Minimizing Your Audit Risk

Audit risk HISRecent changes with CMS audits have certainly caused a good deal of attention. That’s because CMS is now using a very large magnifying glass, searching earnestly for any signs of fraud from upcoding. And Recovery Audit Contractors (RAC) audits now include office visit claims and E and M coding. Much of this increased scrutiny comes from suspicions from CMS that EHR programs have contributed to rising Medicare costs because it’s easier to charge more for services using them.

Why Has Upcoding Become Such a Problem?

The natural evolution of EHR systems has a lot to do with the reason upcoding has become the problem it is today. EHRs have been designed, and marketed to physicians, to result in the highest possible reimbursement. In fact, many templated EHR software programs come with alerts that indicate to the physician when one or two additional services would qualify for a higher level evaluation and management (E/M) code. 

Added to this is the increased use of templated macros injected into the record which decreases the amount of data entry the physician has to do, but also results in cloning from one patient record to another.

According to a report released in May 2012 by the Office of the Inspector General (OIG), physicians have been upgrading their billing from lower-level E/M codes to higher-level codes for the past 10 years. HHS is now cracking down heavily on such practices.

HIS’ Solution

For any physician to avoid having the spotlight upon them, we recommend using a reliable system that will enable maximum reimbursement while still staying compliant with CMS. At HIS we believe SRS is the solution to this problem.

SRS does not code for you. An EHR system should not be making the clinical decision on the E/M codes nor should a physician allow it to. Secondly, a templated system is a linear documentation method that is marred with a time-consuming point-and-click method that is both inefficient and at times highly inaccurate. SRS allows the physician to document how he/she currently documents which is mostly through dictation or voice recognition. Furthermore, it allows the doctor to do so in the most efficient manner possible.

Pairing SRS EHR with HIS expert revenue cycle management services, will ensure complete accuracy in your documentation so you will not raise any "red flags", but we also position you to receive the greatest return possible for the services rendered. We understand that this is not only the best thing for your financial and ethical stability, but for the patients and the medical field in general as well. 

Image courtesy of