Healthcare Technology Featured Article

October 01, 2012

Hospital Association Fires Back at Feds for 'Upcoding' Criticism


It’s been a strange couple of weeks. First, doctors were accused of using electronic health records (EHRs) for their own gain, “upcoding” or charging for more intense treatments of Medicare patients than needed, some not even seeing the patient, but billing for it anyway. 

Then the federal government came down on them. And now, the American Hospital Association (AHA) is chiming in with an answer to a Sept. 24 letter that the Department of Health and Human Services and Attorney General sent to five hospital associations warning about the use of electronic health records to “game” the billing system and commit fraud, according to a story at HealthData Management.

The New York Times, which also analyzed the data, found that “hospitals receiving government subsidies to adopt EHRs had a 47 percent increase in Medicare payments at higher levels from 2006 to 2010, compared with a 32 percent rise at hospitals that hadn’t received subsidies.”

AHA president and CEO Rich Umbdenstock said in the letter that hospitals in the U.S. “take seriously their obligation to properly bill for the services they provide to Medicare and Medicaid beneficiaries,” and that they have a firm and longstanding commitment “to compliance, establishing programs and committing resources to ensure that they receive only the payment to which they are entitled.”

Umbdenstock noted that that the alleged practices described in the letter – “cloning” of medical records and “upcoding”’ of the intensity of care – should not be tolerated.

“Electronic health records hold great promise for improving the efficiency and effectiveness of care. Hospitals have made great strides to comply with the Administration’s regulations for implementing this technology, which also enhances their ability to correctly document and code the care a patient has received,” he added.

Ironically, some believe that the very technology itself may be to blame. The report noted that doctors may been “undercoding” for years, using paper charts. “Technology is simply making coding more efficient,” she revealed.

“It’s critically important to recognize that more accurate documentation of coding does not necessarily equate with fraud. Medicare and Medicaid payment rules are highly complex and the complexity is increasing,” the letter read. “The AHA has long called for national guidelines for hospital ED and clinic visits, and we stand ready to work with CMS in the development and vetting of such guidelines. . . Hospitals share the Administration’s goal of a health system that offers high quality, affordable care and work hard to ensure billing is correct the first time. What’s needed is clearer guidance from CMS, not duplicative audits that divert much needed resources from patient care.”




Edited by Brooke Neuman
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