Electronic health records are defined as “longitudinal electronic records” of patient health information that includes demographics, problems, progress notes, past medical history, vital signs, medications, laboratory work, radiology reports, and immunizations — basically, anything that is being included a traditional medical record, in one easily accessible place.
For instance, MSO Washington, Inc., a medical practice management and billing service company, has agreed to settle allegations of health care fraud and pay the United States $565,000. According to the Department of Justice, the company allegedly submitted claims to Medicare and Medicaid for reimbursement that lacked proper documentation and was not medically necessary. In some instances, the Department of Justice found that procedures were never actually rendered or were billed at rates higher than they should have been.
The contracted healthcare providers were allegedly unaware of the inappropriate billing practices and so were not included in the investigation. The program that came under investigation with a home visit program where doctors and medical professionals visited group homes to see the residence.
As a well-trained and educated medical services specialists, you will be able to recognize the signs of billing fraud. The insurance companies and governmental agencies will rely heavily on the skills and training, as well as moral character, of individuals who have the medical records documentation of individuals at their fingertips.
A financial advantage, too Although not the first priority, electronic health records streamline healthcare process such that business profitability is improved along with patient care. Administrative costs are reduced, revenues are increased, and medical errors (which are financially costly as well as damaging to patients) are decreased.
Reduced billing costs Statistics show that many physicians use lower level office visit codes (E&M codes) than are truly appropriate in order to avoid being audited.. With electronic records, it’s much easier to track what billing codes are appropriate, resulting in proper billing and therefore increased revenues.
Lower transcription costs Electronic medical records eliminate some of the need for transcription, resulting in significant savings for practices, clinics, and other healthcare facilities. Reduced storage costs Because it takes significant storage space to store paper records, electronic versions are significantly cheaper to “store” than hard copy records are. A Boston medical center that sees 750,000 patients a year, for example, has estimated that it will save $6 million annually simply by converting to electronic health records from paper ones.
The owner of MSO Washington Inc. has not admitted liability in the settlement agreement and so it may be possible that the suit was found upon billing errors rather than intentional fraud. This only points to the necessities of hiring and keeping on staff well qualified medical billing services specialists who can help the practice to avoid the potential of being found fraudulent. Quality personnel are also able to improve reimbursement while maintaining legitimate medical billing services coding to insurance companies.
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