Recordkeeping and Billing for Health Care Services, Essay Example

The federal government’s goal for the use of electronic medical records was threefold: improve efficiency, increase patient safety and reduce health care administrative costs. Financial records made public by the New York Times show, however, that Medicare reimbursement costs for hospitals using the new administrative systems have skyrocketed. In 2010 there as in increase of one billion compared to reimbursements in 2005. Hospitals receiving government incentives to adopt new record keeping systems increased Medicare payments by 47% versus 32% for those that did not Clearly finding a solution that will quiet all critics might just be impossible in the short term but a time-based model might not be the long-term solution either.

What can be seen thus far is that the new system has its quirks. Two such quirks that contribute to the rising billing costs of doctors in their offices and in hospitals are the template system, which has resulted in a practice called cloning, and upcoding, a physican’s self-help tool to make Medicaid hourly rates closer to what physicians believe they should be paid.

Doctors can commit fraudulent practices way too easily. When a doctor is putting in the electronic information on her Ipad, she can cut and paste the same examination information for multiple patients with a wave of her finger, increasing the rate across patients. A second way is to click on one of the boxes for services never given. One patient received his records to find that he was billed for a physical that he never had and all his doctor had to do was push a button. A third way, which Dr. Wes details, is through the coding system. Doctors can upcode, wherein they use higher codes that pay more for many reasons, one being to be reimbursed for the time they spend doing things that Medicare does not reimburse like phone calls, emails and the like.

Yet, doctors argue that the new system allows for more detail and this is part of the increased in billing, they are more accurate. From this standpoint it looks like the problems with overbilling might be the workings of a minority of dishonest doctors, or if Dr. Wes would have it vigilantes with a good cause, which can be fixed by removing those options from the system. However, it is more complicated.

Dr. Sidorov notes that the response of Medicare contractors, namely to threaten doctors and hospital administrators of withholding fees for fraud, could work in the short-term but in the long-term will give contractor’s unlimited power to withhold fees without oversight. Moreover, it could result in doctors spending even more time on detailed notes. A second solution would be to remove the template option and to redesign the codes. If using the higher codes, which results in more billing for emergency doctors is done usually as Dr. Wes implies because the information and time required for higher codes is less, then perhaps easier coding. Clearly they are moving in the wrong direction with 155,000 codes.

One proposed solution is the time-based model, namely the doctor is reimbursed based on the time patient treatment requires and the doctor’s level of expertise. For some examinations, more detailed notes are required. But this likely won’t solve the problem either. Time-based models reward specialists not the doctors whose main practice is with elderly Medicaid patients, which are very time consuming. Dr. Wes points out that pays doctors about one third of what doctors believe they should be making. Lawyers might be the example to look too, but they do a lot of work with fees on sliding scales and pro bono. Remove the templates and make billing codes easier at the lower level, and try to convince doctors that they can work on a sliding scale and see how the system responds.