Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Protect yourself against fraudulent EHR documentation

Robert Hitchcock, MD
Tech
January 5, 2013
Share
Tweet
Share

As physicians, we know that no matter what care we provide, Medicare and private payers are going to do what they can to reduce payouts. For the health of the nation, healthcare spending simply cannot continue on its current trajectory. Reform measures such as accountable care organizations, bundled payments and penalties for potentially preventable complications and readmissions may help reduce expenditures, but with healthcare representing such a large and continually growing proportion of this country’s GDP, additional steps are necessary.

So, what does all of this have to do with electronic medical records?

The intent of EHRs, of course, is to improve patient care and ultimately reduce costs—ergo, the government’s push for providers to transition from paper documentation to EHRs. The downside is that certain EHR functionality makes it easier for errors—whether intentional or not—to occur, and on a considerably larger scale.

Many, if not most, EHR systems implement macros, which allow users to generate a lot of documentation with one click. This practice, called charting by exception, can save a significant amount of time and makes using tedious systems less painful. But, the user must then carefully amend the record to make it accurate for that particular patient and visit or run the risk of fraudulent documentation. For some systems, macros are necessary to avoid productivity impacts from using EHRs. Many systems also feature functionality that permits the automatic population of certain parts of a patient’s record without provider review or without relevance to that visit, a practice known as chart cloning. As a result, documentation can be produced for services that were not actually provided. As you can see, upcoding is possible with both of these features.

Soon after The New York Times published its front-page article in September about the substantial increase in Medicare reimbursements for many hospitals after EHR implementation, HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder put hospitals on notice that instances of fraudulent behavior in connection with EHRs would be subject to criminal charges—and that steps would be taken to ferret out this type of fraud.

You could be vulnerable to suspicion of fraud if your EHR automatically generates codes inconsistent with your existing level of documentation—if your EHR suggests how to obtain higher reimbursement fees or how to generate higher codes, or if your EHR makes a patient’s chart more robust than what actually occurred during the patient visit.

As a practicing emergency department physician, I understand why doctors embrace macros and similar EHR features that reduce time spent on documentation and make their job seemingly so much easier. But, these benefits are not without risk, and the risk appears to be escalating as the federal government promises to begin taking a closer look.

You can protect yourself against the risk of improper coding by being familiar with the features of your EHR and how to use them properly. Not all EHR systems rely on cloning or auto-population to maintain clinician efficiency. Some EHRs are structured to avoid the potential for upcoding by enabling providers to capture the elements that populate the patient’s chart at the point of care, without impeding productivity.

With CMS and other payers looking for any good reason to decrease payments, and with the threat of fraud charges now hanging over our heads, it’s more important than ever to make sure that documentation is as accurate as we can make it—which is, after all, a primary goal of EHRs. Like it or not, this technology has become an integral part of the practice of medicine. Bear in mind, though, that it’s merely a tool. How you use it is up to you.

Robert Hitchcock is an emergency physician and Chief Medical Informatics Officer, T-System, Inc.

Image credit: Shutterstock.com

Prev

The increasing stress that radiologists face

January 5, 2013 Kevin 4
…
Next

2 ways to help your patients get better sleep

January 5, 2013 Kevin 3
…

Tagged as: Emergency Medicine, Health IT

Post navigation

< Previous Post
The increasing stress that radiologists face
Next Post >
2 ways to help your patients get better sleep

ADVERTISEMENT

More by Robert Hitchcock, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Keep your government hands off my EHR

    Robert Hitchcock, MD

More in Tech

  • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

    Shanice Spence-Miller, MD
  • How digital tools are reshaping the doctor-patient relationship

    Vineet Vishwanath
  • The promise and perils of AI in health care: Why we need better testing standards

    Max Rollwage, PhD
  • 3 tips for using AI medical scribes to save time charting

    Erica Dorn, FNP
  • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

    Gabe Jones, MBA
  • Generative AI 2025: a 20-minute cheat sheet for busy clinicians

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Protect yourself against fraudulent EHR documentation
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...