Uniform Billing System for Forensic Exam Payments—Mississippi

Overview
Legislation was passed in July 2005 to create a uniform system of payment based on the existing Victim Compensation Program. The new system's rules and regulations require hospitals to submit a universal billing form and a completed sexual assault evidence kit form, with correct coding within a series of recommended codes.

Goals
The goal of standardized billings for forensic medical exams is to ensure that charges are submitted accurately and fairly statewide.

Making the Idea a Reality
In 1998, a committee of prosecutors, criminologists, advocates, medical professionals, and law enforcement officers convened to create a statewide evidence kit that would meet the needs of the state crime lab and provide statewide uniformity.

As the number of SANE services increased, more evidentiary exams were being billed to the counties as required by state law. The individual county boards of supervisors were incurring large bills with no source of revenue. Payment was processed differently by every county. Billed charges were generally processed without thought for accuracy or fairness. The amounts that hospitals were paid varied widely, and some hospitals received no payment.

To offset the inconsistencies, a multidisciplinary statewide SART committee reviewed and completely updated documentation forms in the evidence kit to reflect the U.S. Department of Justice's National Protocol, the International Association of Forensic Nurses' Standards of Practice, and best practices described in the medical, forensic, and criminal justice literature. The new forms were sent to all hospitals, SANE programs, and law enforcement agencies and were posted online for download.

As part of the new payment system, a SANE was hired by the Victim Compensation Program to review every evidence kit and billing form. After review, the data is sent monthly to the SANE program administrator, who provides feedback, consultation, and training to hospitals and SANEs throughout the state. The overall program data is organized and used to provide raw material for research and to pinpoint lack of resources and areas of need.

The initial evidentiary exam and medical care can be billed for amounts up to $1,000. This fee is intended to cover basic medical care, evidentiary procedures, initial sexually transmitted disease and HIV prophylaxis, and pregnancy screening and prevention. Other services are paid as medically necessary when filed under the victim compensation guidelines.

In 2006, a series of regional trainings were held for hospital billers and coders and medical staff in clinical settings.

Lessons Learned
The system is not perfect. Some hospitals are choosing to go unpaid rather than train their staff, and personnel have complained that the form is overly long and involved. The evidence collection kit committee agrees that the form is long, but notes that it includes elements essential to the care and documentation of complex cases.

The Mississippi system is off to a good start. The form is well accepted by SANEs. Physicians and nurses with no specialized forensic training have stated that the form guided their exam and documentation in a helpful way. Some hospitals are setting aside part of the billing proceeds into a SANE fund that pays for continuing education, call time, and the certification exam for their SANEs.

Currently, the billing system assigns usual and customary charges to each CPT (current procedural terminology) code. Ways to automate the system are being explored.

The expertise of a biostatistician is needed to develop a data management system for organizing information and creating data applications. The program is actively searching for grant funds for this technical innovation.

It is helpful to include many different types of professionals in the planning stage to look at billing solutions from many angles. Frontline users must be involved from the beginning. Mississippi also learned that—

• Persons involved in the planning must be at a level of authority to implement the group's decisions.
• Anything important is worth a long-term commitment to the change process.
• Money is a powerful motivation for change. All proposals should have a financial impact statement or business plan. Good intentions are not enough. The potential for profit makes a project attractive.
• It is important to keep research capability in mind when building systems of care.
• Consult with experts.

Contact Information
Mississippi Coalition against Sexual Assault
P.O. Box 4172
Jackson, MS 39296
601–948–0555