Monitoring Potential for Up-Coding Errors in EHR with the Help of a Medical Billing Service

There has been considerable resolve and persuasion from the Federal Government to introduce Electronic Health Record System across the health care continuum. The Health Information Technology for Economic and Clinical Health (HITECH) Act has indeed given much impetus to pace of conversion from paper to electronic medium. The bait of financial incentives and penalties for complying with ‘Meaningful Use Criterion’ or otherwise has done wonders to the overall macro clinical efficiency as well physicians’ operational efficiency. In fact, no one would have foreseen the extent of transformation when the Federal Government first announced its major IT reform in 2009.

One of the significant advantages of EHR is that it has enormously simplified complex documenting during the billing process. As a result physician practices have been able manage higher level coding with far more degree of confidence than before. But, amidst all these catalytic effects of EHR, EHR is also known to have paved for errors that had not been possible with paper documentation. While EHR’s ‘cloning feature’ allows one to copy previous notes to current notes, it could also inherit errors in the previous notes or be filled with information that may not be pertinent to the current visit. 

The consequence of such cloning is that it may promote coding inconsistencies or up-coding. While physicians may benefit initially with inflated reimbursements, they may be susceptible to audit later. Therefore, with their credibility at stake, they should see that EHR is utilized for the purpose it is meant for: safe and efficient patient care. Whether EHR errors come from system inadequacies or personnel incompetence during billing, physicians should actively involve themselves in resolving them through:

Charting reviews while processing bills through electronic systems

Sourcing EHR systems from vendors who promise what is right for you

Generating baseline CPT frequency report of your E&M services for each provider before you adopt an EHR

Evaluating variations in coding patterns

Reviewing your practice records and looking for evidence of cloning or carrying forward notes on physical exams and patient histories

Shutting down “auto-coder” if your EHR has one

Practically, it may seem too much to ask of physicians who are primarily motivated by clinical focus. The best recourse is to engage competent EHR consultants or medical billers and coders who offer EHR consultancy as an extended service. Medicalbillersandcoders.com– with an extended capability for EHR sourcing, implementing and monitoring for physician practices of varying sizes and specialties – should practically solve all of your EHR related woes. Our strategic alliance with leading EHR vendors will help you find custom-made EHR systems that make it easy to find out cloning and up-coding even before the claim is submitted to the payers or Medicare/Medicaid.

Private practices withstanding healthcare reforms: Revenue Management

Private practices are facing many challenges and gone are the days when physicians could easily start their own practice in a small office. The complexities in the form of changing policies, added administrative work and changes in Healthcare IT has made it very difficult for physicians to start or maintain a small or solo practice. Policy changes in the form of EMR/EHR implementation, the need for demonstration of ‘Meaningful Use’ and numerous changes in various departmental processes has made solo or private practice enormously cumbersome to handle and to sustain in terms of profitability. There are numerous other reasons that are forcing private practitioners to turn towards hospitals or form larger groups in order to bring sustainability to the practice.

A survey by Accenture has shed more light on the matter and has revealed that small practices are in the decline. Physicians are packing up their practices due to the uncertain business environment, better access to Healthcare IT in bigger institutions, and for a better manageable workweek. The survey also shows that individual practitioners are in decline at the rate of two percent annually and would decline by five percent annually by the year 2013. Another white paper by The Physicians Foundation examines the effect of the Patient Protection and Affordable Care Act on physician practices in the United States. The report clarifies the attitude of physicians when it comes to reforms and the effect it is having on the way physician practices operate. The survey finds that the majority of physicians plan to alter their practice patterns where the full-time, independent practitioner accepting third party payment would largely be replaced by part-time, locum-tenens, and concierge practitioners.

Small private practices are finding it more difficult to comply with all the guidelines in the reform and upgrade their systems and staff to a level where they can be qualified for the incentives. However, some practices are able to survive this change by employing the services of specialists in various departmental processes. Better EMR/EHR implementation, professional revenue cycle management, better denial management, and error-free medical billing and coding can give an edge to physicians who have decided to continue with their private practice. Optimization of these processes can ensure that physicians reap the financial benefits of the reform even as they provide better health care delivery through a complex process. Medicalbillersandcoders.com is the largest consortium of medical billers and coders in the United States which provides these services for physicians in addition to consultancy and other value added services.