How electronic medical records can lead to coding fraud, and get doctors into major trouble

The perfect storm is coming.

So says a cautionary article shows the dangers of adopting the current generation of electronic medical records. Many of these systems are template-based, leading to easy “cut and paste” documentation. Given the time pressures doctors are increasingly facing, there is tremendous incentive to over-document and over-code.

The subsequent uptick in higher-coding visits, like 99214s and 99215s, is catching the attention of regulators, who are beginning to audit these notes. When a group of coders looked at physician charts from four different practices, they found the failure rate of a chart failing an audit ranged from 20 to 95 percent. The subsequent penalties were found to be from $50,000 to $175,000 per physician, and the outcomes “have been devastating, emotionally as well as financially, for the physicians and staffs of the practices involved.”

Each of these practices used different EMRs, but obviously, the coding engine failed in each instance.

“Automation is not documentation,” write the authors, cautioning doctors that the repercussions of repetitive coding will become increasingly more prevalent as more physicians go digital with the current crop of flawed systems.

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  • Anonymous

    Great points, all. And also ironic that some small physician groups are looking toward EHR as way to actually justify higher billing. Given that EHR is so expensive (even with Obama’s proposed goverment support) it seems that docs and insurers will continue to do the dance, but perhaps virtually rather than by telephone…


  • Anonymous

    I can’t quite understand how this could have happened unless the doctors were keeping an EHR and a paper record as well. Think about it – if you audit an EHR and the level of care that’s documents (even cut/pasted) supports the level of service that’s charged this is accurate coding and a strength of template driven EHR (since it reminds you to document things that you’ve done).

    However if they were dinged for paper records that were discordant, well this is another reason to do away with paper charting. And no, not for perpetuating fraud, but simply because we end up doing more than we can document in the 15 minutes given to us for patient care.

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