HIT Policy Committee to Study EHR Overbilling

Farzad Mostashari, M.D., national coordinator for health information technology, has asked the advisory HIT Policy Committee to study if providers are using electronic health records to up-code billings to Medicare, according to the Center for Public Integrity, a nonpartisan investigative journalism organization.

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Comments (7)
There is definately a lot to learn about this topic. I love all the points you've made seo consultant.
Posted by Adella F | Monday, November 18 2013 at 2:34AM ET
The probable reason codes are higher is because the EMR has made it easier and faster for physicians to document everything they actually did during a visit. Before when a physician had to dictate everything it was not cost effective to take the time to document everything that was done or pay a transcriptionist to type it all.

I don't think the government realized how much information a physician gathers from taking a history and doing a physical exam because for the above reason it was not recorded in the records in the past. The purpose for the medical record used to be for the physician to make notes to jog his/her memory of the previous visit in order to provide a continuity of care for a previously identified problem. Now, the record is used for multiple other medically non-pertinent reasons (as far as the individual patient is concerned) - justification for payment, quality measure reporting, legal documentation, meeting regulatory demands, etc.

When all of the bureaucratic bean counters got involved they decided to change the focus of the chart away from direct patient care and started playing financial games with the chart. Picky coding rules evolved including many that even the people who made the rules can't interpret or explain in an understandable way. In response to the newly created games, the doctors simply provided ALL of the information they gathered at a visit to comply with the rules. Surprise, surprise -- the government's rules of the game backfired on them. By their rules increased documentation = increased reimbursement. Now that they don't like the way the game is being played by the rules, the government wants to play hardball and or change the rules. "Now children - you made the rules so you need to play by the rules, You can't go changing them in the middle of the game!" Does that sound like something you've told your children or grandchildren? Or how about this- "He's just a bully, ignore him, he doesn't know any better and he doesn't like playing by the rules." Or -- "He's mad because he's just a sore loser." Sound familiar? Grow up you government children. Enough of your games. Let us physicians just get back to taking care of patients and don't interfere with our patient care by forcing us to play your silly games. The patients (public) are going to be the losers if you keep this up.
Posted by Doug D | Monday, October 22 2012 at 12:24AM ET
Possibly upcoding occurs as described. However, for years, paper charting has likely resulted in downcoding because of the complexity of documenting all required aspects of the encounter and the accompanying fears of the providers concerning aggressive audits. EMR has its faults and can be abused, but it may also permit better, and higher, coding more appropriate to the work done.
EMR has its benefits, but also can hurt productivity. If the powers that be start throwing impediments to charting and using electronic medical records, they will risk further impairing productivity.
Posted by DONALD H | Sunday, October 21 2012 at 6:46PM ET
So just like laywer the more you document the higher the pay! Justice is served.
Posted by mackley | Thursday, October 18 2012 at 8:32PM ET
So they have figured out that more documentation results in higher level E&M codes DUH!!! So just like laywers the more we write the higher we get paid. JUSTICE is served!!!!
Posted by mackley | Thursday, October 18 2012 at 8:30PM ET
Clinics were also mentioned as a possible source of up-coding by the House members. As the CEO of a Federally Qualified Health Center, ie a "clinic" I would like to clarify that FQHCs are paid a set rate for Medicaid and Medicare visits. Up-coding is of zero advantage to us as we will never get more than our rate for each visit. I think the members of the House are unclear on both the complexity of HIT technology and payment methodology for different types of medical providers.Don't tar us all with the same brush.
Posted by Beatrice B | Thursday, October 18 2012 at 2:01PM ET
Translation: "We're going to spend more tax payer money to try and find out why all the tax payer money that we've already spent has increased medicare costs".
Posted by russ.reese | Thursday, October 18 2012 at 1:55PM ET
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