This is another billing unit method that dates to the pre-digital era and isn't very common except with small clinic practices and independent MTs who work with them.

A gross page is exactly what it sounds like: the number of printed pages (or page breaks in the word processor application) are counted. These may all be charged as whole pages; some vendors will calculate half, third and/or quarter page charges.

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:

Some pages may only contain a few words or lines. Moreover, increasing use of online viewing of medical transcription can make it difficult for customers to determine where one page ends and another begins.

These limitations are especially applicable in electronic medical records (EMRs), where there is no traditional "page break."

On the other hand, it's extremely verifiable for a facility that actually prints out pages, although not recommended for high volumes. Verifiability is as easy as printing the pages and counting them.

How can this method be manipulated?

This billing unit method can be manipulated in the same way as gross lines.

Again, like the gross lines method, formatting becomes less about reability and more about billing methods. Letters may have "orphaned" signature blocks or other inappropriate formatting due solely to billing method issues. In addition, many facilities don't know if they're billed partial pages or what constitutes a partial page.

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

Bottom line: ACT doesn't recommend this billing unit method, nor do we believe it's widely used. Although very verifiable, it isn't reliable. It can be successful in small and/or low-volume settings or where there is a very close relationship with the MT doing the transcription.