With the financial incentives and health care reform that the Obama administration has promised to provide the health care industry, more and more providers are beginning to consider the implementation of an EMR system in their practice.
The idea behind an EMR system is to improve workflow and overall efficiency within the practice and allow providers to provide enhanced quality care and patient safety.
Most physicians also make it a priority of achieving compliant evaluation and management (E/M) coding within their practice. Physicians are often sold on “the promise” that these sophisticated and costly EMR systems will ensure that compliant documentation is achieved and applicable coding is correct, thereby making any E/M decision-making problems disappear.
Unfortunately, the increase in the number of government audits such as the Medicare RAC has revealed that some EMR systems have allowed, or even worse facilitated, the creation of incorrect coding and non-compliant documentation that has led to potentially fraudulent claims for E/M services. Such cases can lead to severe financial penalties and even close the doors on some practices.
During the last several years, numerous articles have high lighted compliance problems intrinsic to the majority of the current EHR systems that are on the market. The number one complaint of such systems relates to coding engines that fail to consider a medical necessity, which CMS describes as “the fundamental reason for payment”.
Some EMR vendors promote their systems by informing providers that they will now be able to increase their reimbursement and bill for higher-level office visits as their EMR system will create the documentation to support that level of visit.
One that is considering purchasing an EMR system due to the financial incentives that are out there must be wary of a vendor that is selling their system based on this viewpoint.
One such practice located on the West Coast purchased an EMR system with the intent to get rid of their current three coders and to use the system for all their coding purposes. Historically this practice did not code for services higher than a level 3 office visit but their EMR system was consistently calling for level 4’s and 5’s.
It didn’t take long for the nightmare to follow when the Centers for Medicare and Medicaid showed up for an audit and recouped more than $1 million in refunds, fines, and penalties owed to CMS. That practice immediately stopped relying on their EMR system for coding and hired five coders to ensure that their coding was done properly moving forward.
When practices investigate the possibility of purchasing an EMR system, they should include experts with a background in compliance and quality documentation on their EMR evaluation team. As a condition for purchase, one should require that the EMR system contains only compliant documentation and coding features.
As folks move forward to take advantage of the incentives that are out there to purchase EMR systems, it’s critical to remember that the main purpose of these systems is to improve your practice’s overall efficiency and quality care that you provide your patients.