JACKSON, Mich.--()--Does the recent spike in higher-level, higher-priced emergency department visits contain a warning for anesthesiologists? The Center for Public Integrity published an analysis, on September 20, of hospital billings showing that the proportion of the two highest levels of “evaluation and management” services has grown at a much faster rate than the proportion of very ill, fragile or elderly patients. The number of high-level services has increased, however, concomitantly with the use of electronic health records (EHRs). EHRs, providers contend, facilitate accurate billing–which may be for higher-level services than in the past because physicians preferred to collect lower fees than spend hours meeting extensive documentation requirements manually.
“initiating more extensive medical reviews to ensure that providers are coding evaluation and management services accurately.”
Just a few days after the Center for Public Integrity release and a New York Times article–not coincidentally–the federal government sent a letter to the American Hospital Association and four other national hospital organizations expressing concern over "troubling indications" that some hospitals are using EHR technology to "game the system, possibly to obtain payments to which they are not entitled." The letter, signed jointly by Secretary of Health and Human Services Kathleen Sebelius and Attorney General Eric Holder, alerted the hospital organizations that Medicare is "specifically reviewing billing through audits to identify and prevent improperly billing" and is "initiating more extensive medical reviews to ensure that providers are coding evaluation and management services accurately."
Anesthesiologists perform a very small percentage of the visit services provided in hospitals, and particularly in emergency departments. The billing codes for anesthesia services do not lend themselves to the subjective interpretation of the visit codes, and electronic anesthesia records are much harder to “game.” Pain specialists report more visit services than do surgical anesthesiologists. ABC’s conclusion:
Any pain specialist or anesthesiologist who reports E/M services using [the two top level] codes more frequently than other visit codes should make sure that the intensity of the service is supported in the patient record, whether electronic or paper. That is the advice that we would give all of our physicians, regardless of particular levels of federal scrutiny. As we have said before and will say again in the future, documentation is key.
About Anesthesia Business Consultants
ABC, established in 1979, is one of the largest billing and practice management companies dedicated to the complex and intricate specialty of anesthesia and pain management. It is both an American Society of Anesthesiologists Practice Management Supporter, and an Anesthesia Quality Institute Preferred Vendor. ABC employs industry leaders, operates under proven efficient processes, and utilizes technology advances to easily adapt to the ever-changing regulatory environment. If you would like more information about this topic, please go to email@example.com.