Upcoding
Ready for the new controversy in healthcare? Before electronic medical records took over there was a criticism of doctors that they didn’t put enough information or documentation in the patient’s chart for each visit. This was really for billing and coding purposes and in no way reflected reality or the work doctors did with a patient. Doctors were punished for this by not being able to bill as much for each visit. With the advent of the EMR or EHR there came an advantage to the new technology. It made it easier to code each visit and get an optimal reimbursement. Of course, no advantage can ever go to the physicians so that will have to stop as well. In a new American Medical News article, they list how the Centers for Medicare & Medicaid Services are now scrutinizing the accuracy of physician documentation who use the features of electronic health record systems to support their billing. “Auditors and lawmakers have suggested that recent increases in the rates at which doctors bill costlier, higher-level services could be attributable to the enhanced billing capabilities provided by EHRs.” We are damned if we do and damned if we don’t! The whole thing is a stupid cat-and-mouse game anyway. Coding and billing and auditing are creations of the insurance companies who want to screw docs out of payment. Any benefits given to the physicians will soon be removed by the all powerful insurers. And the worst part is that none of it means anything to patient care. That is why a “monthly membership” model without billing a third-party would remove all this. Without the risk of auditing the only thing that would be placed in the chart is the basic SOAP note and those things pertinent to the patient’s care.
Recall that several years ago one of the major payers in California was taken to court by a physician group because it had started to massively disallow Level 4’s – because, of course, a lot more Level 4’s were being submitted thanks to the adoption of EMR’s.
An efficient note on a patient well-known to a competent physician could simply read: [Vitals], continuing mildly prod’v cough. Exam normal. Bronchitis. z-pak”
The doc already knows the patient has hypertension, and has already counseled him 20 times not to smoke. The notes are minimal as is the wait time and administrative overhead. The patient got better care – yes better! – because the doc spent more time with him and less working for the insurance companies and government. Repeating all this is as wasteful as it is stupid.
yes alot of what is observed and discussed is “normal”. So writing all that down is a potential time waster unles done quickly, but they dont like it if your notes appear to much like you pasted it in from a template. Insurers want a custom burger for every patient but only want to pay for shit on a shingle.