Study: Hospitals Are Not Systematically Upcoding to Increase Reimbursement

A new study has found hospitals are not using electronic health records to increase the bills they are submitting to Medicare.

The study was performed by Ashish Jha, MD, MPH, a researcher at the Harvard School of Public Health in Boston, and Julia Adler-Milstein, PhD, an assistant professor at the University of Michigan School of Public Health in Ann Arbor. 

For the study, the researchers compared billing records from 393 hospitals with EHRs to 782 hospitals that still utilize paper records. The researchers compared hospitals that matched in a number of areas, such as size and status as a for-profit or nonprofit institution.

"We found that EHRs didn't really change billing practices at all," said Dr. Jha, in a Kaiser Health News report.

However, Donald Simborg, MD, an associate professor of medicine at the University of California, San Francisco School of Medicine, who has led government advisory panels concerning fraud and digital health records, believes the study fails to touch upon the area that really needs to be examined.

"They're looking in the wrong place," said Dr. Simborg, in the report. While the study performed by Dr. Jha and Dr. Adler-Milstein strictly examined inpatient records, Dr. Simborg believes emergency department and outpatient clinic are the real area of concern.

According to Dr. Simborg, hospitals have been maximizing bills for inpatient stays for years. However, physicians in EDs and outpatient clinics began using EHRs more recently, and Dr. Simborg believes that has led to over-documentation in those settings.

It is standard for EHRs to have auto-fill functions for certain types of patient visits, such as a Medicare annual physical. The auto-fill functions can help physicians become more efficient, but there is a downside as well. If physicians do not perform a service during a visit that is included in an EHR's standard patient visit, it is their job to manually delete the service. If the unperformed service is not deleted, a higher than necessary bill is generated, according to the report.

Dr. Simborg believes the issue needs to be resolved by focusing more on the software companies that create the EHRs, rather than the hospitals. Software companies "can develop the guidelines that would reduce the likelihood that an EHR would be abused," he said.  

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