Healthcare News & Insights

How hospitals can prevent EHR fraud

As more hospitals expand their use of electronic health records (EHR) systems, they’ll have to make sure certain EHR functions don’t lead to improper billing. 

179135084Of course, it’s not that EHRs make fraud more likely to happen. But some EHRs include functions that may lead to mistakes or provide billing shortcuts, which in turn could appear like fraud to payors and auditors, reports Fierce EMR.

It’s important that facilities try to address these areas for potential improper billing now. The Office of the Inspector General (OIG) reported in its yearly workplan that it will be on the look out for potential EHR fraud.

Detecting EHR issues

Most hospitals know they have to watch out for things like note cloning. But there are other less well-known areas that could lead to fraudulent billing.

Specifically, EHR functions that might streamline documentation are more likely to create billing problems. For example:

  • care templates that are automatically fill out based on expectations of what services will be performed
  • EHR functions that allow staff to alter notes but hide that they were changed, or that automatically add text to elevate billing codes
  • older EHR functions that give providers the ability to corrupt or delete auditing functions, and
  • other problems with source attribution from copying notes and templates.

Addressing problem areas

The feds and private payors conducting more audits and watching for any sign of EHR-enabled fraud. Payors will be looking for discrepancies in records, repeated data errors or other mistakes which indicate cloning and claims that lack individualized information as signs of potential EHR-enabled fraud.

As a result, hospitals will need to take steps to reduce the risk of improper EHR billing and documentation errors. To address areas that might facilitate fraud or other errors, facilities should:

  • Implement policies and procedures for responsible use of certain EHR functions. For example: Determining when it’s acceptable to copy and paste notes, or how often you’ll audit your EHR system.
  • Be sparing when using functions for streamlining documentation. It’s also important your staff understands not to rely to heavily on copy-paste or auto-fill functions and include individualized information in claims.
  • Limit access to records from third parties.
  • Ensure records are being reviewed for discrepancies, changes or other errors.

Taking some of these actions and keeping records of what’s done can help your facility defend itself in the event of an audit.

Providers that are planning on adopting or changing EHRs may want to do some additional research so they can avoid systems that enable or encourage improper billing.

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