Wednesday, June 24, 2009

Line Count Methodology

Tired of trying to unravel the line count mystery? Well, you’re not alone. In fact, it turns out that this is one of the most controversial, frustrating, misunderstood, misused, and abused concepts in the industry.

The good news is that over the past several years there has been some modest progress in this area. We are seeing a slow but unmistakable trend toward standardization.Definitions
Let’s start with a few basic definitions that have been adopted by the leading industry organizations: AAMT, AHIMA & MTIA.

1. Gross Character: Any letter, number, symbol or function key necessary for the final appearance and content of a document, including the space bar, carriage return, underscore, bold, and any character contained within a macro, header or footer.
2. Net Character: Printed characters only. Note: to convert to Gross Characters multiply Net Characters by 1.2

3. Net Line: A defined line length that includes a predetermined number of gross characters (55, 60, 65, 70, 75, etc.). Note: Net lines are generally determined by dividing the total gross characters in a report by the defined line length.

4. Gross Line: Any printed line that has one or more characters. Note: no distinction is made here between full and partial lines. (To convert Gross Lines to Net Lines multiply Gross Lines by .70).

5. Keystroke: Each stroke of a key is counted – including the space bar, carriage return, underscore, bold, etc. Note: macros become an issue here – technically, if a macro requires three keystrokes, then for billing purposes, three keystrokes would be billed.

6. Net Word: A net word is defined as five (5) alpha/numeric characters plus one(1) space for a total of six (6) characters.

7. Recorded Minute: One recorded minute of dictation is equal to an average of 777 gross characters for Medical Records dictation (including ER) and an average of 782 gross characters for Physician Practices dictation.A Line Defined: The Elusive “Standard”
Over the years the definition of a line has varied significantly in terms of gross characters. The range has typically been from 55 to 80 keystrokes. More recently, a 65 keystroke (gross character) line has emerged as something of an industry standard, although a fair amount of variation continues to exist. However, even as this standard has emerged, there continues to be significant controversy over gross characters, net characters, macro characters, etc. In other words, a 65 character line can still mean different things to different people. Some companies actually have two ways of measuring a line – one for billing purposes and one for wage payment purposes. The idea is to create a small spread – bill for all keystrokes while paying only for hard characters.
The Billing Conundrum

It turns out that there is a fair degree of flexibility in establishing billing parameters. It boils down to negotiating a rate with a prospective client. Even if you determine that you will attempt to adhere to the standards provided in the definitions above there is still a fair amount of lattitude that derives from the subjectivity inherent in the definitions. For example, assume that you decide to bill based on a 65 character line. What about partial lines? Again it depends on how the contract is written. On the one hand you could structure the contract to require that all gross characters in a given report be added up and divided by 65 to produce a total billable line count. In other words you are basing the billing on the definition of a Net Line above. I personally like this method. It is clean and is likely to become the defacto standard for billing large accounts.


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