Recently, there have been many calls from around the industry that medical coders are using Electronic Health Records (EHRs) software to overstate their collections and as a result, boost their payments. However, the government has taken notice of this and is taking steps to ensure that this does not go on any further. The government is investigating the potential of EHRs to aid in fraud and abuse due to an increased rate of payments to those who have adopted EHR software.
But looking at the other side of the picture presents a different story. The healthcare professionals are of the opinion that EHRs allow them to actually better document their claims and more accurately, thereby increasing the rate of payments.
So who is at fault? Are EHR systems really prone to these loopholes or there is no such grey area? Do EHR systems really increase accuracy of claims filed and improve payments? Someone who is going to adopt the EHR technology might be concerned with both aspects. The fact of the matter is, EHR systems do in fact help physicians document their services more accurately. However, up-coding for the sake of receiving higher payments might be a problem area, but nothing that cannot be controlled.
You must adhere to coding guidelines. In order to minimize your risk of exposure to RAC audits, make sure multiple patient notes do not contain identical text. This will help in having specific information about every patient and will reduce chances of any fraud.
You must educate yourself on the latest HHS coding guidelines in order to have a better understanding of how it is done.
Another important method to avoid any frauds is to conduct regular internal audits by an independent coder to know if there are any grey areas.