The average physician who uses an electronic health record (EHR) undercharges an estimated $30,000 or more each year based on evaluation and management (E/M) coding. In some cases this additional income could greatly impact the overall financial health of a practice. A deeper understanding
The shortfall occurs when reviews are based on the medical necessity of the visit and what is actually performed during the history, physical and complexity determination. Compounding this, EHRs tend to bring in text through copy and paste or templates that often contains inaccuracies, but which may be used to support the E/M code that is submitted. The Office of Inspector General (OIG) of the HHS considers this to be consistent with fraud, as detailed in the OIG’s Semiannual Report to Congress released in the Spring of 2014, and an echo of similar concerns expressed in the OIG annual work plans for 2012, 2013, and 2014.
This has resulted in a situation where:
1. Providers are being under-compensated for their work, while at the same time:
2. Generating documents containing imported text that could put them, in the opinion of the OIG and others, guilty of committing fraud.
Inaccurate EHR based E/M coding occurs as a result of:
- Poorly designed EHR coding tools (there is no peer-review, certification process or vendor oversight for EHR based automated E/M coding tools, it is completely up to the vendor to interpret the E/M coding guidelines).
- Poorly implemented EHR systems with regards to their E/M coding components, including templates and default settings.
- Difficult to use tools to modify E/M related settings and inadequate user training materials.
- A lack of user knowledge as to the nuances of E/M and how to apply these to their to their EHR.
- A lack of coding professional involvement in setting up and maintaining EHR coding components.
Inaccurate documentation resulting from imported text is largely tied to providers being in a hurry, but also related to EHRs not giving adequate warnings that text has been imported.
A growing number of practices who engage in in-depth analysis and optimization of the EHRs have seen marked revenue increases, with more accurate E/M coding being a major contributor. Now that you have gone through the pain of adopting an EHR, it is time to learn how take full advantage of it as a clinical and business tool.
The following articles provide additional details on EHR coding and documentation challenges:
- EHRs and E/M Coding: Warnings, Pitfalls and Best Practices
- Warning: Import Text Properly – Ensure Clinical Documentation Integrity in your Electronic Health Records
For further information and insight on EHRs as business tools, please contact Dr. Michael Stearns at email@example.com
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