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All Things HIT

Sep 29 2012   5:52PM GMT

CMS’s warning on EHR billing fraud is a mistake chasing a mistake!

Posted by: AllinHIT
CMS, Coding and documentation, EHR fraud and abuse, Fraud and abuse, HHS, Medicare fraud and abuse, ONC, upcoding

HHS chief Kathleen Sebelius, and Attorney General Eric Holder, recently sent a letter to five hospital organizations –the American Hospital Association (AHA), Federation of American Hospitals (FHA), Association of Academic Health Centers (AAHC), Association of American Medical Colleges (AAMC) and the National Association of Public Hospitals and Health Systems (NAPH) — warning that their EHR should not be used to game the system when billing CMS.

My first thought was that hospitals should  heed the warning. The Obama administration has been very diligent in exposing Medicare fraud, probably more than any other administration in U.S. history. It was announced last week that Recovery Audit Contractor (RAC), Connolly, will be conducting extensive audits on CPT 99215 (a level five office visit), much to the chagrin of the AMA. My second thought was these audits, and the warning of audits associated with EHR use could penalize physicians for honest mistakes during implementation. The warning is a mistake chasing a mistake!

I’ve seen many instances where the physician has keyed in the wrong code, as an Epic trainer and go-live consultant. Capturing the N2 billing code when it should have been the E2 billing code for an established patient is one example. Of course, the N2 code (new patient, service level 2), is at a higher reimbursement.  These are honest, unintentional mistakes that are very common during implementation and beyond. This warning will only increase the wait times physicians are already dealing with during implementation. Don’t get me wrong, I do understand that fraudulent intent is possible with some practices, and the government must address these issues. However, I’m at odds with the timing and the approach. Hence, I have a couple of suggestions for HHS/CMS/ONC.

My first suggestion has to do with the approach. Extending a hand to assist hospitals with billing more accurately with their EHR is a better approach than warning these five organizations. This approach reflects a supportive role in solving the issue of inaccurate billing, versus a punitive role in a criminal and fraudulent billing. There is a huge difference between the two, the latter represents a threatening tone, whereas the former reflects collaborative one. Mock audits for hospitals should be done on a volunteer basis once the right approach has been established. This would accomplish two things; 1) It would be a real assessment of the hospital’s exposure, allowing them to implement corrective action and develop best practices. 2) It would give CMS an idea of the most common mistakes made with EHR billing.  This is just a few suggestions, out of many.  I’m certain that the AHA, FHA, AAHC, AAMC and the NAPH also have a few!

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