Upcoding has been the subject of much press since the release of a rather contested New York Times article in September. In it, critics of electronic health records blame the systems for unfairly increasing E/M coding levels over the last few years, and even the HHS reported the practice was “vulnerable to fraud and abuse.”
However, while scouring Twitter, we found a tweet from social media extraordinaire Dr. Kevin Pho (@kevinmd) about the upcoding firestorm and “why doctors are unfairly targeted.”
In the blog post he linked to, KevinMD.com blogger Shadowfax, MD, defends the doctor’s position, saying the aid of EHRs has helped physicians meet Medicare’s 5-level coding guidelines more efficiently.
Now ICD-10 is already caused for panic among many a doctor, so just think about what else you should be prepared for before you’ve even crossed over. See below for more details.
EHRs and Coding: Not a Happy Marriage?
ICD-10 Watch (@ICD10Watch) tweeted a new piece earlier today: “How to fit EHRs into your ICD-10 Transition.” This also got the wheels turning.
EHR implementation is, of course, likely to uproot a number of habits and procedures at your practice.
And while the Times article that has the healthcare world up in arms points to the E&M code as the culprit of the Medicare overbilling, the cause may simply the result of the system compensating for the physician when viewed from the perspective of the EHR.
As a similar Information Week article points out, “what many doctors claim is that their EHRs help them document the work they actually did, which often results in higher codes than they might have put in if they didn’t have an EHR.”
In other words, threats of overbilling and overcoding may simply be the result of an EHR doing the job physicians have a tough time carrying out. Still, you never know where else you may get hit. Watch yourself.
What’s This About a Non-Enforcement Period?
Steve Sisko (@ShimCode), a healthcare business and technology writer blogger, tweeted an interesting question today: “Are you ready for an ICD-10 ‘non-enforcement period?”
Since it’s been an eventful year, it’s possible you’ve forgotten that CMS folded under pressure earlier this year with enforcing HIPAA 5010 transactions. It’s always possible that CMS may allow another non-enforcement period subsequent to 10/1/2014, allowing providers to submit claims containing ICD-9 or ICD-10 codes, regardless of the professional date of service or institutional discharge dates.
The question is – will your system and vendor solutions be flexible enough to accommodate a non-enforcement period?
Hurricanes, Tornadoes, and Earthquakes… Oh my.
Of course, natural disasters like Hurricane Sandy are always a cause for worry. One interesting reaction: HIT expert Brad Justus (@brad_justus) tweeted out an ICD-10 Watch post detailing the codes needed for monsters and monster storms.
And while Carl Natale detailed codes concerning everything from coding common diagnoses (bronchiolitis, asthma), he even included nuclear radiation exposure leading to cannibalism.
While some of the codes he listed may seem a bit excessive, the following is true: don’t be caught with your pants down regarding natural disaster coding. ICD-10 will be far more specific, which is a gift and a curse in a time where you may have lost your client-server or paper records.
What do you expect from ICD-10?
