The American Health Information Management Association is urging more research on the causes of higher levels of coding and reimbursement through the use of electronic health records.

The Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology are held a “listening session” in Washington on May 3 with stakeholders with the topic being EHRs and billing. CMS has warned providers not to “game the system” by using EHRs to bill at higher treatment levels than warranted. Providers have retorted that better specification and documentation of treatment via EHRs is leading to higher utilization of more appropriate codes for treatment.

“The extent to which EHRs have led to improper reimbursement is unclear,” Sue Bowman, senior director of coding policy and compliance at AHIMA, told federal officials. “EHRs produce more complete and accurate documentation, and this could be leading medical providers to seek reimbursement for services they have always been providing, but weren’t properly documenting before. Higher levels of reimbursement do not necessarily equate to fraud.”

Bowman suggested the development of a code of ethics for EHR vendors and users to design and use the system appropriately, guidelines to ensure features in an EHR are correctly used, development by CMS of a national set of coding guidelines for hospital reporting of emergency department and clinic visits, and education and training on coding with EHRs.

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