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Who teaches medical billing? A national cross-sectional survey of Australian medical education stakeholders
  1. Margaret Faux1,
  2. Jonathan Wardle1,2,3,
  3. Angelica G Thompson-Butel4,
  4. Jon Adams1
  1. 1 Faculty of Health, University of Technology, Sydney, New South Wales, Australia
  2. 2 School of Medicine, Boston University, Boston, Massachusetts, USA
  3. 3 School of Medicine, University of Washington, Seattle, Washington, USA
  4. 4 Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
  1. Correspondence to Ms Margaret Faux; margaret.a.faux{at}


Importance Billing errors and healthcare fraud have been described by the WHO as ‘the last great unreduced health-care cost’. Estimates suggest that 7% of global health expenditure (US$487 billion) is wasted from this phenomenon. Irrespective of different payment models, challenges exist at the interface of medical billing and medical practice across the globe. Medical billing education has been cited as an effective preventative strategy, with targeted education saving $A250 million in Australia in 1 year from an estimated $A1–3 billion of waste.

Objective This study attempts to systematically map all avenues of medical practitioner education on medical billing in Australia and explores the perceptions of medical education stakeholders on this topic.

Design National cross-sectional survey between April 2014 and June 2015. No patient or public involvement. Data analysis—descriptive statistics via frequency distributions.

Participants All stakeholders who educate medical practitioners regarding clinical practice (n=66). 86% responded.

Results There is little medical billing education occurring in Australia. The majority of stakeholders (70%, n=40) did not offer/have never offered a medical billing course. 89% thought medical billing should be taught, including 30% (n=17) who were already teaching it. There was no consensus on when medical billing education should occur.

Conclusions To our knowledge, this is the first attempt of any country to map the ways doctors learn the complex legal and administrative infrastructure in which they work. Consistent with US findings, Australian doctors may not have expected legal and administrative literacy. Rather than reliance on ad hoc training, development of an Australian medical billing curriculum should be encouraged to improve compliance, expedite judicial processes and reduce waste. In the absence of adequate education, disciplinary bodies in all countries must consider pleas of ignorance by doctors under investigation, where appropriate, for incorrect medical billing.

  • health economics
  • health Policy
  • law (see medical law)
  • public health

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  • Contributors MF wrote the firstdraft of the paper in its entirety and has finalised all subsequent draftsincorporating the feedback and suggestions of the other authors. In addition,she is responsible for the concept and design of the study, conducted allliterature searches and compiled the references, prepared the tables, wasinvolved in the data collection and analysed and interpreted the results. JW isthe principal supervisor for MF’s doctorate. JW has made substantialcontributions to this paper at every stage, including having involvement in theproposed concept and design of the study, through to making substantialcontributions to the paper via review, critical analysis, feedback andre-drafting sections of the paper to refine important intellectual content. AGT-Bconducted the majority of the data collection and was also involved in dataanalysis and interpretation. She has made a substantial contribution to thecontent of the discussion section of the paper as a result of her closeassociation with the data. JA is the co-supervisor of MF’s doctorate. He hasmade substantial contributions to later drafts of this paper via review andre-drafting of important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MF is the founder and CEO of a medical billing company, and the holder of a patent for a medical billing app. AGT-B received fees from MF for casual work as a research assistant during the data collection phase of this project.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Human Research Ethics Committee of the University of Technology, Sydney (HREC 2014000060).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We do not see data sharing as relevant to this study; however, the deidentified results are available to researchers having an interest in this area. Please contact the corresponding author by email to make enquiries.

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