According to OIG, the latter part of its investigation is not related to the recent letters to HHS from Republican lawmakers to the Office of the National Coordinator of Health IT, in which leading Congressmen and Senators asked for the suspension of EHR incentive payments. The letters came in the wake of articles in The New York Times and the Center for Public Integrity that suggested the use of EHRs for upcoding had become widespread and was raising Medicare costs.
The OIG's review of the incentive program and potentially inappropriate Medicare payments related to EHR use are both included in its recently issued fiscal 2013 work plan. "We are not doing any work on this that is not in the work plan," OIG spokesman Don White told InformationWeek Healthcare.
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That work plan states, "We will review Medicare incentive payments to eligible health care professionals and hospitals for adopting electronic health records (EHR) and the Centers for Medicare & Medicaid Services (CMS) safeguards to prevent erroneous incentive payments."
OIG also says it will "review Medicare incentive payment data from 2011 to identify payments to providers that should not have received incentive payments (e.g., those not meeting selected Meaningful Use criteria)." This appears to represent an intensification of the random audits prescribed in CMS' Meaningful Use regulations.
Another section of the work plan specifies that OIG will do the same kind of review with regard to Medicaid incentives for adoption of EHRs. Although providers receiving Medicaid incentives need not show Meaningful Use in the first year to get those payments, they must attest that they have purchased, implemented, and operated the technology. OIG will determine whether providers who received incentives actually did what they claimed.
With regard to the upcoding review, a number of hospitals have received lengthy OIG questionnaires about how they use their EHRs, according to report from the recent annual meeting of the College of Health Information Management Executives (CHIME). The hospitals were given until Friday, Oct. 26, to respond to the 18-page survey, a HealthLeaders article noted.
One of the main charges in the New York Times and CPI pieces was that providers were "cutting and pasting" old visit notes into new ones to justify their inflated charges. The OIG questionnaire specifically asked, "Does the hospital have a policy regarding the use of the copy/paste feature in EHR technology?"
The survey covers many other areas, ranging from computer-assisted coding and security and privacy procedures to the manner in which physicians and nurses entered progress notes in their EHRs.
OIG launched this review, the work plan says, after hearing from Medicare contractors that have "noted an increased frequency of medical records with identical documentation across services." To find out how much of this is related to EHR use, the OIG states, "We will… review multiple E/M [evaluation and management] services for the same providers and beneficiaries to identify electronic health records (EHR) documentation practices associated with potentially improper payments."
In September, shortly after the investigative articles were published, the Obama Administration sent a strongly worded letter about upcoding to medical associations. HHS Secretary Kathleen Sebelius and Attorney General Eric Holder said in the letter, "There are troubling indications that some providers are using [EHR] technology to game the system, possibly to obtain payments to which they are not entitled." The officials said their departments would step up audits and law enforcement to fight the practice.
On Oct. 5, the leaders of four House committees sent Sebelius a letter in which they demanded a halt to Stage 2 of the EHR incentive program. Besides citing examples of what they regarded as weaknesses in the Meaningful Use Stage 2 requirements, the Congressional leaders also cited the New York Times article about the association between EHR adoption and higher charges to Medicare.
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