Geez, you can’t win for losing these days. First the feds put enormous pressure on hospitals to near-bankrupt themselves buying sophisticated EMRs and meet Meaningful Use standards. Now, as a piece in The New York Times notes, the feds are going after hospitals which are allegedly using EMRs to upcode Medicare and Medicaid claims.
As my colleague John notes, the key finding that The New York Times article discusses is that Medicare costs have gone up substantially for those using an EHR. This has the feds’ knickers in a twist. The administration now plans to look aggressively for providers who are committing coding fraud, while also considering whether it needs to change the way it pays for care.
In a letter signed by U.S. Attorney General Eric Holder Jr. and HHS secretary Kathleen Sebelius, the Obama administration said that their are “troubling indications” of abuse in how hospitals are using EMRs to bill for services.
The letter, which went out to five major hospital trade associations, warned that it was aware of abuses such as “cloning” of medical records — in which information on one patient is repeated in other records to inflate reimbursement. CMS has also gotten reports that hospitals are upcoding the intensity of care or severity of a patient’s condition.
The American Hospital Association, for its part, says the problem is partly on CMS’s own shoulders. As it noted in a letter responding to the administration, hospitals have been using CPT and E/M codes to report utilization at clinics and emergency departments. The AHA has asked CMS to implement a set of national hospital E/M visits developed by an independent expert panel, but to date, CMS has neither implemented those guidelines nor proposed its own, the association says.
You know what? I think the AHA has a very good point. Unless CMS issues a single national standard for reporting such visits, coding is going to all over the place. That’s just reality.
Meanwhile, as to whether hospitals are trying to put the squeeze on CMS by fraudulently upcoding, it’s anyone’s guess, but my theory is that hospitals are merely doing a better job of capturing what they’re already doing . So while I appreciate the need for CMS to be vigilant, they might want to do some studies before they accuse hospitals of criminal misbehavior.