July 22, 2013 – The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals and hospitals who adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health record (EHR) technology.
July 22, 2013 – The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals and hospitals who adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health record (EHR) technology. The federal government announced recently that it is undertaking targeted audits of hospitals to uncover fraud concerning upcoded medical services in the use of EHRs.
According to www.healthit.gov, EHRs are a digital version of a patient’s paper chart. “EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.” To entice doctors and hospitals to implement EHR systems, the Federal Government is offering up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.
The concern regarding upcoded billings stems from a drastic rise in Medicare payments to hospitals that have implemented EHRs. This sudden rise in billings prompted the government to scrutinize hospitals with EHR systems in place. The detailed coding ability of electronic health records leaves it vulnerable to upcoding, some experts say.
Upcoding occurs when a provider intentionally bills for a more expensive or additional code on a billing claim to Medicare or Medicaid. This amounts to a false claim because the claim to CMS fraudulently reflects the use of a more expensive procedure or device than was actually used or was necessary.
IF YOU KNOW ARE AWARE OF GOVERNMENT FRAUD RELATING TO UPCODED MEDICARE OR MEDICAID BILLINGS, CONTACT THE WHISTLEBLOWER ATTORNEYS AT LEVY KONIGSBERG LLP FOR A FREE CONSULTATION AT (800) 315-3806 OR TOLL FREE AT 1.888.FRAUD.USA (1.888.372.8387), OR BY SUBMITTING AN ONLINE INQUIRY.
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