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NYT: "Medicare Billing Rises as Records Turn Electronic"

NYT: "Medicare Billing Rises as Records Turn Electronic"

by Deleted user -
Number of replies: 4

http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronic-records.html?_r=0

Is the billing rise due simply to more efficient documentation, or is it inadvertent  or conscious fraud? Or, perhaps, something more nuanced?

IMO, there's a disconnect in this article  between the increased billing on the one hand, and the EHR "point and click" templating, on the other. As they say in the sciences, correlation doesn't equal causation. E.g., there have always been docs who like to speed up their documentation using templates, or a sort of "memorized" H&P; all MTs have seen (well, heard) these, and shaken their heads in dismay to hear a hasty, sloppy dictation of an obviously perfunctory  exam. I wonder whether having a templated EHR actually increases the number of docs willing to take that sort of shortcut, or just makes it quicker to do it. 

... And it's all a separate issue from what I think is the dreadful harm potentially done to the clarity, accuracy, and personalization of the medical record with the use of these point-and-click things; one hears that many physicians don't care for them much, either.

...But the latter is an MT problem, not a coding problem. This potential "up-coding", whether deliberate or not,  could become a coding problem. I don't know enough about coding yet to have any notion what, if anything, should be done; but it's good to be aware of these whirlpools of controversy swirling ahead of us... 

Re: NYT: "Medicare Billing Rises as Records Turn Electronic"

by Deleted user -

I agree that the situation described in this article would seem to make upcoding easier and perhaps more tempting.  Wouldn't a good auditor spot this right away, though?

Certainly CMS seems to be making an example out of them!  LOL

There have always been medical professionals around who want to game the system. 

I can remember one instance where one of the people I worked for was furious about not getting paid.  This was a very long time ago, but basically this person was quite behind on progress notes and treatment plans, so I had to tell this individual that I couldn't submit anything to the insurance companies until the documentation was caught up.  The other members of the practice were in agreement, as the practice was at risk.  The codes must be justified by the documentation, and the documentation must be accurate.

The practice was set up in a way that this person remained unpaid until the insurance company paid the claims.  The patient documentation was caught up quickly (ha!) and I stayed late for a while to get everything caught up.  We never had an issue again.  With physicians and a hospital, I would think that compliance would get involved?  Our state medical board, at least, has very strict rules on medical records and documentation.  They can and have terminated institutional permits and dinged medical licenses for that.

The "point and click" was sold to practioners as time-saving, but the rest of the industry is also evolving.  It's risky to cheat, as CMS and the insurance companies also all have increased capabilities, the likes of which apparently flagged this hospital system.

Thank you so much for posting this great article and for your interesting comments!  :)

Re: NYT: "Medicare Billing Rises as Records Turn Electronic"

by Deleted user -

Pam- did you see this today?  Yikes!

http://www.nytimes.com/2012/09/25/business/us-warns-hospitals-on-medicare-billing.html?_r=1&ref=business

Re: NYT: "Medicare Billing Rises as Records Turn Electronic"

by Deleted user -

Years ago when I was working for a large commerical lab, we hired a consultant to reveiw all of our CPT codes and procedures to see if we were "leaving money on the table"  I am wondering how much of the "increase" they are seeing is related to this type of situation.  There could also be the fact that hospitals are hiring creditialed coders who know how to properly code procecures and are well trained to avoid upcoding,fraud, and abuse.  Correct coding can lead to an increase in revenue but it can also decrease it.

The other thought I had regarding this article is the person who wrote it has no clue as to how things work and this is just political fodder.  We all know it is an election year.

Re: NYT: "Medicare Billing Rises as Records Turn Electronic"

by Deleted user -

I did see it-- thanks for posting it. 

Again, as a mere coding student I'm hesitant to opine on whether this issue is a real problem or a perceived one--but I do wonder if the "cloning" isn't more of a problem than the potential "up-coding." You'd think that proper auditing would catch at least much or most of the up-coding, after which appropriate deterrents would be applied; but it wouldn't necessarily be easy to catch patient record "cloning," in the setting of boilerplate template language. I.e., if the records all look very similar anyway, in the absence of free-text usage.