Healthcare Business News

AHA to HHS: Let's work on EHR compliance

By Joe Carlson
Posted: November 14, 2012 - 2:30 pm ET

The American Hospital Association wants to work with the government to ensure that the sellers of electronic health-record systems are producing systems that comply with federal law and don't lead healthcare providers to submit bills that later get them in trouble.

The Nov. 12 letter from the hospital interest group (PDF) comes after news organizations and federal auditors said there are signs that hospitals have been using the federally subsidized electronic records systems to increase their bills without providing more services than before.

In September, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder sent an open letter (PDF) to the AHA and several other hospital groups warning hospitals and doctors that the government had seen "troubling indications" that EHRs were being used to "game the system" and increase reimbursements.

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For example, the systems can be used to cut and paste old reports into new records that fit the desired level of billing and to upcode for more-intensive emergency and management, or E/M, services than were provided, the letter from Sebelius and Holder said.

Initially, hospitals protested by saying, among other things, that the technology might be facilitating more meticulous record-keeping than before, which allowed hospitals to submit more accurate—but more expensive—bills.

But in its letter to HHS this week, the AHA drew distinctions between hospitals and the makers of EHR systems, saying that hospitals wanted to work with the government to help monitor the software makers.

"In many instances, hospitals, as consumers of software and data processing services, could serve as a first preventive defense to abusive billing submitted in their name," the Nov. 12 AHA letter says, suggesting the idea of a meeting in which compliance guidance for EHRs could be developed.

"Working together, we can undertake a set of activities to provide national guidelines for E/M coding by hospitals, create greater certainty that products sold by the vendors of EHRs and other automated tools promote compliance with those guidelines and develop meaningful guidance on compliance," the AHA letter says.

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