imageCome on folks bring something to the table or some data. We have same problem with studies out all over the web that won’t give you the data either to verify models. NISS and I have discussions over some of the material they research, study with no data meant in one case over a million available models.  Remember Accretive, a 3rd party that even went to far as to show Wall Street executives actual patient files and got busted when they lost their notebook in addition to a few other non ethical activities. See what I keep saying, having folks around with some background in coding, health IT helps a lot so when news comes out, those folks know where to go look, better than a “guessing perception”.

Accretive Health Debt Collector Employee Has Laptop Stolen With Non Encrypted Patient Data from 2 Hospitals And Had Access to All the Data Via Revenue Cycling - Patient Information Was Shared With Wall Street Investors – Algorithms For Profit Again?

I read that letter back in September and myself and others on the web said the same thing then, show us something.  Copy and paste is  needed portion of entering chart records and like anything else it can be abused but again it depends on the design of the medical records and doctors are supposed to enter notes “as they see it”.  A little copy and paste of relevant material beats the heck out of a big long template any day as you are getting the doctor’s interpretation that way.  A template with words other than the ones produced by the doctor are also easy to find as well.  A little copy and paste as I have seen it may only be a portion of the chart note too, only what applies…anybody remember “auto text” on Word documents, been around for a long time and some doctor still do their notes this way.  I used to watch them do it when they didn’t have an EHR, so we can’t boycott “Word” too can we? 

HHS and DOJ Send Letters to Hospital Trade Associations Warning of Gaming Billing System Via Use of Electronic Medical Records–Hospitals Just Learned How to Bill Better & Hired Consultants–Case of Being Algo Duped With Numbers?

You can read more at the link below as I used to help doctors bill for extended visits when they legally did the work and EHRs do imagemake the documentation easier.  Sure there’s cheaters everywhere but most are not so let’s go after those guys and cut out the blanket accusations.  Just because one doesn’t understand the mechanics of an EHR, ask first.  Here’s your most common area right here with the 99213 for ambulatory and you can see pre-audits are coming on those.  Geez when I integrated my program with a billing program I literally had a visual of a super bill screen they could use and put in their ICD9 codes  and it went right to the billing software and created a claim.  Back a few years ago the visual of a super bill helped in the move to electronic records as it was something all were familiar with seeing.  Today you still see it but it’s not needed as another combined screen makes it more efficient. 

Medicare Contractors to Expand Prepayment Audits To Include Office Visits Beyond a 99213 To Ensure Documentation for 99214 and 99215 Is In Order For Higher Level Extended Visits and Exams

Most of the systems have options too, and consultants come in and lend a hand there with configurations. It’s like me buying a copy of “Word” to use, and Microsoft is not liable for what I do with it.  One thing too seniors do require more time.  A doctor friend of mine says that all the time and that it was more fun when he was younger as his base of patients did not have as many seniors and he felt the diagnosis processes were easier, which they were for a couple of reasons, younger people don’t have as many chronic conditions and we more identified of them identified today plus getting old sucks and the older we get, the more issues we are likely to have.  I don’t think I need a study for that as it’s common sense as getting old sucks.  Patient demographics changed a lot for him in twenty years. 

So you do have two legal items that will result in higher billing to a degree with older patients needing more time and the doctor being able to chart and document versus having a paper chart.  That fear of going beyond a 99213 is real and many doctors would not bill for their actual time for the fact that it would stall and delay claims getting paid.  There’s more than me that will tell you that, I heard it plenty of times and again part of the benefits of an EHR is the ability to actually bill for the real time spent and have the needed documentation.  There’s nothing that a practice hates worse than having claims stalled as now you go into gosh knows how long before it may get paid.

Yes there are cheaters as it is not a perfect world and the new fraud prevention software will and already is a big help there.  Those folks do need to be caught and we have come a long ways as it’s not as easy anymore for folks to commit some the blatant fraud as the software catches a lot of it.  Clearinghouse services help providers as well with catching real mistake too.

EHR Vendors to Focus on Usability? What a Surprise, Many Systems Have Done This For Years, EHR Systems Owned By Insurers Though Might Be Subject to Different Flavors and Goals

Again I go back to the low hanging fruit out there with big conglomerates like HCA who is said to be so far ahead of the average. 

How is HCA a For Profit Hospital Chain, Making All That Money–Billing in the ER a Contributing Factor for Reimbursements–The Algorithms Move Money and Created Some Very Large Profits And Others Generated ER Care Parameters for the Facilities

Let’s not forget the other side of the coin here that comes up with insurers using their algorithms to where their math was denying compensation and we have a 3rd party involved here, where I think the hunt will end up most of the time, so compensation is dependent on the algorithms on the other side.

Med Solutions ended up with a Senate investigation and found that sure there were some denied appropriately but how about the ones inappropriately denied, like in this case.  Medicare has contractors that are subsidiaries of insurance companies so is there an incentive to watch for this?  It’s just a question worth pondering as insurers when they do their own might be watching the pennies a little closer but to cut the amount of claims and bills down when they get paid for processing might take a little money out of the over all till? 

Med Solutions and Blue Cross Caught On the Stress Test Denial Algorithm (video)

Again I think the new software that HHS is running should pin point a lot of abuse and that’s the best tool to algorithmically search and find patterns.  I really just don’t get it with EHR vendors on the whole being the cause and I will say this that when a 3rd party vendor promises additional income or savings at a certain percentage, well we have a little history on a few of those as to what can happen.  Was this just not in the news a couple days ago?

Government Recovers $4.2 Billion in Medicare and Medicaid Fraud–With Numbers This Good Using Anti Fraud Analytics To Help Identify Patterns, Maybe Some Cheating Obsessions Might Lighten Up A Little

It certainly is not going to be buried in some “hard” coding in a software program but again parameters can be set as well as the parameters of any 3rd party supplied software. I realize too the average person is not going to have the same perception and facts that I talk about as they have never written code and everyone who doesn’t understand the mechanics out there guesses and and doesn’t have a “mechanical perception” on how this all works.  Many folks work with various versions of  spreadsheets with code added to their functionality for their analytics but remember some developer wrote those too:)  BD   


The Obama administration is forging ahead with a multi-billion dollar plan to shift from paper to electronic medical records, despite continuing concerns the program may be prompting some doctors and hospitals to improperly bill higher fees to Medicare. An investigation into those billing questions — which convened a hearing Wednesday — has yet to produce much in the way of results, and critics are questioning the seriousness of the efforts.  

“There is a lot we don’t know about that,” Farzad Mostashari, the National Coordinator for Health Information Technology, said Wednesday at a hearing of policy experts studying the billing issue. “We don’t know if the shift (in higher billing) reflects appropriate coding or inappropriate coding.” He added: “We don’t know if this leads to an increase in costs … or has other impacts.”

At the hearing’s conclusion panel chair Paul Tang, of the Palo Alto Medical Foundation in California, said that the group had little information about whether digital records improperly contributed to rising health care costs.

“We don’t have any data, positive or negative, that would be useful,” he said.


Post a Comment

Google Analytics Alternative