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Showing posts from October, 2012

An Insider's View on Upcoding and the Center For Public Integrity's Article on 'Cracking the Code'

The Center for Public Integrity  has a piece titled " Cracking the Codes " which is making waves in the medical world over the last several weeks, as it has revealed data indicating a massive increase in Medicare billing by hospitals and physicians ever since the federal government began incentivizing physicians and hospitals to start using Electronic Medical Records (EMRs). The immediate (and understandable) fear is that doctors are abusing the built-in efficiencies of EMRs to over-document and/or over-bill. For novice readers unfamiliar with ER billing, here is a quick primer: ER charts are coded into 5 separate categories (plus a sixth for critical care), based on the complexity and risk of the case. The complexity and risk is derived from the ultimate diagnoses, the number of history (the patient's version of his complaints) elements involved, number of physical exam elements (number of body systems examined) examined, and the medical decision making (MDM). MDM is co