EHR: Potential Mining Disaster?

September 27th, 2012

EHR products can make it so easy to create a nice long note about patient care.

Frequently all a provider must do is cut, paste and modify.  Based on the information provided, the software then suggests a higher code than you would have been paid under the old system.

How great is this?  Incentive money and higher average charges too!

But beware!  If your average level of service has increased from what it was without EHR, you run a real risk of being "data mined" and audited. 

Remember medical necessity underlies all documentation!  The length and detail of your note is irrelevant if you there if the medical necessity for services performed is not clear.

Five major Hospital Associates were sent a sternly worded letter by Kathleen Sebelius, Secretary of HHS and Eric Holder, US Attorney General,  warning about the misuse of electronic health records to upcode.

In part the letter reads:

False documentation of medical care is not just bad medical care; it's illegal.  These indications include potential "cloning" of medical records to inflate what providers get paid.

The letter details some of the new administrative tools available to mine data and pursue those suspected of fraud.

The letter continues:

We will not tolerate health care fraud.  The President initiated in 2009 an unprecedented Cabinet-level effort to combat health care fraud and protect the Medicare trust fund; and we take those responsibilities very seriously.

Law enforcement will take appropriate steps to pursue health care providers who misuse electronic health records to bill for services never provided.

Scarey stuff.  Be careful out there.  Let medical necessity dictate what is done; and code accordingly.  IGNORE the codes suggested by your EHR!

Tags: EHR, Fraud, Upcoding


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