This method is probably the most inaccurate method of accounting for billable units. ACT doesn't recommend this unit of measure.

Gross line billing was widely used in the pre-digital era of transcription. Abuse by both vendors and facilities was widespread, as the method is easily manipulated.

According to 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, the limitations of this method are:

All lines are counted equally, so a line containing only one word is counted the same as a line that fills the entire width of the page.

How can this method be manipulated?

The limitation given in the VBC white paper really doesn't address the numerous underlying issues with this method.

Vendor abuse can include:

excessive paragraphing

long and frequent paragraph titles

large fonts

large left and right margins

Client abuse can include:

continuous text with no paragraphs

elimination of paragraph titles

extremely small and/or variable width fonts

very small left and right margins

In short, formatting for readability was sacrificed in order to increase or decrease the billable units.

Because this method is so unreliable, there will be no discussion about how to offset the issues to work with it. Please contact ACT if your facility insists on using this method and you would like to reduce exposure to the more blatant practices and/or verify invoices, or convert to a more reliable method.