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If you have read Todd Billings’ previous work, you might perhaps already have noted (and read!) his most recent book. Let me phrase this slightly differently and more precisely: Most of the readers, who have probably heard and shared the recommendations of Billings’ previous works such as Calvin, participation, and the gift: The activity of believers in union with Christ (2008); The Word of God for the people of God (2010); Union with Christ: Reframing theology and ministry for the church (2011); Calvin’s theology and its reception: Disputes, developments, and new possibilities (co-edited with John Hesselink, 2012); Rejoicing in lament: Wrestling with incurable cancer and life in Christ (2015), and/or Remembrance, communion, and hope: Rediscovering the Gospel at the Lord’s table (2018), would thus also be very interested in his most recent book on facing one of the most profound existential questions in life, namely how to deal with our mortality – engaging death – and start living anew.

This article addresses the complexities of ethical billing and coding practices for neurofeedback and quantitative EEG (qEEG) services. It explores the historical development of Current Procedural Terminology (CPT) codes related to neurofeedback, examines current best practices in billing, and identifies potential legal and ethical pitfalls, including recent fraud cases. Special attention is given to Medicare's policies, the nuances of incident to billing, and the role of technicians in service delivery. The paper underscores the importance of documentation, scope-of-practice considerations, and transparency with payers and patients. Additionally, the advocacy efforts of professional organizations such as the International Society for Neuroregulation & Research (ISNR) and the Association for Applied Psychophysiology and Biofeedback (AAPB) are reviewed, particularly their ongoing initiative to update and refine CPT codes to better reflect clinical practice. Through a comprehensive synthesis of guidance from the AMA, CMS, professional ethics codes, and payer policies, the article serves as both a practical guide and a call to uphold ethical standards in the neuroregulation field.

The comparison of three modified electricity billing mechanisms (model I, model II, and model III) for low tension (LT-I) residential consumers of Maharashtra, India, is presented in this paper. Models I and II are presented in detail along with the results in the previous version of this paper in the year 2020 and year 2022. In continuation of this work, model III is presented in this paper in the year 2023. The main components of this mechanism are traditional billing, time-of-day billing, and an optional facility to use renewable energy by implementing net metering. The combination of these elements generates three distinct billing mechanisms. These have several advantages, like the profits of the existing mechanism, renewable integration, grid stability, demand management, cost saving, environmental benefits, and customer empowerment. The projected billing mechanism is developed and implemented in MATLAB software, and a real-time application is created. The comparison between these three mechanisms helps in giving the best mechanism with respect to residential consumers. Lastly, the philosophy for the future extension to this work is presented which is based on the concept of overseas billing mechanism i.e., seasonal time of day tariff of Sacramento Municipal Utility District and Arizona Public Service.

AbstractBackground‘Surprise billing’, or the phenomenon of unexpected coverage gaps in which patients receiving out-of-network medical bills after what they thought was in-network care, has been a major focus of policymakers and advocacy groups recently, particularly in the Emergency Department (ED) setting, where patients' ability to choose a provider is exceedingly limited. The No Surprises Act is the legislative culmination to address “surprise bills,” with the aim of promoting price transparency as a solution for billing irregularities. However, the knowledge and perceptions of patients regarding emergency care price transparency, particularly the degree to which ED patients are cost conscious is unknown. Accordingly, we sought to quantify that perception by measuring patients' direct predictions for the cost of their care. MethodsWe conducted an in-person survey of patients in Emergency Departments (EDs) over an 10-month period at two campuses within a large academic hospital system in southern Connecticut. We surveyed a convenience sample of patients at the bedside regarding demographics, care seeking perceptions and their estimates of the total and out-of-pocket costs for their ED care. Survey data was linked to institutional hospital finance datasets including actual charges and payments. We then later obtained the actual costs and billed amounts and compared these to the patients' estimates using a paired t-test. We also analyzed results according to certain patient demographics. ResultsA total of 600 patients were approached for survey, and data from 455 were available for the final analysis. On average, patients overestimated the cost of their care by $2484 and overestimated out-of-pocket cost by $144; both of these results met statistical significance ( p < .005). Patients were better able to predict both total and out-of-pocket costs if they were: college educated or above; unemployed or retired; aged 65 or older; or had private insurance. Uninsured patients could better predict total cost but not out-of-pocket costs. One in 4 patients reported considering the cost of care prior to visiting the ED. Only 12 patients reported trying to look up that price before coming. ConclusionsThis study is the first to our knowledge that sought to quantify how patients perceive the cost of acute, unscheduled care in the ED. We found that ED patients generally do not consider the price before going to the ED, and subsequently overestimate the negotiated total costs of acute, unscheduled emergency care as well as their out-of-pocket responsibility for care. Certain demographics are less predictive of this association. Notably, patients with Medicare/Medicaid and those with high school education or below were of the furthest off in predicting the actual cost of care. This lends credence to the established trend of patients' limited knowledge of the total cost of healthcare; moreover, that they overestimate the cost of their care could serve as a barrier to accessing that care particularly in more vulnerable groups. We hope that this finding adds useful information to policymakers in sculpting future legislation around surprise billing.

Point-of-care ultrasound (POCUS) is a common modality utilized in emergency departments (EDs). Image acquisition and storage workflows have significantly improved. Saving POCUS images is considered standard of care. However, documentation compliance is a struggle for clinicians in the chaotic ED environment. We sought to implement a simple electronic medical record (EMR) deficiency workflow to improve capture of POCUS documentation and billing in a large healthcare setting. A retrospective review of all POCUS studies across 12 EDs was performed from January 1 to December 31, 2023. All EDs utilized the same EMR with standardized workflow. Clinicians were recommended to complete charting within 48 h of patient disposition. A POCUS deficiency workflow was implemented on June 1, 2023 to improve compliance. Deficiency workflow was defined as automated in-basket messaging that appeared after POCUS order entry. Deficiency remained in the clinicians in-basket until procedure note was completed. We compared POCUS chart deficiencies for lack of procedural documentation. Descriptive statistics were performed. 5013 POCUS were reviewed during the study period, 42 % before and 58 % after implementation. There was a 3.0 % absolute reduction (CI 2.01 %, 3.97 %) in procedure note deficiency from the pre-intervention to post-intervention period, 4.44 %. to 1.45 %. A POCUS deficiency workflow improved documentation across our healthcare system. This directly improved billing of POCUS studies and decreased late chart notifications. This workflow can be implemented in any medical specialty that utilizes POCUS. We recommend large healthcare systems investigate similar workflows to improve documentation and billing of POCUS exams.

Nonlinear pricing and taxation complicate economic decisions by creating multiple marginal prices for the same good. This paper provides a framework to uncover consumers' perceived price of nonlinear price schedules. I exploit price variation at spatial discontinuities in electricity service areas, where households in the same city experience substantially different nonlinear pricing. Using household-level panel data from administrative records, I find strong evidence that consumers respond to average price rather than marginal or expected marginal price. This suboptimizing behavior makes nonlinear pricing unsuccessful in achieving its policy goal of energy conservation and critically changes the welfare implications of nonlinear pricing.

Background: Additional billing is commonly and legally practiced in some countries for patients covered by health insurance. However, knowledge and understanding of the additional billings are limited. This study reviews evidence on additional billing practices including definition, scope of practice, regulations and their effects on insured patients. Methods: A systematic search of the full-text papers that provided the details of balance billing for health services, written in English, and published between 2000 and 2021 was carried out in Scopus, MEDLINE, EMBASE and Web of Science. Articles were screened independently by at least 2 reviewers for eligibility. Thematic analysis was applied. Results: In total, 94 studies were selected for the final analysis. Most of the included articles (83%) reported findings from the United States (US). Numerous terms of additional billings were used across countries such as balance billing, surprise billing, extra billing, supplements and out-of-pocket (OOP) spending. The range of services incurred these additional bills also varied across countries, insurance plans, and healthcare facilities; the frequently reported were emergency services, surgeries, and specialist consultation. There were a few positive though more studies reported negative effects of the substantial additional bills which undermined universal health coverage (UHC) goals by causing financial hardship and reducing access to care. A range of government measures had been applied to mitigate these adverse effects, but some difficulties still exist. Conclusion: Additional billings varied in terms of terminology, definitions, practices, profiles, regulations, and outcomes. There were a set of policy tools aimed to control substantial billing to insured patients despite some limitations and challenges. Governments should apply multiple policy measures to improve financial risk protection to the insured population.