A recent study reported in a Modern Healthcare article found that EHRs didn’t cause upcoding, despite fears of note cloning and overdocumentation that resulted in increased scrutiny of EHR-using providers by the Office of the Inspector General for HHS.
The study, published by Julia Adler-Milstein of the University of Michigan and Dr. Ashish K. Jha, an internist with the Veterans Affairs Department and professor with the Harvard School of Public Health, compared billing from two groups of hospitals using a case-mix index. The study compared early adopters of EHRs, from 2008 to 2012, and hospitals that were similar in all other respects except EHR use.
The two groups were indistinguishable, the authors found, with both increasing the weight of their codes nearly identically. They also reported that the results held for several subgroups including hospitals with the highest proportions of Medicare admissions, hospitals in the most competitive markets, and for-profit hospitals.
One of the authors, Dr. Ashish K. Jha, said in an interview that while his co-author believed from the start that hospitals wouldn’t wait for EHRs to maximize coding, he approached the study with a different opinion. In fact, he accepted initial reports of upcoding at face value.
“And I was wrong,” he said in the Modern Healthcare interview. “This (study) should offer everyone a little bit of reassurance, that we have not created this one, very important, potentially financially significant, unintended consequence. I think everyone has been worried about this.”
Jha did warn that this doesn’t mean the issue is dead. “We need to track this—I don’t think the issue is settled and done,” he warns. “But as long as we monitor this closely, it shouldn’t be an issue.”
The OIG issued a January 2014 report revealing the results of a questionnaire it had disseminated among Medicare’s contractors, in which it found few efforts to police or oversee potential fraud enabled by EHR systems. This report followed a September 2012 New York Times article that reported EHR software allowed doctors to copy-and-paste documentation from one encounter to another to generate fraudulent claims or to use artificial intelligence to ensure the most intensive code for a given procedure.
As we reported in a January 2014 post, EMR Copy and Paste: How to Avoid Fraud, neither of these actions necessarily causes fraud, and there are safeguards that practices can use to insure they are not in danger of giving the appearance of fraud.
In fact, MediTouch EHR software gives providers the tools they need to ensure they are coding and billing appropriately, including:
- Tools to help you select the appropriate level of E&M coding to reflect the level of difficulty and time spent for the encounter
- Reporting options that allow you to track your percentages for each E&M code and compare to your peers
- Grand Central option allows you to accurately tailor the imported older record with current treatment plan, history, physical exam and more
And as we said in that blog post, “just as Quickbooks doesn’t cause embezzlement, EHRs don’t cause Medicare fraud.“
We’re glad to see actual research that supports this idea, instead of assumptions.