Feds to investigate EHR 'upcoding' at U.S. hospitals

Mostashari will determine whether certain software should be 'off limits'

National Coordinator for Health IT Farzad Mostashari plans to launch an internal review to determine whether electronic health record (EHR) systems encourage providers to overbill Medicare by selecting higher-paying treatment codes, a process known as "upcoding."

In an interview with the Center for Public Integrity on Monday, Mostashari said that his office's Health IT Policy Committee will examine the issue and offer recommendations for addressing it.

Mostashari's comments came after a recent Center for Public Integrity investigation, as well as a New York Times analysis, found that EHR systems could be contributing to a rise in upcoding.

Last month, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius sent a letter to several health care and hospital associations warning that the Obama administration will not tolerate hospitals' attempts to "game the system" by using EHR systems to boost Medicare and Medicaid payments.

Mostashari said that he has asked the Policy Committee to provide guidance on whether EHR systems are triggering higher billing codes by allowing physicians to cut and paste data from a patient's previous visits, a practice known as "cloning." Mostashari said, "If we are just copying the same information over and over, that's not good medicine."

He added that he hopes to determine whether certain software functions that seem to prompt physicians to inflate their bills "should be off limits" (Schulte, Center for Public Integrity, 10/16).

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