Use EMR Templates? CMS Now Watching You

First the government wanted you to switch to electronic medical records and electronic filing to become more efficient; now they investigate you if you do.

The Centers for Medicare and Medicaid (CMS) have quietly put the word out to its audit contractors who review Medicare claims to scrutinize healthcare providers who use electronic medical record templates to file for reimbursement.

“In the past, review contractors were to consider any documentation to support pre- and post-payment determinations,” CMS wrote to in a Nov. 9 update to its review auditors. “Review contractors shall now consider all [emphasis ours] permanent medical record entries even those entries created using Limited Space Templates and extract any usable information relevant to the claim made by the physician, treating practitioner, or licensed/certified medical professional (LCMP) regarding the in-person visit.”

The update, inocuously titled, “Progress Notes and Forms,” instructs auditors to begin scrutinizing providers beginning last week.

“The purpose of this change request (CR) is to define Progress Notes, Progress Note Template, and Supplemental Form as well as guidelines regarding which documents Review Contractors must consider when making a determination utilizing the following: Progress Notes, Limited Space Progress Note Template, Open Ended Progress Note Template and Supplemental Forms,” according to the update summary.

“These revised instructions, effective this week, specifically target the use of inappropriate template shortcuts in EHRs,” wrote Marla Durben Hirsch, editor at FierceEMR.com, which broke the story.

In spring CMS’s Office of Inspector General announced it would investigate providers who submit claims to Medicare using templates. The issue received national media attention in September when the Center for Public Integrity, a not-for-profit organization that conducts investigative journalism, published a series of articles in September that suggested that, among other things, the use of templates may be behind upcoding by providers. This practice and others would result in Medicare fraud that the Center projected could be as much as $11 billion over 10 years.

Even though the Center’s investigation was based on anecdotes and speculation, and found no concrete proof of upcoding, the Obama administration warned providers that it would be cracking down on upcoding. Secretary of the U.S. Department of Health and Human Services Kathleen Sebelius and U.S. Attorney General Eric Holder issued a joint letter to providers that their respective agencies, in addition to the FBI and other law enforcement organizations, will be “monitoring these trends” and “will take appropriate steps to pursue health providers who misuse electronic health records to bill for services never provided.”

Previously:

Inspector General Finding May Delay EHR Incentive Payments

DOJ Sweep Nets 91 for $430 Million in Alleged Medicare Fraud

Obama Administration Warns Providers Over Medicare Fraud

The Healthcare Fraud That Wasn’t

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