Electronic health records are being blamed, in part, for the skyrocketing payments associated with level four and level five evaluation and management codes. Over the last decade, the additional costs for E&M coding increases are estimated to be in the billions.
Early in September The Center for Public Integrity and CMS released several reports detailing how auto-coding, record cloning, and EHR software prompts make it easy to achieve inflated upper-level coding and additional payment for services. It’s safe to assume that other payers are also analyzing claim submissions to determine if the number of level four and level five E&M codes are increasing for a provider or group.
Whether you currently have an EHR or not, there are some steps your practice can take to ensure that it is in compliance with Medicare standards, and lower its risk profile.
- If your practice doesn't have a compliance plan — get one. Call your specialty society or use the version available on the OIG's website called OIG Compliance Program for Individual and Small Group Physician Practices. You can download the article by clicking here.
- Whether you are using and EHR or paper charts, it is critical that you are actually doing chart reviews.
- If you are shopping for an EHR, be very wary of vendors who promise your patient encounters will come out at a higher level after you adopt their system.
- Run a productivity report of your E&M services for each provider before you adopt an EHR to determine a baseline of what percentage of your visits currently fall into the level four and five category.
- If you already have an EHR, running a productivity report quarterly is a must. Look carefully at your practice's use of level 1 through level 5 codes for new patients, consults, established patients, and hospital visits for each provider.
- Assess variations within your practice. Is there one provider whose visits all seem to be level four, while other providers’ codes are more varied?
- Audit your practice records to make sure that there is sufficient documentation to justify the level coded, whether using paper or electronic records. Look for evidence of cloning or carrying forward notes on physical exams and patient histories. For paper records, remember the rule “if it’s not documented, it didn’t happen.”
- If you are using voice recognition-transcribed notes, make sure that the final note makes sense. Voice recognition programs often don’t “hear” similar words correctly and “the eye” could be heard as “thigh”, etc…
- Consider turning off the "auto-coder." As many coding experts have pointed out, physicians still need to use their brains. Remember, the nature of the presenting problem will be looked at in an audit — as uncomfortable as an ingrown toenail is, it hardly qualifies as a level 4 problem in terms of complexity and medical decision making.
Most of all — be proactive. There's little reason to doubt that the OIG will be looking at the connection between EHR-prompted coding and overbilling for patient services. Make sure your patient records accurately reflect physician services