Modernization
of medical records has been one of the keys elements of healthcare reform and
was thought to lead to a decrease in administrative cost by decreasing inefficiencies
in the way medical records were previously maintained. I didn't anticipate that
electronic medical records could lead to increases in Medicare fraud and
providers billing for a higher level of service than the care actually given to
the patient. This New York Times article discusses the increase in billing for
healthcare services and increase in Medicare fraud noted after the
implementation of electronic health records. Some of this increase in billing
for higher level services is driven by the relative ease with which providers
can clone information from one medical record to another i.e. essentially
copying one patient’s information into another patient's medical record.
This practice allows certain unethical providers to bill Medicare and private
insurance companies for higher level of service while actually providing the
patient with a lower level of medical service.
The
other side which is not reported in this article and is often cited by
hospitals and providers is that now they are billing the customers more
accurately than they were prior to the introduction of medical records. The
rationale being that prior to introduction of medical records, patients and
insurance providers were being under billed due to errors in reporting of ICD 9
codes for diagnoses and lack of proper documentation. EMRs have made proper
documentation easier and have reduced the coding errors by automation of this
process, hence leading to billing which is actually a much better
representation of the level of medical service provided to the patient.
As always, the truth lies somewhere in the middle. I
personally think the trend is probably more towards overbilling, with
elimination of fee for service payment structure being the most logical but
politically difficult solution of this problem.
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