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Incorrectly Coded E/M Claims and How Your EMR is Helping?

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Electronic Medical Records (EMRs) have streamlined the storage, retrieval and modification of medical records. Additionally, EMR vendors flaunt that the systems lead to enhanced accuracy in evaluation and management (E/M) coding via features such as better charge capture, higher reimbursements and extensive insurance follow up.

However, despite EMRs generally having templates for coding or computer assisted coding (CAC), they were not initially built as coding instruments and have shown several problems with the process. Thus, there is always the doubt of fraudulent coding in these systems for which the Department of Health and Human Services’ Office of the Inspector General (OIG) is trying to devise solutions.

A report issued by the OIG in May revealed a loss of $6.7 billion in improper Medicare payments due to fifty-five percent of E/M service claims in 2010 being wrongly coded and/or lacking documentation.

The report highlighted that 32.3 billion for E/M services were paid by Medicare that year, which represented about 30 percent of 2010’s Part B payments. Additionally, in 2010, the OIG disclosed that the billing of higher level codes by physicians had risen, and this had caused higher payment levels for E/M services of all visit types from 2001 to 2010.

Moreover, the Centers for Medicare & Medicaid Services (CMS)disclosed that E/M claims were 50 percent more probable to be paid for as errors in contrast to other Part B services, adding that the highest amount of improper payments were due to insufficient documentation and faults in coding.

A medical record review by the CMS found that the $6.7 billion loss was 21 percent of Medicare payments for E/M services in 2010. They also revealed that 42 percent of claims for E/M services that year were incorrectly coded, while 19 percent lacked in documentation.

How your EMR is helping?

You can use your EMR to generate comparative billing reports for evaluation and management services in addition to yearly chart reviews to identify E/M issues.  Reviewing your notes also helps identify if your notes are clinically important and accurate.

Moreover, EMR tools help ensure that you are up coding when it is required and down coding when that is required. This helps overcome numerous potential errors.

Additionally, if you customize your EMR templates to make them increasingly practice-specific, and to represent your most regular patient types, you will encounter lesser errors. Moreover, you have the ability to select and fill out multiple fields which could save you a lot of time, but make sure you are alert as patients’ conditions vary.

In conclusion, an EMR system is not the only requisite to avoid inaccurate coding; you also need to pay attention while the entries are being made as many human errors will bypass the systems.

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