I had a really fascinating discussion recently with @AlexHBurgess where we discussed the role of billing codes in an EHR today and also the future of billing codes as EHR notes get much better and more granular. This is particularly interesting to me as I’m at the HealthPort HIM Summit the next couple days.
Here’s the question that started the conversation:
If an EHR is a billing engine, then do we need billing to change to get the EHR to change? #KareoChat https://t.co/9exuETpMMI
— John Lynn (@techguy) July 23, 2015
This was @AlexHBurgess’s response:
No need for quality-oriented billing codes when structured clinical data is easier to mine/share #kareochat #EHR https://t.co/ShlapdGbT3
— Alex Burgess (@AlexHBurgess) July 23, 2015
And then I replied:
@AlexHBurgess That's something worth chewing on. If we have enough structured data, then why do we need a human to do a billing code?
— John Lynn (@techguy) July 23, 2015
The last question is something worth chewing on. I’ll have to ask it of a few HIM managers the next couple days. I think the simple answer is that we’ll still likely need billing codes. I don’t think that our payers are forward thinking enough or at least progressive enough to try and push forward a non-billing code reimbursement system. It’s pretty interesting to think about though.
The second reason I don’t think it’s likely to happen is that the data in the EHR will likely not be good enough. Although, if the data in the EHR (and not just the billing codes that were selected) were how you got paid, then you’d see a dramatic improvement in the quality of the EHR data. So, maybe it’s not a bad idea after all. I’m pretty sure my medical billing friends would scoff at this idea as they think about the number of times they’ve had to have doctors correct something in the paper chart to make sure the billing was ok.
Long story short, I think that you could theoretically get rid of medical billing codes and just use EHR data for reimbursement. However, in practice I don’t really see this ever becoming a reality. At least not in the short to medium term.
I would love to see that happen but as you say John this is not likely to be the case anytime soon. There are a lot of reasons why using claims/billing codes are such poor proxies and abstractions to perform risk stratification and it would be preferred that actual clinical data and not some downstream proxy was used to do that.