Report: EHR Shortcuts can lead to Medical Coding Errors, Improper Billing and Lost Revenue

by | Last updated Jun 19, 2023 | Published on Jul 12, 2017 | Medical Coding

EHR Medical Coding
Share this:

Electronic health records (EHRs) offer many benefits, but are not without flaws. Many studies have shown how physicians have problems with EHR data entry and the copy-paste function. A recent report from Practice Management Institute (PMI) says that the use of EHR shortcuts can cause medical coding errors, causing considerable damage to both patients and physicians. PMI, the nation’s leading and largest provider of non-clinical practice management education, stresses the importance of expert medical coding services to ensure accurate claim submission.

Medical coding is a critical task in all types of healthcare settings – physician offices, hospitals, skilled nursing home, and other medical facilities. Proper and accurate use of ICD-10, CPT and HCPCS codes is necessary as hospital payments, physician reimbursement, medical data collection, quality review, and other assessments are based on these codes.

Reporting on the study in a press release, Benziga draws attention to recent estimates which say that 75 – 80% of the medical bills patients receive are inaccurate due to medical coding errors. The OIG study showed that:

  • Medicare inappropriately paid about $6.7 billion for incorrectly coded claims and those lacking proper documentation, which was about 21% of Medicare payment for Evaluation and Management (E/M) services in 2010
  • As much 42% of claims submitted to Medicare were incorrectly coded
  • Incorrect coding included both upcoding and downcoding
  • 19% of claims lacked proper documentation
  • Claims submitted by high-coding physicians were more likely to have coding errors or insufficient documented compared to claims from other physicians

The automated features of EHRs are widely touted as tools that can ease coding, increase productivity and save time. However, PMI says that they can actually EHR shortcuts can lead to major errors in coding and documentation. Use of such shortcuts by physicians or untrained staff can lead to many problems such as:

  • Errors in claim submission
  • Increased risks and costs for patients
  • Missed revenue opportunities for physicians
  • A backlog of denials
  • Increased risk of audits and liability
  • Fraud and abuse allegations

Medical coding and billing errors can also have a negative impact on federally and state-funded healthcare programs.

The OIG called upon Medicare to address coding problems associated with E/M services to “properly safeguard Medicare.” “Given the substantial spending on E/M services and the prevalence of error, CMS must use all of the tools at its disposal to more effectively identify and eliminate improper payments associated with E/M services”, said the report, while recommending the education of physicians remains a critical component to improving coding practices.

However, while physicians should take care while using EHR shortcuts, they cannot be expected to be knowledgeable about the intricacies of medical coding. Every specialty has its own set of codes, which are reviewed annually and often subject to changes. Moreover, proper use of modifiers is necessary to accurately report services rendered. Modifiers are a critical component of coding and improper use will result in lost revenue and possible audits.

Benziga reports President and CEO of PMI David Womack as saying, “Employing well-trained staff responsible for the coding process is a must and can save big problems from cropping up down the line,”… “It’s vitally important to ensure proper training for all medical staff involved in the medical coding process.”

Reliable medical coding companies have a team of certified and well-trained coders who are up-to-date on the latest codes. Such services are critical for healthcare consumers and physicians to receive proper reimbursement and also avoid penalties and paybacks.

  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
    Meghann Drella
    CPC: Senior Solutions Manager: Practice and RCM

    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

  • Amber Darst
    Amber Darst
    Solutions Manager: Practice and RCM

    Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.

  • Loralee Kapp
    Loralee Kapp
    Solutions Manager: Practice and RCM

    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.