The character as a billable unit is really at the heart of any current discussion in the industry, whether its ASCII, black on white, or white and black characters.

Again: there is no billing method that cannot be manipulated, even the visible black character.

A Standard Unit of Measure for Transcribed Reports, a white paper co-authored by the American Health Information Management Association (AHIMA) and Medical Transcription Industry Alliance (MTIA) Joint Task Force on Standards Development defines billing metrics, then compares them. In reality, the only difference between the 65-character line, ASCII lines and the visible black character is the character units that are included in the metric.

The standard unit white paper asserts that the VBC is the only metric that is verifiable, definable, measurable, consistent, ethical and reconcilable. However, in my opinion this conclusion is reached by manipulation of the conclusions and findings, and exclusion of a full discussion.

The stated limitation of a 65-character line:

The inclusion of nonprinting characters and formatting instructions makes it difficult to validate the line count of individual documents.

The stated limitation of the ASCII character line:

Because spaces and tabs are included in this definition, it is not easy to count a document with the naked eye.

In concocting limitations that don't actually exist in practical application to business, and by ignoring how the VBC can also be manipulated, the Joint Task Force is able to check off all five of the MTIA Billing Method Principles. Even then, the VBC measured up equally to the ASCII character method - so a sixth principle was added, although not defined: reconciliation.

How can this method be manipulated?

The standard unit white paper doesn't address a common practice: multiple billing for one character.

For example: uppercase characters.

M = 1 character. It can also be 2 characters. It's visible. It's black.

m = 1 character. It can also be 2 characters. It's visible. It's black.

M = 1 character. It can also be 3 characters. It's visible. It's black.

Even though the VBC isn't supposed to count format codes, it could be argued that the code itself isn't being counted. In the 65-character line, the format code toggle switches are counted once each; i.e.,

m = 3 characters (1 toggle on, one for the letter m, and 1 toggle off).

For a single character, the 65-character method nets a higher character count. However, in the next example, any method counting each uppercase character as 2 characters and each bolded uppercase character as 3 nets a higher line count for the VBC.

PHYSICAL EXAMINATION =

Each character counted only once:

20 characters (ASCII)

20 characters (65-character)

19 characters (VBC)

Uppercase characters counted as 2 characters:

40 characters (ASCII)

40 characters (65 character)

38 characters (VBC)

Uppercase/bold

40 characters (ASCII)

42 characters (65 character definition counting uppercase as 2 characters and toggle on/toggle off as 1 character each)

57 characters (VBC counting uppercase/bolded characters as 3 characters each)

The white paper conclusions also ignore available technology that can detect invisible characters and either delete them or highlight them. The programming to do this would be easy to implement into any platform or can be incorporated into standalone scripting. In the highly technical environment that transcription operates in and with the volume of characters being generated, it is fallacious to promote one billing unit over another on the basis that it can be counted with the naked eye. If a facility generates 10,000 pages of text and each page averages 1500 characters, even verifying 5% would mean counting 750,000 characters with the naked eye.

As there is technology available that will count the characters, however defined, there is technology available that will eliminate any contractually unbillable characters prior to the count.

The white paper also doesn't address the method of "weighting" report types and dictators by adding characters to work types and dictator templates. This is invisible to the client, as it's done with programming on the back end. Any facility that believes this can't possibly be happening to them because they're using an ASP (application service provider) that automatically calculates and reports the billing should be aware that many of the ASPs have this feature built in.

Bottom line:

Unless there is an independent method for verifying that billable units are counted in accordance with the terms of the contract, no standard is exempt from manipulation.

ACT's insider experts are available to consult with your facility to make your outside service's billing as accurate and reliable as possible.