Electronic Health Records
Driven by government incentives, as well as the move towards more high tech solutions to improve the overall quality of care, more hospital systems are transitioning to Electronic Health Records (EHR). Although there are significant benefits of utilizing an EHR, there is also the risk that sloppy or abusive EHR practices may lead to increased reimbursement. One of these practices is chart “cloning”. Chart cloning occurs when information in one medical record is used repeatedly in other medical records. This concern prompted a recent warning letter from U.S. Attorney General Eric Holder and the Secretary of Health and Human Services Kathleen Sebelius to five major hospital trade associations, citing possible abuses involving technology (including chart “cloning”) that are designed to inflate reimbursement. The letter came on the heels of a front-page-article in The New York Times (“Medicare Billing Rises as Records turn Electronic” New York Times, 21 September 2012) which detailed the ways in which the greater use of electronic records by hospitals and doctors might be contributing to a rise in Medicare billing. This article stated that much of the higher billing is taking place in hospital emergency rooms, where hospitals are classifying many more patients as sicker and needing more care.
Electronic documentation habits such as copy and paste do save valuable time by reducing the amount of time a provider needs to spend to complete documentation. An oft-used practice with EHRs is to copy information from one patient encounter and use it as a template to insert into the next record during similar encounters. This bad habit can also be perpetuated when senior providers pass down the practice during training. Finally, the use of macros in EHRs can cause the charts to look similar regardless of the “medical necessity” of what was documented. The overall effect of “cloning” is that it can harm the record by taking away the credibility of the provider’s documentation while at the same time also putting the provider and practice at risk for losing audits and resulting in payer take-backs.
How can providers avoid this trap? The solution requires an understanding that the EHR is just another tool for documentation and not the answer to documentation challenges. Providers also need to keep in mind that replicating bad documentation practices “electronically” simply results in a “bad practice that you can do faster.” Finally, providers must embrace a certain responsibility to prevent copy-and-paste errors and other documentation mistakes. Awareness and education is the first step in addressing this problem and will allow provider groups to proactively establish clearly defined policies against this practice.
We have provided selected portions of the September 24, 2012 New York Times article on the following pages, along with links to both New York Times articles referenced above. If you would like to discuss this with a MedData representative please contact your MedData Client Service Director and they will put you in touch with someone from MedData’s Compliance Department.
The following are selected portions from a September 24, 2012 article in the New York Times titled “U.S. Warning to Hospitals on Medicare Bill Abuses,” written by Reed Abelson and Julie Creswell.
Saying there are “troubling indications” of abuse in the way hospitals use electronic records to bill for Medicare and Medicaid reimbursement, the Obama administration warned on Monday that it would not tolerate what it called attempts to “game the system” and vowed to vigorously prosecute doctors and hospitals implicated in fraud.
The strongly worded letter, signed by the Attorney General, Eric H. Holder Jr., and the Secretary of Health and Human Services, Kathleen Sebelius, said, “electronic health records have the potential to save money and save lives.”
But the letter continued, “There are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled. False documentation of care is not just bad patient care; it’s illegal.”
“Obviously, we are very concerned” that the adoption of electronic health records “could lead to coding inappropriately,” an administration official said. While aggressively looking for any providers who are committing fraud, the administration will also consider whether it needs to make changes in the way it pays for care.
The letter, sent to five major hospital trade associations, cited possible abuses including “cloning” of medical records, where information about one patient is repeated in other records to inflate reimbursement.
“There are also reports that some hospitals may be using electronic health records to facilitate ‘up-coding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care,” the letter said.
Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to an analysis by The Times of Medicare data from the American Hospital Directory. Regulators also say physicians have changed the way they bill for office visits similarly, increasing their payments by billions of dollars.
Regulators, including the Office of Inspector General for Health and Human Services, are concerned about the increase in billing for the most expensive evaluation services by hospitals, in the emergency room, and by doctors in their offices. Private insurers have also expressed concern about the higher level of billing.
The Centers for Medicare and Medicaid Services is conducting audits to prevent improper billing. The agency is also starting more extensive medical reviews of billing practices that will identify those hospitals or doctors that are billing for much more expensive services than their peers, according to the letter. While not unprecedented, the letter is especially blunt.
“This letter underscores our resolve to ensure payment accuracy and to prevent and prosecute health care fraud,” the letter said. The letter reminded hospitals that a patient’s medical information “must be verified individually to ensure accuracy: it cannot be cut and pasted from a different record of the patient, which risks medical errors as well as overpayments.”