Keeping in mind that there is no billing method that cannot be manipulated, recorded minutes are the most concretely verifiable units.

This method consists of running a report on the dictation system for the total number of dictated minutes during the billing period. Any industry standard dictation system has the ability to run these reports. In addition, the reports can be sorted by criteria: report type, dictator, date, etc., allowing for drill-down evaluation of which report types or dictators are costing the most. It's simple, visible, verifiable, and eliminates all question of what constitutes a measurable billing unit.

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:

Fast and slow talkers can skew the total number of minutes. Long pauses are sometimes recorded in their entirety, so customers pay for dead air.

But are these really limitations? For the slow dictator and the dictator who backtracks and makes corrections and deletions, the recorded minute method of dictation places responsibility on the dictator to be organized and utilize best practices when dictating. It compensates the transcriptionist (MT) for deletions and time spent listening to dictators who are fumbling, mumbling, talking to others in the room. It compensates the transcription service (MTSO) for expenses that can be incurred when a dictator calls in but doesn't say much. The client has complete control over this cost and it places responsibility for poor dictation habits where they belong: on the dictator.

Services that have used this billing method state that the fast talkers, the template users and the slow talkers balance out to make this a very fair method of billing for all parties.

Digital recorders: All digital recorders contain encoded information about the file, including the date and time of dictation and the length of dictation. The information can be extracted to a database and reported.

ACT's technical consultants have the ability to perform this extraction. Please contact us if you have any questions.

Minutes multiplied by lines: Some vendors utilize a method where they multiple the recorded minutes by a number of lines instead of counting actual transcribed lines of text or minutes of dictation.

For example: A vendor may determine that there are 10 "lines" (definition unknown) to a recorded minute.

10 minutes of recorded dictation x 10 lines = 100 billable "lines" or units

This method is as verifiable as recorded minutes of dictation. However, the use of this method isn't always disclosed to the client. In addition, as noted, the definition of a "line" in this instance may not be disclosed.

How can this method be manipulated?:

If your facility has its own dictation system and vendors work off that system, this method cannot be manipulated and the recorded minutes of dictation becomes a completely verifiable and measurable method of billing for transcription services. If your facility has access to the digital voice files from the handheld recorders, it can run independent reports and this method is completely verifiable and measurable.

There are several ways the minutes of dictation could be manipulated on a vendor's dictation system. One would be to set the system to add minutes or seconds to each dictation. This would be completely invisible to the client.

For example, the system could be programmed to add X minutes to all dictation by Dr. Motormouth or Dr. Normals. Or all operative reports.

If minutes are multiplied by lines to generate a billable unit, both the practice and the definition of a "line" may not be disclosed to the client. Even if it is, the minutes of dictation are open to manipulation as discussed above. In addition, the definition of a line can be manipulated (see Characters for a complete discussion).

Bottom line: Recorded minutes as a billable unit is an excellent, verifiable method for facilities that maintain their own dictation system. If you are using a vendor's dictation system, it can be reliable; however, if you are not confident about it, the experts at ACT can help determine if there is manipulation in the system.