In the wake of an expose in The New York Times claiming that upcoding and overbilling was increasing with the use of EMRs, and members of Congress riding the claim, I guess ONC had no choice but to take the allegations seriously. So fearless leader Farzad Mostashari, M.D. has asked the advisory HIT Policy Committee to study whether providers are using EMRs to upcode Medicare bills.
I suppose you can tell from how I put that that I’m far from convinced EMRs are generating massive amounts of illegitimate bills, but the idea is “out there” now and dangerous to the future of HITECH objectives. So I suppose it’s a good thing that ONC is investigating.
Dr. Mostashari wants to find out whether EMRs tend to foster the use of higher billing codes by encouraging doctors to cut and paste information from one patient encounter to another, according to an interview with the Center for Public Integrity. He’s also asking the policy committee to determine whether some EMR functions prompt physicians to overbill.
All of this leaves me sort of uneasy.
Don’t get me wrong, I’m not suggesting that EMRs aren’t generating any upcoding issues at all. We all know that many physicians feel pressured to cut and paste text in an effort to get through their heavy workloads, particularly if they’re not otherwise comfortable with their system.
Also, I can’t deny that there are bad apples in every profession, including medicine, who could conceivably be taking advantage of the newness of the technology to reap a profit.
No, my concerns are more that countless providers will have one more thing to worry about as they use the new technology, and that policymakers will view EMRs with a level of suspicion they hadn’t before. We’re at a tricky point in the overall EMR adoption curve, and bad vibes and publicity are the last thing we need. Meaningful Use compliance is tough enough as it is.
Any patient who has ever read an EOB (explanation of benefits) from an insurance company can tell you that they get frequent notifications that some part of a doctor’s bill has been rejected as a duplicate or unnecessary service. CMS contractors as far as I can tell do the same thing. The provider and patient get these EOB’s and then one or both may need to say No, this was done, and that was done, and here is why.
Of course, I’ve also seen EOB’s where work never done is included. Many years ago, we got an EOB from the hospital for one of our then newborn kids for a test supposedly done a few days before he was born. In general, this sort of this is out and out fraud (ignoring legit mistakes), and can just as easily be done without an EHR, though I suppose that EHRs make it a bit easier.
If you’ve ever watched a doctor mark up the charges pre EHR, it’s very easy to overbill. You may have a checklist sheet, and the doctor X’s off a bunch of items on that sheet based on your diagnosis and treatment. Obviously, ICD10 makes the former a lot ‘messier’ (and which will be far easier to do in an EHR), but he/she would likely have the exact same treatment choices to mark off as would be found in the EHR. You have to pick treatments. Simple cut and paste of notes and patient instructions shouldn’t (from what I’ve seen in EHR’s) generate billing, at least not without the doctor’s approval. Fraud detection programs should spot most overcharging. Or so I would think.
[…] previous postings, I’ve noted that for various reasons, doctors using EMRs are tending to bill for more E/M […]