EHR Use Might Allow Health Care Providers To Overbill Medicare

The proliferation of electronic health record systems might be leading some  health care providers to overbill Medicare, the Center for Public Integrity reports.

Billing Details

When using EHRs while treating Medicare patients, physicians can select among  escalating payment codes for billing purposes.

For example, doctors must choose one of five payment codes for an office  visit that best reflects the amount of time spent with a patient and the  complexity of the care. The lowest-level code pays about $20, while the  highest-level code pays about $100.

Stephen Levinson — a Connecticut physician and author of a book about  medical coding — said that sometimes the system improperly raises billing  levels based on the amount of patient medical history added to the EHR.

Details of CPI Investigation

According to a recent CPI investigation, thousands of health care providers  have been billing Medicare at increasingly higher rates over the past decade,  costing taxpayers at least $11 billion in inflated fees.

The investigation found that many health care providers using EHR  systems are choosing higher-paying treatment codes to inflate their bills,  a process known as “upcoding.”

Some of the largest increases in upcoding have occurred in hospital emergency  departments, which have widely adopted EHR systems and rarely are audited by  Medicare, according to the investigation.

HHS Plans Investigation

Donald White — spokesperson for the HHS Office of the Inspector General —  has said that the issue of upcoding is “on the radar” and that the office will  be “looking into these codes and how [EHRs] may be affecting them.”

However, government officials say that they do not have a system to monitor  the hundreds of different billing and medical software packages being used  across the U.S.

Physicians’ Response

Some physicians note that EHR systems allow them to correct billing  practices that for years did not pay them enough.

Robert Tennant — a lobbyist with the Medical Group Management Association —  said, “With a paper-based system, there’s a little bit of concern from providers  that they don’t have sufficient documentation to support a particular” coding  level. However, he said that EHRs can help clinicians quickly retrieve a  patient’s history.

Tennant said, “I don’t use the term ‘upcode.’ I use ‘correct code.’ I see it  more as physicians being reimbursed more appropriately for the work that they’re  doing” (Schulte, Center for Public Integrity, 9/19).

Source: iHealthBeat

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