: +46 457 66582

[pt] Este trabalho apresenta um modelo de tarifação dinâmica cujo objetivo é determinar qual o preço que deve ser cobrado por uma chamada telefônica, originada em uma estação móvel, de forma a maximizar a receita da empresa operadora do serviço móvel celular, garantindo os valores máximos aceitáveis para a probabilidade de bloqueio de uma chamada e para a probabilidade de queda de ligações devido ao handoff. / [en] This work presents a dynamic pricing model whose objective is to determinate the price that should be charged for a telephone call originated in a mobile phone in order to maximize the telephone enterprise revenue as long as it guarantees the maximum acceptable values for the probability of blocking of originating calls and for calls that are requesting a handoff. / [es] Este trabajo presenta un modelo de tarifación dinámica cuyo objetivo es determinar cuál es el precio que deve ser cobrado por una llamada telefónica, originada en una estación móvil, de tal forma que maximize la receta de la empresa operadora del servicio móvil celular, garantizando los valores máximos aceptables para la probabilidad de bloqueo de una llamada y para la probabilidad de caída de conexión debido al handoff.

Incorrect and inaccurate municipal billing system poses a challenge in the local government system in South Africa. The communities in the various municipalities were dissatisfied with the incorrect and inaccurate municipal bills that were being issued. Consequently public confidence in terms of the billing system dwindled, communities were unwilling to pay for the bills issued and as such debt accumulated and the municipalities could not recover the debt. The research question, therefore, is that the municipal bills sent to customers were incorrect or inaccurate and revenue was lost. Public confidence with regard to municipal billings system declined and communities were unwilling to pay for the incorrect or inaccurate bills issued. Debts accumulated and seemingly the municipal billing system had an impact on revenue collection in selected South African cities. There is currently no scientific research which has been conducted at academic level to determine the core problem as reported in newspapers, public domain and municipal areas to share the information nationally and internationally regarding the state of municipal billing system, debt and revenue management challenges. The research suggests that in order to improve the efficiency of the collection of service charges, the billing and collection systems must be decentralised, accessible to the consumer, matched with the income cycle and paying capacity of the consumer. The study covers an analysis of the municipal billing system and revenue collection in the City of Johannesburg Metropolitan Municipality, Nelson Mandela Bay Metropolitan Municipality and Ekurhuleni Metropolitan Municipality and suggests measures for financial sustainability in the three cities. The study used both the qualitative case study and the quantitative approach to effectively collect and analyse the data needed. The research problem which informs this study is incorrect, inaccurate municipal bills sent to customers and lost revenue. The result of incorrect and inaccurate bills was that public confidence declined and communities protested to pay for the incorrect, inaccurate bills issued and thus debt accumulated. In examining this problem, the research begins with a description of the context of empirical analysis, of the local government system, municipal billing system and revenue collection in South Africa. The study analysed profound issues regarding local governance systems namely: legislation, policies, procedures, public administration and its environmental factors, spheres of government, financial administration and standards, intergovernmental relations functions, municipal structure and functions, elements of municipal billing systems, sources of revenue, municipal billing systems challenges in the three metropolitan municipalities, debts accumulation and deficiency in municipal billing systems and information technology. The study recommends the need for a sound municipal billing and collection system essentially regarding the taxes levied and collected by these metropolitan municipalities. A sound municipal billing system should be configured with a short turnaround strategy to serve demand notices and the collection of dues from individual customers, thereby enabling efficient cash recycling. An efficient billing system is essential for taxes levied by municipalities and their collection from consumers. The study also provides an opportunity for further academic research in the field of municipal billing systems and revenue collection. Hopefully, this study will become a catalyst for future research, policy alternatives and planning for local government and academic institutions nationally and internationally regarding the municipal billing system and revenue collection fields. / Dissertation (MAdmin)--University of Pretoria, 2014. / gm2014 / School of Public Management and Administration / unrestricted