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Tuesday, December 24, 2013

Are electronic health records causing medical bills to rise?

By Kenneth Gray
While the goal of the recent shift to using electronic health records in hospitals was to lower the cost of healthcare and improve efficiency, it appears to have had a number of negative effects that were not anticipated. Some doctors and hospitals are now billing higher fees to Medicare, private insurers and patients after making the change to electronic health records.

The new system actually makes it easier for hospitals to bill more for their services whether or not they are actually providing additional care. Patients are discovering more than ever that they are overbilled and even charged for procedures they never received.

Medical billing efficiency has not benefited patients as much as doctors
Special equipment converts paper records to digital ones

Enforcement needed

The government has spent more than $30 billion in incentives since 2009 to help doctors and hospitals obtain equipment for converting to electronic medical record keeping from traditional paper files. The intentions of the program were to increase patient safety, improve hospitals efficiency and ultimately lower the cost of health care.

Unfortunately, the government failed to enforce strict controls over billing software which many hospitals are now using for medical fraud. In 2010 hospitals received $1 billion dollars more in Medicare reimbursements than they had five years before by taking advantage of electronic billing codes. 

Reimbursement increase

While digital medical records actually do serve to lower costs for hospitals by allowing smoother information sharing and cutting down on medical errors, the effect of doctors’ more aggressive billing tactics have increased the overall cost to patients.

The connection between the shift to electronic records and the increase in medical bills is easy to identify based on records from the beginning of the program. Hospitals saw a steep increase in higher reimbursements coinciding with the year they made the change to electronic health records with a 47 percent rise in Medicare payments.

Tracking down violators

Federal and state regulators as well as investigators for the U.S. Department of Health are now faced with the task of finding the providers who are taking advantage of the new technology. The electronic system is more vulnerable to fraud because of the ease with which doctors can cut and paste examinations for multiple patients. Doctors and hospitals can manipulate billing codes to gain higher fees when they are not providing any more care.

This has been especially problematic in hospitals providing emergency services which use the billing software more often. Many doctors claim that their new coding systems are more accurate and that they were under billing in past. However, the fact remains that health care costs have steeply increased and electronic records are known to be an easier and faster way to be fraudulent.

Patients are losing

Even though electronic health records could be beneficial for hospitals, the abuse of the new system has made healthcare costs even more difficult for patients to pay. Doctors are including billing codes for exams and procedures that never took place and overcharging patients, especially those receiving Medicare.

In its push to convert medical billing to an electronic system, the government failed to prevent the possibility of fraud and provide stricter regulations that would protect patients from paying too much for medical bills. 

About the author: Kenneth Gray has years of experience resolving health insurance issues and specializing in medical billing for A-Fordable Billing Solution.

Image: Juhan Sonin. Creative Commons

1 comment:

  1. I hope all their doctors are aware of the risk of getting a free EHR. I wonder how they would react to this news. http://www.forbes.com/sites/kashmirhill/2013/10/24/practice-fusion-reviews-whoops/