Viewpoint: EHRs often create coding errors

EHR vendors always have a happy tale to tell. Deborah Grider gets to hear the other side of the story.

President of the American Academy of Professional Coders, the Indianapolis consultant heard a new tale last year when a surgical practice on the West Coast called on her for triage in the wake of a federal audit.

A year earlier, the midsized group practice had switched to an electronic health record system, and like an estimated 15 to 20 percent of all EHR-based practices, it used the system to handle its coding.

The nightmares followed soon after. Though this practice rarely codes for services higher than level 3, the new EHR was routinely calling for level 4's and 5's.

This, as one might expect, did not sit well with the Centers for Medicare & Medicaid Services in a routine review of documentation. And so a thorough audit of the practice followed. The result: More than $1 million in refunds, fines, and penalties owed to CMS.

"These were simple mistakes, because they were just assuming the system was doing the coding as the vendor told them it was," Grider says. After all, cutting down on personnel and overhead costs was a key factor in their decision to implement an EHR-as it is with most any practice that takes on the technology.

"You can try to appeal this," Grider told the audited practice. "But it's a waste of your time and effort. Your best bet is to negotiate this and get on with your business."

The practice managed to pay the fine and return to business as usual. Could your practice survive a similar miscue?

Contrary to the conventional wisdom spewed by EHR vendors and the looming mandate presented by the Obama administration, Grider says coding claims with electronic health records is not for everyone-and especially those practices that are looking to cut staff.

Since its audit, the West Coast practice has sworn off EHRs for coding. And those three coding specialists who once seemed expendable? They've been replaced with five coders to keep a handle on the practice's increased productivity. Many EHR-based practices also employ IT experts and database managers to ensure things are functioning smoothly.

"If [practices] don't have a valid reason for [EHRs], they should wait until the time when it's required," says Grider. "It's actually more complex than using paper."

How can practices merely trying to do the right thing be thrown for such a loss? There's plenty of blame to go around, says Stephen Levinson, MD, a retired physician who has dedicated himself to troubleshooting the nation's nascent EHR systems.

Author of the book Practical EHR: Electronic Record Solutions for Compliance and Quality Care (American Medical Association, 2008), Levinson and a team of co-writers (including Grider) contributed "The perfect storm," our cover article in this issue. The book and the article identify the roots of today's EHR problems and lay out a specific course for the systems' proper use. Beginning on page 18, Levinson et al explore the fundamental missteps vendors, regulators, and practices make in ensuring compliant EHR implementation and use.

"I'm an advocate of electronic records, but I'm not in favor of electronic records that are not compliant," says Levinson. And that, far too often, is the case, he says. "The goal is not to destroy EHRs; it's to identify the issues that need to be made better."

Erich BurnettEditor-in-Chief

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