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And the #AHIMACon12 Winner Is …

Posted on October 3, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

… ICD-10 by a landslide. For those of you wondering whether “upcoding” might just steal 10’s thunder, it wasn’t meant to be. Providers and vendors alike brushed aside the phrase – some with a shrug of the shoulders, others with a roll of the eyes, and some with a “What did you expect?” The general consensus I gathered on the show floor was that technology such as electronic medical records enables doctors to code more accurately – not fraudulently. Everyone agreed that paper-based processes have for years resulted in doctors under-coding, and now that technology and workplace culture have caught up, those same doctors are finding it more efficient to code accurately, thus leading to more accurate, i.e. higher, reimbursement.

Speaking of reimbursement, John mentioned in a recent blog that ICD-10 is on the list when it comes to Top 5 Revenue Cycle Management Issues, and I couldn’t agree more. Talking with vendors and their physician customers at the show brought home to me just how fine a line providers walk when it comes to coding and revenue. As we move closer to Oct. 1, 2014, and the final push towards ICD-10, I am eager to see how these more granular, accurate codes play out in the revenue space. If a doctor codes more accurately in 10 (and hopefully provides quality care at the same time), and as a result sees higher reimbursements, will this somehow turn into a price increase that will trickle down to patients through payers? Where will the touted cost-effectiveness really come in? At any rate, I am definitely seeing the cause and effect relationship between coding and revenue more clearly as the ICD-10 deadline draws near.

ICD-10 was the focus of the only educational session I was able to attend, and it was well worth the time. “The Good, the Bad and the Reality: Lessons from the Frontlines of ICD-10 Implementation” featured the stories of Sutter Health, Vanderbilt University Medical Center and Deloitte Consulting. Both Danielle Reno from Sutter Health and Gary Perrizo from VUMC stressed strategy, education and testing in the run up to 2014. I got the impression from them and the physicians in the audience with me that though everyone is grateful for the extra time to make the switch, no one should be taking the time for granted. “Lollygagging” as I tell my children, is not advisable.

As you probably know by now, I’m a big fan of social media in the healthcare space, and I was very impressed with the efforts the AHIMA team took to incorporate social networking into just about everything – especially compared to last year. The attendees at AHIMA seem more like a Facebook crowd, and that was indeed the sentiment I heard from several vendors. That being said, I do think the tweet stream was more active than last year, probably due in large part to the @AHIMAResources team taking a proactive approach to socially marketing the event. I hear that next year (the event will be in my hometown of Atlanta) we’ll see the hashtag on all the slide presentations, which may encourage attendees to get in on the tweeting action.

Overall it was a fun, educational first trip to Chicago and second trip to AHIMA. (You can check out some of the more memorable images from the show below.) Seeing the sun rise and set over Lake Michigan in early Fall was a real treat. I hope that Atlanta will have equally spectacular vistas to offer next year.

AHIMA 2013 will take place in Atlanta Oct. 26-30.

This book caught my eye on the show floor. Anyone read it yet?

This picture does no justice to the spectacular views I had from the 95th floor of Chicago’s John Hancock building, thanks to the fun folks at Healthport.

The Precyse team flew a special member in just for the show.

The Friedman Marketing group was nice enough to hold another tweetup after show hours.

My coworkers presented me with a lovely birthday balloon bouquet from one of the two balloon artists on the show floor.

EHR Incentive Increases Medicare Costs

Posted on September 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There is a major trend happening in healthcare that was covered pretty well in The New York Times. That’s right. EHR doesn’t often get much play in the major journals, but this is a really big deal. Plus, I’ve had doctors write into me about the subject as well.

The key finding that The New York Times article discusses is that Medicare costs have gone up substantially for those using an EHR. This is happening because doctors are upcoding more than they’d done previously. It’s a bit ironic to me that this is going to be a major problem for Medicare since 6 years ago when I first started writing about EHR software one of the major reasons to implement an EHR was to increase your revenue by upcoding.

I’ll never forget the first time I saw the challenge of coding first hand. I was at AAFP sitting at a table of physicians who were there to discuss EHR. This older lady and a gentleman shared with the group that they were chronic under coders. It felt a bit like an AA meeting where these doctors were finally coming clean on their habits. The rest of the doctors in the group just nodded their head since they knew that under coding was a major issue in healthcare.

What Medicare or the administration didn’t seem to realize is that the cost of Medicare is based on this under coding. Doctors have been under coding for so long that it just became part of the cost structure. Little did those in Congress think that by spending $36 billion on EHR (or whatever number you prefer) they’d actually cost Medicare billions of extra dollars. I bet the CBO didn’t plan for that in their budget projections.

This new trend in upcoding begs the question on whether doctors are doing this legitimately or if this is a form of fraud and abuse that’s being made possible by EHR. In a completely unscientific way, I suggest that probably 95% of the upcoding that’s happening is legitimate. Plus, a large portion of the 5% upcoding fraud and abuse would have been happening regardless of EHR. Why do I believe that so little of the upcoding is legitimate?

It goes back to that experience at AAFP where I heard doctors talk about their under coding habits. There was an underlying tension in their statements that they would love to bill more, but they had a number of underlying fears that made them choose not to code higher. First was fear of audit. The last thing any doctor wants is an audit and if under coding will avoid the dreaded audit, then it is the price to pay for that comfort. Second, I’ve heard doctor after doctor talk about times a patient examination should have been at a higher coding level, but their documentation didn’t match that higher level code. The doctors chose to under code the visit as opposed to documenting the normal findings in the visit which would allow them to code at a higher level.

EMR doesn’t do much for the first fear described above. However, EMR often makes it possible for a doctor to code a normal finding in the EMR that they wouldn’t have taken the time to code in a paper chart. I expect that this accounts for a good portion of the upcoding we’re seeing. Combine that with easy chart reviews and EMR coding engines and you see Medicare costs increasing by billions of dollars thanks to EHR. Oh the unintended consequences of government intervention.