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.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “Upcoding

  1. Pat
    May 15, 2013 at 12:43 pm

    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.

  2. Dug
    May 15, 2013 at 10:10 am

    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.

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