In EHR-equipped EDs, high bills not indicative of fraud

Tools

Higher coding in emergency departments (ED) that use EHRS may be due to their treatment of sicker patients and more complex cases--not necessarily billing fraud, according to new analysis published in the New England Journal of Medicine.   

The analysis of Medicare ED discharges, conducted by Stephen R Pitts, M.D., of Emory University School of Medicine in Atlanta, acknowledges  that EHRs, with their checklists and templates, can facilitate improper billing behavior.

However, many other factors have likely contributed to the higher billing rates in the ED. These other factors include a marked increased in the use of new diagnostic technology; the greater use of the ED for first contact care; the desire for greater medical certainty before discharging a patient due to the lack of medical homes and other follow up care; and reduced inpatient capability, leading to a shift of work from inpatient floors to the ED.

"The result of these changes is an increasingly interventionist ED practice style, illustrated not only by increased imaging, but also by increased laboratory testing and initiation of IV fluids. Whether this trend has truly improved patient safety and quality of care is unknown, but it has certainly increased the complexity of the medical decision-making component of documentation, which translates into higher physician billing," he points out.

Pitts recommended that to prevent improper billing physicians should receive coding education, their claims reviewed, and higher billers be scrutinized, as recommended by the Office of the Inspector General in a recent report on physician billing.

To learn more:
- here's the article
- read the OIG's report

Related Articles:
EHRs increasingly the target of fraud fighters
OIG official: 2013 work plan to focus on EHR-enabled fraud
Mostashari to investigate EHR overbilling accusations