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medical transcription line count definitions for use by MTWorld medical transcriptionist users and other healthcare professionals

Tired of trying to unravel the medical transcription line count mystery? Frustrated with looking for but not finding a standard medical transcription line count definition? 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 medical transcription industry.

The sad fact is that the concept of medical transcription line counts is a concept that is begging for standardization. Why hasn't it been standardized to this point? Good question. The short answer is that there is a lot of money involved and not everyone would benefit equally from MT line count standardization. And if history is any indication, it will require a great many more years of political wrangling to get everyone on the same page. One of the great lessons of Economics is that power comes from the assymetry of information. In other words, the fuzziness surrounding this issue of what constitutes a medical transcription line is a source of great financial benefit for some medical transcription industry players and obviously is a source of consternation for others.

The good news is that over the past several years there has been some modest progress in the area of medical transcription line counts. We are seeing a slow but unmistakable trend toward standardization.

Let's start with a few basic definitions that have been adopted by the leading industry medical transcription organizations: AHDI, AHIMA & MTIA.

1.   Gross Medical Transcription Character:  In counting medical transcription lines, any letter, number, symbol or function key necessary for the final appearance and content of a medical transcription document, including the space bar, carriage return, underscore, bold, and any character contained within a macro, header or footer.

2.   Net Medical Transcription Character:  Printed characters only.   Note: to convert to Gross Characters multiply Net Characters by 1.2

3.   Net Medical Transcription 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 Medical Transcription 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.   Medical Transcription Keystroke:   Each stroke of a key is counted - including the space bar, carriage return, underscore, bold, etc. constitutes a medical transcription keystroke.  Note: macros become an issue here - technically, if a macro requires three keystrokes, then for billing purposes, three keystrokes would be billed.

6.   Net Medical Transcription 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 medical transcription 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.

Over the years the definition of a medical transcription line has varied significantly in terms of gross characters and keystrokes. 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.

It turns out that there is a fair degree of flexibility in establishing medical transcription 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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For example:

Assume that for the billing period, your medical transcription line count software calculates a total of 3,500,000 transcribed gross characters and that your contract defines a billable line as 65 gross characters. Assume that you have negotiated a price of 14 cents per billable line. Your bill would be calculated as follows:

3,500,000 divided by 65 = 53,846 billable lines

53,846 multiplied by .14 = $7,538.00

Alternatively, you could deliver formatted medical transcription reports to the client that are based on a 65 gross character line and then count all lines. Full and partial lines would count the same for billing purposes (See Gross Lines definition above). Consider how this might affect your bill for the same billing period.

Using the Gross to Net Line conversion factor shown above (multiply Gross Lines by .70 to get Net lines or conversely divide Net Lines by .70 to get Gross lines) we discover that we have produced 76,922 Gross Lines. If we are billing for gross lines at the same billing rate of 14 cents per line then our bill would read as follows:

76,922 multiplied by .14 = $10,769.00

A significant difference is noted between the two bills.

There is nothing wrong with negotiating a more favorable contract for yourself or your company as long as things are clearly spelled out in advance. And as it turns out, this simple fact is primarily responsible for the billing variation that continues to persist in the industry. Companies attempt to negotiate terms that favor them by playing with character and line definitions.

Another factor that could be used to influence medical transcription billing is the font size of finished formatted reports. A 12 point font with a 1 inch margin will yield a very different line count than a 10 point font with the same 1 inch margin. These subtle differences can mean big money over the life of a contract and should be thought through carefully. Obviously, a gross character definition for a line (65 gross characters per line, for example) will eliminate this problem. A gross character is billed the same regardless of whether it is a 10 point or 12 point font - which, I believe is as it should be.

Depending on the average length of the reports you are transcribing, billing mmedical transcription reports by the page can also make sense. Typically this is most beneficial when dealing with a higher quantity of partial page reports. Billing by the page for these shorter reports essentially guarantees a minimum line count for each report. This can be important as the setup and formatting requirements for the larger volume of shorter reports can become onerous. If negotiated properly, billing by the page can be yield more income per line of transcription than billing for straight line counts. Obviously, certain types of accounts lend themselves more readily to this type of billing arrangement.

For example, if you charge $4.00 per page and the average line count for the client is 20 lines per report, then you are averaging 20 cents per line - which may be more than you would otherwise bill on a per line basis.

A number of companies have developed software technology to facilitate the line counting and billing process.

These include:

Abacus - Sorcerer Software,

InstantTextPro, Version III - Textware Solutions

MedPen - Emmaus MedPen

MP Count - Emmaus MedPen

Slycount II - Sylvan Software

Slycount IV (MS Word) - Sylvan Software

WP Count - Productive Performance, Inc.

In addition, Microsoft Word and other word processing software packages have their own built in line counting utility - which may prove adequate depending on your application. The best programs provide the option of including or excluding spaces, carriage returns, headers, footers, etc. This allows for optimal flexibility in tracking and billing line counts.

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