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Polsinelli Shughart Health Reform and Related Health Policy News
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Health Reform + Related Health Policy News

Update for September 26, 2012


Top News


Hospitals, Obama Administration Spar over ‘Upcoding’ and EHR Guidance

In response to recent news reports that hospitals are using electronic health records to “game the system” by “upcoding” the intensity of care, the Obama administration sent a “strongly worded” letter to the American Hospital Association and other hospital groups warning that CMS will consider using its authority to address inappropriate coding through its payment rules.  The administration’s letter from HHS Secretary Kathleen Sebelius and Attorney General Eric Holder said that properly used EHR systems potentially can save money and lives but that there are “troubling indications that some providers are using this technology to game the system.”  The letter said that CMS is “initiating more extensive medical reviews to ensure that providers are coding evaluation and management services accurately.”   AHA responded that HHS should offer more clarity, not more “duplicative audits” that divert resources from patient care.  “No one questions the need for auditors to identify billing mistakes, but the flood of new auditing programs, such as Recovery Audit Contractors, MACs and others, is drowning hospitals with a deluge of redundant audits, unmanageable record requests, and inappropriate denials,” AHA wrote.  AHA also said that hospitals are appealing 40 percent of denials and have a 75 percent success rate.  Additional details are available here.


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Additional Reading

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Federal Register

Click here to preview a summary of notices which appeared in the September 21 - September 27, 2012 Federal Register.




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