BNA’s Health Care Daily Report™ sets the standard for reliable, high-intensity coverage of breaking health care news, covering all major legal, policy, industry, and consumer developments in a...
Providers may be using electronic health record (EHR) technology to engage in illegal Medicare billing practices, according to a letter the departments of Health and Human Services and Justice sent to five hospital associations Sept. 24.
DOJ and HHS said they have become aware of “troubling indications” that some providers may be electronically duplicating patient records to increase Medicare billing.
“There are also reports that some hospitals may be using electronic health records to facilitate 'upcoding' 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.
The letter, signed by HHS Secretary Kathleen Sebelius and Attorney General Eric Holder, also said HHS and DOJ would ramp up efforts to pursue and prosecute any fraud associated with EHRs.
“The Department of Justice, the Department of Health and Human Services, the [Federal Bureau of Investigation], and other law enforcement agencies are monitoring these trends, and will take action where warranted,” the departments said in the letter, which was sent to the American Hospital Association, the Federation of American Hospitals, the Association of Academic Health Centers, the Association of American Medical Colleges, and the National Association of Public Hospitals and Health Systems.
Provider adoption of EHR technology has been on the rise in part due to a Medicare and Medicaid incentive program.
The program was mandated under the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Reinvestment and Recovery Act (ARRA), to encourage physicians and hospitals to adopt and meaningfully use certified EHR systems to improve care and save costs.
AHA, in a response to the HHS-DOJ letter, said that while it agreed that upcoding and using EHRs to duplicate patient records should not be allowed, the Centers for Medicare & Medicaid Services should provide national guidelines for evaluation and management (E/M) coding.
E/M coding converts a patient-doctor visit into a five-digit Current Procedural Terminology (CPT) code that is then used for billing purposes.
“What's needed is clearer guidance from CMS, not duplicative audits that divert much needed resources from patient care,” AHA President and Chief Executive Officer Richard Umbdenstock said in the letter.
Hospitals face a growing number of auditors, including Recovery Audit Contractors and Medicare Administrative Contractors, he said.
Umbdenstock said that once CMS releases national guidelines, a proposal should be “presented to the AMA's CPT Editorial Panel to create unique CPT codes for hospital reporting of ED [emergency department] and clinic visits based on the national guidelines.”
AHA has made 11 requests to CMS since 2001 to create national guidelines for coding hospital emergency department and clinic visits, Umbdenstock said.
In a response to BNA, Joel White, executive director of the Health IT NOW Coalition, said Sept. 25 he agreed that national coding guidelines need to be released.
“The AHA response was appropriate,” White said. “The administration shares some responsibility for upgrading coding standards.”
The Health IT Now Coalition represents 65 health information technology organizations and promotes the deployment of health IT solutions.
White also said the administration should do more to leverage existing technologies, such as authenticated biometrics, to protect EHRs from fraud.
Overall, White said he was pleased that the administration was “stepping up to fight EHR fraud” and that the letter will lead to hospitals tightening up their policies surrounding the use of EHRs.
Harry Greenspun, a senior adviser for health care transformation and technology at the Deloitte Center for Health Solutions, told BNA Sept. 25 that while EHRs can facilitate upcoding, they can also help with investigations into possible fraud.
“This should help dampen some criticism of the use of EHRs for upcoding,” Greenspun said. “More importantly, given that as much as 30 percent of health care spending is wasted on unnecessary, inefficient, and uncoordinated care (along with a smaller contribution of fraud), the conversion to electronic health data is essential to control that waste.”
By James Swann
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)